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PubMedDate not supplied

Using concept maps and visual representations for collaborative curriculum development.

A picture is worth a thousand words, and in the development of collaborative curricula among colleges and universities, a concept map or visual representation may save thousands of hours of semantic wrangling. Using pictures in curriculum development allows participants with varying backgrounds to share their visions and values, and promotes work at the conceptual level before detailed planning proceeds. A curriculum development team found the use of concept mapping and visual representations to be one of their most valuable means of developing consensus among three faculty groups and practicing nurses. The authors examine concept mapping as a heuristic tool for curriculum development in the context of creating a joint collaborative nursing curriculum in two languages among a university and two community colleges. The use of other visual representations to compensate for some of the limitations of concept mapping are also described. Recommendations are made based on the authors' experience with these tools.

Audiovisual Aids↗
PubMedDate not supplied

Examining the margins: a concept analysis of marginalization.

The aim of this analysis is to explore the concept of social marginalization for the purpose of concept development. Specifically, the article intends to clarify the relationship between health disparities and marginalization and generate knowledge about working with people who are socially marginalized. Concept development evolved from the critical analysis of relevant literature generated through searches of nursing and social science databases. Literature was organized thematically and themes related to marginalization as a social process were included and analyzed. The article explores the challenges of using marginalization as an independent concept and suggests areas for future inquiry and research.

Humans↗
PubMed2003

Human factors: imperative concepts for information systems in critical care.

This article provides an overview of human factors, ergonomics, human-computer interaction, and usability concepts as they relate to critical care settings. The use of these concepts can improve patient safety and the productivity of nurses, especially as they relate to the use of information systems. A framework for human-computer interaction is presented. Examples illustrate how the suite of human factors concepts is used to create intuitive, effective data presentations for use in critical care including an intensive care unit (ICU) summary display, an alternative graphic display, and modeling information sources of decision making in a neonatal ICU. The importance of integrating these concepts into advanced practice nurses' environments is made apparent.

Critical Care↗
PubMed2003

Is the concept of informed consent applicable to clinical research involving critically ill patients?

Informed consent is a process through which patients or their surrogates authorize medical interventions or involvement in research. The concept of informed consent is supported by ethical principles and legal tradition in the United States. It grew in importance during the 20th century because of documented abuse of research subjects, which led to its codification in federal consent requirements for clinical research. For the most part, the concept and the codification are based on a model of competent patients who are capable of informed decision-making and can communicate their wishes. However, most critically ill patients are incompetent and cannot communicate easily. As a result, family members usually must give consent for them. Yet family members frequently are unavailable, and when they are available, they may not know the patient's wishes. Furthermore, family members may not be legally authorized to give consent for research involvement under state law. For these and other reasons, it has been argued that the concept of informed consent is not applicable to clinical research involving the critically ill and that such consent is not necessary in certain circumstances. Yet, for all its inadequacies, the concept of informed consent and the federal consent requirements should be retained because they promote respect for patients and their right of self-determination and because investigator discretion is not adequate. Stronger research oversight may be as important as informed consent in protecting patient welfare.

Clinical Trials as Topic↗
PubMed2000

Species concepts and malaria parasites: detecting a cryptic species of Plasmodium.

Species of malaria parasite (phylum Apicomplexa: genus Plasmodium) have traditionally been described using the similarity species concept (based primarily on differences in morphological or life-history characteristics). The biological species concept (reproductive isolation) and phylogenetic species concept (based on monophyly) have not been used before in defining species of Plasmodium. Plasmodium azurophilum, described from Anolis lizards in the eastern Caribbean, is actually a two-species cryptic complex. The parasites were studied from eight islands, from Puerto Rico in the north to Grenada in the south. Morphology of the two species is very similar (differences are indistinguishable to the eye), but one infects only erythrocytes and the other only white blood cells. Molecular data for the cytochrome b gene reveal that the two forms are reproductively isolated; distinct haplotypes are present on each island and are never shared between the erythrocyte-infecting and leucocyte-infecting species. Each forms a monophyletic lineage indicating that they diverged before becoming established in the anoles of the eastern Caribbean. This comparison of the similarity, biological and phylogenetic species concepts for malaria parasites reveals the limited value of using only similarity measures in defining protozoan species.

Animals↗
PubMed1997

A critique of the concept of quality of life.

Taking a philosophical approach, ancient Greek philosophers and Christians began to investigate the concept of quality of life. Later, such philisophical pursuit was replaced by the school of positivism, which indicated that science was and still is the only valid form of enquiry. Through such positivistic science, the metaphysical nature of the concept of quality of life is thought to be uncovered. However, the later Wittgensteinian philosophical thoughts demonstrated that there is no metaphysical understanding of any concepts but there is only knowledge of playing language games. In the light of this philosophy, prior to any scientific investigations, researchers have already understood and agreed on the concept of quality of life by playing language games. From the above philosophical analyses, outlines some implications for health care research.

Health Services Research↗
PubMed2004

The risk of congenital abnormalities in children fathered by men treated with azathioprine or mercaptopurine before conception.

BACKGROUND: Immunosuppressive therapy with azathioprine and mercaptopurine is commonly used in patients with various chronic diseases. The few existing data on the reproductive safety of these drugs after paternal use before conception are inconclusive. AIM: To examine the risk of congenital abnormalities in children fathered by men exposed to azathioprine or mercaptopurine before conception. METHODS: This was a Danish population-based cohort study, based on data from the Prescription Database, the Medical Birth Registry and the Hospital Discharge Registry of North Jutland County, Denmark. Fifty-four exposed pregnancies, in which the father filed a prescription for azathioprine or mercaptopurine (between 1 January 1991 and 31 December 2001) before conception, were included. The controls comprised 57 195 pregnancies with no paternal azathioprine or mercaptopurine use. RESULTS: Four children with congenital abnormalities (underlying paternal diseases: glomerulonephritis and severe skin disease) were found in 54 exposed pregnancies (7.4%), compared with 2334 (4.1%) in controls. The adjusted odds ratio for congenital abnormalities in children fathered by men treated with azathioprine or mercaptopurine was 1.8 (95% confidence interval, 0.7-5.0). CONCLUSIONS: Our data may indicate that paternal use of azathioprine or mercaptopurine before conception is associated with an increased risk of congenital abnormalities. However, more data are needed to determine whether the association is causal.

Abnormalities, Drug-Induced↗
PubMed1991

A concept analysis of empowerment.

In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research.

Humans↗
PubMed1994

An argument against the use of the concept of 'persons' in health care ethics.

This paper discusses the use of the concept of 'persons', and its related principle 'respect for persons', in health care ethics. It is suggested that the main use of the concept is in attempts to answer the questions: 'Who owes moral respect?' and 'To whom is it owed?'. An examination of different writers and their use of the concept of 'persons' show it to be unsuccessful in answering the first question, and dangerous and unacceptable in answering the second. Therefore, it is suggested the concept should not be used at all in health care ethics. An alternative idea is suggested, based on the work of Hursthouse (1992).

Aged↗
PubMed1995

Health promotion: a concept analysis.

Health promotion is a concept which is frequently used, but is often ill defined. Current health care trends, and the emphasis on the nurse of the future as a promoter of health suggest that it would be useful to attempt to clarify the concept. This paper develops a conceptual analysis of health promotion using the process developed by Rodgers (1989). Attributes, antecedents, consequences and references are described following an examination of the ongoing debate in the literature surrounding the meaning of the concept. Empirical work is also reviewed which suggests that nurses' understandings of the concept are firmly embedded in the more traditional approach rather than the more modern or new paradigm approach to health promotion. A model case is described, and the analysis results in a proposed definition of health promotion which it is hoped will stimulate further discussion.

Attitude to Health↗
PubMed1996

An analysis of the concept 'patient satisfaction' as it relates to contemporary nursing care.

Patient satisfaction has become an established indicator of the quality of health care yet, despite the abundance of measurement surveys reported in the literature, there are few theoretical underpinnings for this important concept. An analysis of the concept of patient satisfaction, specifically as it relates to contemporary nursing care, provides an excellent vantage point to more closely examine this key measure of health care quality. A review of pertinent literature is presented, followed by examination of the uses of the concept in professional literature as well as more general sources. Defining attributes cited throughout the literature are identified along with the concept's antecedents and consequences. Empirical referents, definitions, and measurements are also presented. The analysis concludes with re-examination of some of the assumptions underlying patient satisfaction literature in general, and thoughts regarding the significance of patient satisfaction with nursing care in particular. Suggestions for future inquiry are offered.

Humans↗
PubMed2004

Concept development of family resilience: a study of Korean families with a chronically ill child.

AIMS: To clarify and delineate the concept of family resilience in the context of the chronic illness of a child. This study also investigated the concept of family resilience in relation to family functioning in order to compare and contrast family resilience and family functioning. DESIGN AND METHOD: Three phases of the hybrid model of concept development were applied: theoretical, fieldwork and final analytical. In the theoretical phase, a working definition of family resilience was developed by a literature review. The fieldwork phase comprised in-depth interviews with 11 parents with a chronically ill child, in the paediatric oncology unit of a university hospital in South Korea. The qualitative data obtained from the interviews were analysed to find attributes of family resilience. The final analytical phase compared and interpreted the findings from the theoretical and fieldwork phases in order to clarify and refine the concept of resilience. RESULTS: The definition of family resilience was of an enduring force that leads a family to change its functioning dynamics in order to solve problems encountered. Twenty-one conceptual attributes of family resilience emerging from this study were differentiated into four dimensions: (i) intrinsic family characteristics, (ii) family member orientation related to family characteristics, (iii) responsiveness to stress and (iv) external orientation. CONCLUSIONS: Family resilience is an enduring force that leads a family to change its dynamics of functioning in order to solve problems associated with stresses encountered. This conceptualization led to the development of a model of family coping that incorporates both family resilience and family functioning, as the property and as the process of change, respectively. RELEVANCE TO CLINICAL PRACTICE: In order to build a family that functions better under stress, it is necessary for nurses to focus more attention on family resilience, especially in terms of the development of intervention strategies to strengthen family resilience.

Adaptation, Psychological↗
PubMed2006

Is conception delay a risk factor for reduced gestation or birthweight?

Previous studies have suggested an association between delays in conception and adverse perinatal outcomes, specifically, low birthweight and preterm birth. We investigated the relationship between conception delay (defined as >6 months to become pregnant) and three perinatal outcomes: low birthweight (LBW; <2500 g), preterm birth (PTB; <37 weeks), and small-for-gestational-age (SGA; <10th percentile weight for given gestational age) using data from the Collaborative Perinatal Project. The study cohort was limited to pregnancies with a known time-to-pregnancy (n = 8465; 15%). Generalised estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals [CI] for risk of adverse perinatal outcomes accounting for the clustering of pregnancy outcomes for women with more than one pregnancy. After adjusting for confounders, all ORs were close to the null (LBW, OR = 1.01; 95% CI = 0.86, 1.20), (PTB, OR = 1.10; 95% CI = 0.95, 1.27), (SGA, OR = 1.06; 95% CI = 0.91, 1.25). Thus, we found no evidence to support an adverse relationship between conception delay and decrements in gestation or birthweight among this select sample of fertile women, even after varying the cut-point for defining conception delay.

Adult↗
PubMed2006

Bayesian selection of predictors of conception probabilities across the menstrual cycle.

There is increasing interest in identifying predictors of human fertility, including environmental exposures, behavioural factors, and biomarkers, such as mucus or reproductive hormones. Epidemiological studies typically measure fecundability, the per menstrual cycle probability of conception, using time to pregnancy data. A critical predictor, which is often ignored in the design or analysis, is the timing of non-contracepting intercourse in the menstrual cycle. In order to limit confounding by behavioural differences between exposure groups, it may be preferable to base inferences on day-specific conception probabilities in relation to intercourse timing. This article proposes Bayesian methods for selection of predictors of day-specific conception probabilities. A particular focus is the case in which data on ovulation timing are not available. We focus on the selection of fertile days in the cycle during which conception probabilities are non-negligible and predictors may play a role. Data from recent European and Italian prospective studies of daily fecundability are presented, and the proposed approach is used to estimate cervical mucus effects within a mid-cycle potentially fertile window using data from the Italian study.

Bayes Theorem↗
PubMed2006

The Oxford Conception Study design and recruitment experience.

The Oxford Conception Study is a randomised controlled trial that aims to determine whether or not information about potential fertility from a device that monitors urinary hormones will increase the conception rate in women wishing to conceive. Three modified versions of a fertility monitor have been developed for the study. The monitor measures the levels of urinary oestrone-3-glucuronide (E3G) and luteinising hormone (LH), and the display indicates high or low fertility. The monitor requests all women to test their urine from day 6 to day 25 of the menstrual cycle inclusive. One-third of women are randomised to receive information from the fertility monitor about the early fertile time (from the first rise in E3G until the LH surge is detected), one-third receive information about the late fertile time (the onset of the LH surge and the following 2 days), and a third do not receive any information (control group). All the women are followed up for 6 months or until they are pregnant. A total of 1453 women have been recruited into the study, reaching the study recruitment goal for 80% power to detect a 10% difference in three-cycle pregnancy rate between the Late Fertile Time group (50%) and the Control group (40%), allowing for a 15% non-pregnancy drop-out rate. Follow-up of the women is currently ongoing. The primary analysis will compare the cumulative three-cycle pregnancy rate between each of the study arms. Time-specific conception probabilities will be estimated from coitus information recorded in 12-h intervals. The data from this study will also allow many additional questions to be addressed, including changes in intercourse patterns with feedback about the fertile days and other questions in relation to menstrual cycle function, sexual intercourse, stress, exposures to tobacco products, alcohol, caffeine and medications, fertility and pregnancy outcomes. In addition to presenting the study design, we review the recruitment experience for the Oxford Conception Study. We have achieved sustained and effective recruitment over time by primary use of recruiting via the Internet.

Adolescent↗
PubMed1997

Current issues in exercise metabolism: the crossover concept.

1. Since ancient times, athletes have consumed proteins because of the belief they were the necessary substrate for optimal performance. Even though this concept was proven to be incorrect before the beginning of the 19th century, the practice continued until several decades ago. 2. By 1939, careful metabolic investigations on the changes in the respiratory exchange ratio had demonstrated that the metabolic transformations of lipids and carbohydrates were the primary sources of energy for muscular exercise. 3. Metabolic investigations on the profile of energy transformations during exercise have indicated that aspects related to exercise intensity, state of training, the availability of circulating free fatty acids, the activity of the sympathetic nervous system, resting levels of muscle and liver glycogen and muscle triglyceride concentrations have to be considered to explain a specific response. 4. In 1994, Brooks and Mercier introduced the concept of 'crossover' in their review manuscript to explain the shift in substrate utilization from lipids to carbohydrates by trained subjects when the power output was increased. In addition, the concept was advanced to reconcile divergent results by different investigators. 5. In 1995, Coggan and associates investigated the glucose kinetics of non-trained and trained subjects performing power outputs equal to 80% VO2max and concluded that the crossover concept was unable to explain their metabolic results from trained subjects. 6. Because of the importance of the topic to exercise physiologists and the uncertainties the controversy has created for teachers and researchers, the American Physiological Society Section on Environmental and Exercise Physiology scheduled a Point-Counterpoint forum at the 1997 Experimental Biology Meeting. The subsequent manuscripts of Brooks and Coggan are a result of that forum.

Biotransformation↗
PubMed2007

Perceptions of the concept of health among nurses working in mental health services: a phenomenographic study.

A new understanding of the concept of health is needed to meet the goal of mental health nursing, which besides reducing disease is to strengthen the patient's health. The aim of the present study was to describe perceptions of the concept of health among nurses working in mental health services. Twelve Swedish nurses working in mental health services were interviewed and data were analysed with a phenomenographic approach. The nurses expressed 10 perceptions, which constituted three description categories: autonomy, process, and participation. The result showed that health was more than absence of disease. Simultaneously, perceptions were expressed indicating that health was viewed as absence of disease, which implies that the concept is not sufficiently defined. The result emphasizes the need to clarify the concept of health if it is to be used as a goal in mental health nursing and to integrate a clarified definition of health at all hierarchical levels in mental health care services.

Adult↗
PubMed2000

Changes in uterine and ovarian arterial impedance during the periovulatory period in conception and nonconception cycles.

OBJECTIVE: To evaluate whether the Doppler velocimetry of uterine and ovarian arteries during the periovulatory period in conception cycles differs from that in nonconception cycles. DESIGN: Transvaginal color Doppler sonography was used to assess uterine and ovarian perfusion in 63 infertile women during the periovulatory period. RESULTS: In the conception cycles (n = 16), the PI values of uterine arteries at the day of ovulation were significantly less than those in nonconception cycles (n = 47). There were no significant differences in the PI values of ovarian arteries between the conception and nonconception cycles. CONCLUSIONS: In the present study, the conception cycles showed lower vascular impedance in the uterine during the periovulatory period than did the nonconception cycles. This endometrial perfusion presents an accurate noninvasive assay of uterine receptivity that can be used to predict the successful outcome of implantation and to reveal unexplained infertility problems.

Adult↗