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Children with chronic illness. The prevention of dysfunction.

Children with long-term illnesses are at risk of developing problems in psychological adjustment and in functioning in activities of daily life. Their families face increased risks of marital and economic dysfunction, and siblings too face special tasks living with a chronically ill child. A variety of interventions can help children and families to cope effectively with the tasks of chronic illness. Pediatricians should be alert to effects on the family. Children respond to family stress in very predictable ways. Inasmuch as the stress of chronic illness may affect the marital relationship, there is a likelihood of concurrent behavioral and school problems. Relatively sudden changes in behavior may signal family issues that require professional attention. Drotar et al. maintain that professionals should serve as guides or advocates for children with chronic illness and their families. The relationship that develops between families and professionals is based on trust. They believe that "trust appears to evolve from the following principles: (1) continuity of relationship, (2) active participation by professional caregivers, (3) mutual participation of child and family, (4) advocacy, (5) a focus on coping and competence, (6) a developmental perspective, and (7) a family-centered focus." Cadman et al. identified a similar set of elements that characterizes an efficacious preventive intervention approach. In addition, they propose specific programmatic efforts that are associated with less morbidity. These include ongoing education and counseling for the child, family, and community regarding chronic illness and its management, use of stress management techniques to promote mastery and reduce the impact of stressful life events, and facilitation of social support mechanisms for families with chronically ill children. We have added consideration of the child's performance in school.

Adaptation, Psychological↗

The burden of proof: a critical review of orthodontic claims made by some general practitioners.

The increased demand for orthodontic treatment in the developed countries has led to a recent proliferation of "motel courses" that are specifically designed for general practitioners. Most of the techniques presented are only those that have long been available for selection by discerning orthodontists. However, when they are applied exclusively and indiscriminately by inexperienced clinicians, this may result in either prolonged, unnecessary treatment or failure through instability. Therefore some of the claims that are made will be examined and discussed with a review of the literature.

Education, Dental, Continuing↗

Whose child is this? Assessment and treatment of children in foster care.

Clinicians who treat children in foster care must continually balance the development and therapeutic needs of the foster child with the expectations of a complex network of caretakers and professionals with whom the child interacts. A model that integrates individual and systemic issues in the assessment and treatment of children in foster care is proposed.

Adaptation, Psychological↗

Integration of theory and practice in learning mental health nursing.

This article describes an action research project that aimed at a better integration of theory and practice in the education of mental health nursing students. Two partners, an institute of nursing and health care and a university hospital, collaborated to develop a new educational programme for mental health nursing. The blocks of theoretical studies were implemented simultaneously with practical training, and the theory content was taught by nursing teachers as well as by nurse practitioners who worked on the teaching wards. In addition, the students had their own personal nurse-preceptors on the wards. The nurse managers were responsible for the educational level of the teaching wards and the director of nursing planned the teaching arrangements together with the nursing teachers. In all, the project involved over 50 different actors and several researchers. The results are encouraging: all the participants - students, preceptors, nurse managers and nursing teachers - found the project rewarding and they want to continue to develop and improve the level of teaching and learning in mental health nursing education. All the participants grew and developed professionally during the project.

Adult↗

'Thinking for two': a case study of speech and language therapists working through assistants.

BACKGROUND: Many speech and language therapists (SLTs) in the UK work with speech and language therapy assistants, and the numbers of SLT assistants is expected to grow. There has been very little empirical investigation of how SLTs feel about this situation or the effect on working practices of working indirectly. AIMS: To investigate SLTs' opinions on working with SLT assistants in a small-scale research case study. METHODS AND PROCEDURES: The study design was a case study of five SLTs delivering intervention within a research intervention project. Prepared questionnaire and formal interview techniques were used to elicit opinions on working through assistants, and a content analysis was performed. OUTCOMES AND RESULTS: Although respondents could see value in working through assistants, they stressed the time required to do so and the difficulties of adapting and updating therapy plans when working indirectly. CONCLUSIONS: The study suggests a variety of factors that have to be carefully managed if SLTs are to work competently through assistants.

Allied Health Personnel↗

Conflicting paradigms of health visiting: a continuing debate for professional practice.

The interpretation of health visiting practice has formed the focus of a professional debate amongst practitioners and those involved in health visiting education for many years. More recently, changes in nurse education, government legislation and general anxiety about the future of health visiting have added to the intensity of the debate. In re-examining the conceptual origins of health visiting, this paper proposes one possible explanation for this phenomenon in which the author describes four conflicting paradigms of practice. The author argues that it is the tendency of practitioners to adopt one specific paradigm of practice which has contributed to the continuing debate and current professional uncertainty experienced by health visitors. The authors goes on to suggest a conceptual framework for practice developed from an epistemology of practice grounded in reflection in practice and the principles of health visiting. It is argued that this approach to practice allows practitioners to reconsider their practice in terms of the values and beliefs underpinning health visiting rather than identified tasks and client groups. It may also provide practitioners with the opportunity of developing and adapting strategies to meet current health needs rather than the traditions of practice.

Community Health Nursing↗

Guidelines for a curriculum in healthcare quality and resource management.

Issues of quality pervade American society. Demands for accountability for the quality of and the resources utilized in delivering healthcare services are coming from consumer advocacy groups, regulatory agencies, third-party payers, and corporate purchasers of healthcare. To date, institutions of higher education do not consistently offer either adequate or coordinated programs to prepare healthcare professionals to assume the regulator role. Promoting quality is both a mandate and a legacy, and each professional will need to be involved to ensure continuing quality care for consumers. Active collaboration between academic, service, and professional organizations, as well as a strong commitment to the development and timely implementation of a suitable curriculum, are imperative.

Curriculum↗

Reengineering the Lithuanian healthcare system: a hospital quality improvement initiative.

A tertiary-level academic hospital in Kaunas, Lithuania, adopted a continuous quality improvement (CQI) management paradigm from June 1996 through July 1997 in response to new political, economic, and social environments. This article presents an overview of the hospital's strategy, initial steps, and main accomplishments, as well as mitigating factors that arose in its quest to manage its own resources. Because historical influences are key to understanding the Lithuanian healthcare system, this discussion includes pre- and post-independence dynamics that caused a multidisciplinary hospital management team to choose a CQI approach that targets organizational and professional structures for change. In addition, it identifies environmental factors, internal and external to the hospital organization, that influence the continued development and sustainability of these healthcare management reform efforts.

Academic Medical Centers↗

The role of a scientific society in physiology education: current and future perspectives.

As a professional society of physiologists involved in research and teaching, the American Physiological Society (APS) is "...devoted to fostering education, scientific research, and the dissemination of information in the physiological sciences." Established long-range goals for education guide the development of current and future programs at all education levels. K-12 outreach programs develop working relationships between physiologists and K-12 teachers within local communities and improve the quality of precollege science education. At the undergraduate level, APS programs foster excellence in physiology education and promote student interest in physiology careers. At the graduate level, activities promote excellence in graduate training and the professional development of students, including a focus on underrepresented groups. At each of these levels, the Society includes activities for the continuing education of its members. Looking to the future, the Society plans to expand the programs and resources offered to researchers and educators at all levels. On-line programs, resources, and communications have been initiated and will play an even more important role in the future.

Adult↗

Instrumentation and practice standards for electrocardiographic monitoring in special care units. A report for health professionals by a Task Force of the Council on Clinical Cardiology, American Heart Association.

The proposed recommendations for continuous electrocardiographic monitoring systems represent goals for future development. Description of a technique in the report does not constitute an endorsement of its clinical use. Lead systems for ECG monitoring must adequately sense the cardiac electrical field and the leads should be standardized. Future monitors should be capable of simultaneously displaying and analyzing multiple leads. Recommendations for electrode placement and position of patient are made. Important parameters in each category of standards for instrumentation published in 1983 in the American National Standard for Cardiac Monitors, Heart Rate Meters, and Alarms are listed. Selected procedures proposed by the Association for the Advancement of Medical Instrumentation to inform users of minimally acceptable accuracy of computerized systems in a standardized manner are presented. Emphasis is placed on the importance of nursing and medical staff capabilities. Personnel qualifications and training as well as systems to assure and maintain quality of immediate ECG diagnosis are highlighted.

Allied Health Personnel↗

Issues and implications of establishing guidelines for the use of behavioral techniques.

Several guidelines surrounding the use of behavioral procedures have recently appeared, the best of which is that of the National Association of Retarded Citizens (NARC). Some issues and implications of the establishment of guidelines are briefly reviewed in the context of the NARC guidelines. Issues include the factual versus opinion bases for guidelines and the need to continue the development of explicit behavioral criteria for assessing staff competence. Implications for programs include the impact of guidelines on the professional boundaries, administrative decision-making, and budgeting, together with the dangers of expanding the regulatory bureaucracy. Several miscellaneous impacts are noted, including a potential for curbing innovative behavioral technology.

Behavior Control↗

A pilot program to promote professional growth for neuroscience nurses.

A pilot program was developed as a strategy to increase professional growth on a neuroscience unit. The primary objective of the program was to allow staff nurses to participate in activities that interface with the neuroscience patient population. Nurses could choose an area of interest that related to their unit responsibilities. This experience provided the participants with the unique opportunity to participate in patient care from the perspective of another discipline. The staff were enthusiastic about the experience and shared it eagerly with their peers. Participants' evaluation of the program was overwhelmingly favorable. The data suggest that this program was an effective means of increasing professional growth and staff development.

Education, Nursing, Continuing↗

A new era in acute care.

Acute care continues to be the primary place of employment for occupational therapists. It is a challenging environment that requires the skills of our most experienced practitioners. Because the acute care hospital is likely to remain an entry point for rehabilitative care, this area of practice warrants continued attention in our professional literature. We hope this issue will stimulate therapists to write more articles, conduct more research, and develop more programs in acute care occupational therapy.

Acute Disease↗

Using nursing theory to introduce change in practice.

This article outlines the theoretical basis of nursing using Carper's (1978) fundamental patterns of knowing and explains how this theory can be integrated with practice. The authors also describe how Carper's theory was used to introduce change related to the reduction in junior doctors' hours through the development, implementation and evaluation of nurse practitioners. Using a SWOT analysis exercise and various workshops, practitioners have been able to develop professionally and integrate the art and science of nursing.

Education, Nursing, Continuing↗

Educating the provider community about the new role of the peer review organization.

This report suggests an educational format that has been used successfully in Michigan to introduce the Health Care Quality Improvement Initiative to the medical community. The activities related to pattern analysis and the Fourth Scope of Work will require a collaborative effort between the medical community and the peer review organization (PRO). To improve understanding by providers and practitioners of pattern analysis, the Fourth Scope of Work, and the new PRO requirements, a series of educational programs was designed. The first presentation in the educational series included information about the changes between the Third and Fourth Scope of Work as well as the new structure within the PRO responsible for the pattern analysis activities: the Center for Health Outcomes and Evaluation. Descriptions of the process to be followed in interactions between the Center and providers and practitioners also were included: For the second session, a hands-on exercise was created to introduce the concept of a pattern. The exercise included graphic representations of patterns and a worksheet format to encourage the user to find specific data points within tables and graphs, describe a pattern in hospital outcome data, and verify that the same outcome pattern appeared in subgroups of hospitals and physicians. The third component in the educational series was a demonstration of the interaction between the Center and a hospital participating in a cooperative improvement project. Hospital-specific and physician-specific data, with appropriate comparative data, were provided to an audience made up of hospital administrators, practicing physicians, and allied health personnel who then worked through the issues related to data validation, definition of a project, agreement on interventions, and remeasurement of the outcome under study.

Centers for Medicare and Medicaid Services, U.S.↗

Performance appraisal system for therapeutic recreation.

Therapeutic Recreation professionals continually strive for effective performance standards for their clients. In addition to standards for clients, Therapeutic Recreation Specialists must also develop performance standards for themselves to meet the continual challenge of accountability in the 80's. This paper identifies the need to develop a performance appraisal system as well as the benefits. The elements of the standards include: specificity, observability, measurability, attainment and mutual determination. The paper also reviews the process of assignment of relative weights, categories of review and detailed standards for the Director of Therapeutic Recreation and Therapeutic Recreation Specialist at the Rehabilitation Institute of Detroit.

Employee Performance Appraisal↗

Peer review & record review systems.

This paper describes the implementation of both peer review and record review systems as initiated at the University Hospitals of Cleveland occupational therapy department. Peer review evaluations can be used to ascertain a therapist's need for continuing education in a specific area, to evaluate and improve standards of practice, to gather statistics on professional objectives, and to develop Professional Standards Review Organization criteria. The system of peer review stimulated an improvement in documentation of services provided by occupational therapists, as well as in critical self-awareness of individual strengths and weaknesses. A separate method of record review was instituted to provide a basis for evaluating individual performance for either recognition or disciplinary purposes. Unlike peer review, record review results become incorporated into the therapist's personnel record.

Hospital Departments↗