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PubMed1999

Students' expectations of postregistration degree programmes.

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.

Attitude of Health Personnel↗
PubMed2001

Validation of a questionnaire to evaluate the quality of life of nonprofessional caregivers of dependent persons.

AIM OF THE STUDY: To determine the acceptance, validity and reliability of the questionnaire for assessing the type of informal care that caregivers of dependent people give and the effects this care might have on the health of the carer. BACKGROUND: In Spain, the formal health care system provides 12% of the total time dedicated to health care, the remaining 88% is carried out by the informal system within the home environment. The act of caring has effects on various areas of the life of the carer and on family functioning. This makes clear the existing risk when the principal carer becomes a secondary nurse. METHODS: This research was a cross-sectional design, carried out in municipalities in the province of Barcelona (Spain) from January to December 1997. The subjects of the study were 240 caregivers of dependent people. The questionnaire (ICUB97Copyright ) is based on the Virginia Henderson's 14 Needs nursing model. The validity of the content was assessed through the consensus of a group of experts, validity of design by means of comparison with the hypotheses. RESULTS: Test-retest reliability was completed for the three parts of the questionnaire and the kappa index values was 0.89, 0.80 and 0.75 for each part. The higher the level of dependency of the person cared for, the more care tasks the carer had to perform. A correlation coefficient of 0.58 was obtained for the Barthel Index (P < 0.001) and 0.53 on the Philadelphia Index (P < 0.001). The care tasks performed by the carer showing greatest correlation with dependency level were; help with elimination (r=0.73, P < 0.001), help with feeding (r=0.55, P < 0.001) and help in personal development (r=0.55, P=0.001). CONCLUSIONS: This questionnaire provides a reliable and valid instrument for measuring the care given by caregivers to dependent people, to meet their basic needs as well as for assessing the needs of the carers who experience problems by the act of caring. It is therefore important for nursing practice, to have a validated instrument available for identifying the tasks performed by family carers and the effects on their health.

Activities of Daily Living↗
PubMed1999

Clinical nursing supervision in the workplace--effects on moral stress and job satisfaction.

AIM: To investigate nurses' satisfaction with their work environment and moral stress levels as effects of systematic clinical nursing supervision. BACKGROUND: Nurses have identified high workload, low influence over work assignment, limited avenues for skills development and diminishing support from supervisors as sources of considerable tension resulting in deterioration of work conditions and decreased job satisfaction. METHODS: This study is a descriptive-correlational study. Data were analysed by means of descriptive statistics. RESULTS: The major result indicates moral stress in the workplace. It was found that a significant relationship existed between moral sensitivity and systematic nursing clinical supervision. CONCLUSION: The results point to the need to support nurses in developing personal qualities, integrated knowledge and self-awareness, which is in line with the effects of clinical nursing supervision reported in other studies.

Adult↗
PubMed2001

Psychiatric nurses' conceptions of how a group supervision programme in nursing care influences their professional competence: a 4-year follow-up study.

AIM: The aim of the study was to describe, after 4 years, psychiatric nurses' conceptions of how a 2-year group supervision programme within nursing care had influenced their professional competence. BACKGROUND: The intention of group supervision in nursing care is to understand nurses' experiences within real care settings and to structure these in a professional and personal context. METHODS: Ten psychiatric nurses participated in a 2-year group supervision programme. They were interviewed 4 years after the group supervision was ended. Data were analysed according to the phenomenographic method. FINDINGS: Six description categories emerged: a feeling of job satisfaction; gaining knowledge and competence; gaining a sense of security in nursing situations; a feeling of personal development; realizing the value of supervision; and a sense of professional solidarity. CONCLUSIONS: The findings of the 4-year follow-up showed that a group supervision programme in nursing care had lasting influences on the psychiatric nurses' professional competence in the form of a pronounced professional identity and an integrated nursing care perspective. Group supervision contributes to maintaining the strength and energy needed to carry on working, which makes continuing supervision necessary. IMPLICATIONS: An important research implication could be to investigate the type of knowledge that ought to be developed within group supervision in nursing care.

Attitude of Health Personnel↗
PubMed1997

Case management: a week in the life of a clinical case management team.

This paper describes the work of a clinical case management core team (four nurses and an occupational therapist) during the course of a week. Information was gathered through non-participant observation of the team by two independent researchers. Transcripts produced from the data recorded were examined. From this, seven categories of activity were identified: planned client contact; unplanned client contact; family/carer contact; liaison; administration; team information sharing and supervision, training and personal development. These categories were felt to encompass the range of activities practised by the team. The amount of time that case managers spent engaged in these core functions was calculated. Detailed examples are presented. Results are discussed with reference to Kanter's components and principles of clinical case management.

Adult↗
PubMed2002

What can clinical teachers learn from Harry Potter and the Philosopher's Stone?

Many clinical teachers acquire a working knowledge of the principles of teaching and learning through observation, by adopting positive and rejecting negative examples of clinical instruction. Well selected vignettes of teaching behaviours taken from contemporary film and literature may provide rich substrate by which to engage clinical teachers in discourse about instructional technique. This paper draws on J K Rowling's novel and its companion film, Harry Potter and the Philosopher's Stone, and critically analyses the teaching styles of the staff at Hogwarts School of Wizardry and Witchcraft in the context of contemporary generic and medical education literature. Specifically, it argues that effective teachers demonstrate not only an in-depth knowledge of their discipline but possess a keen appreciation of the cognitive changes that occur in their students during the learning process. They are, furthermore, proficient in core instructional skills such as small group facilitation, feedback and questioning. Most importantly, effective teachers model appropriate attitudes in their professional setting and possess highly developed personal qualities such as creativity, flexibility and enthusiasm.

Clinical Competence↗
PubMed2003

Learning together: clinical skills teaching for medical and nursing students.

OBJECTIVE: To evaluate the feasibility and effectiveness of shared learning of clinical skills for medical and nursing students at the University of Manchester. DESIGN: Medical and nursing students learned clinical skills in either uniprofessional or multiprofessional groups. These groups rotated through skills stations taught by multiprofessional facilitators. The groups stayed together for a series of 3 sessions held at weekly intervals (an induction meeting followed by 2 3-hour teaching sessions). Both quantitative and qualitative methods were used to evaluate the project. CONTEXT: A total of 113 Year 3 students registered on the Medical (n = 41), Bachelor of Nursing (Honours) (n = 43) or the Diploma for Professional Studies in Nursing (n = 29) courses participated in the project which was set in the clinical skills unit of a teaching hospital. RESULTS: Pre- and post self-evaluation of confidence levels for the taught skills revealed a statistically significant increase for all skills. The primary reason students gave for participation in the project was to learn or consolidate skills. An additional inducement for participation was the opportunity to share knowledge and observations between professional groups. Tutors also evaluated the experience favourably, particularly with regard to small group discussions. They indicated that the programme provided an opportunity to standardise clinical skills teaching. CONCLUSION: Collaborative learning opportunities for nursing and medical students are feasible and add value to the learning experience. Data indicate positive outcomes of learning in multiprofessional groups, comprising increased confidence levels, increased understanding of others' professional roles and personal development.

Clinical Competence↗
PubMed2003

The possible contribution of student drawings to evaluation in a new problem-based learning medical programme: a pilot study.

OBJECTIVE: In January 2001, the Nelson R. Mandela School of Medicine in Durban, South Africa implemented Year 1 of a problem-based learning (PBL) curriculum. In attempting to comprehensively evaluate the first year, every aspect was investigated. Problem-based learning requires that, in addition to skills competency and knowledge acquisition, students undergo personal development on their journey towards becoming reflective professionals. Suitable methods of evaluation are therefore necessary to measure some of the new objectives. This discussion appraises the possible use of student drawings as a qualitative evaluation tool. METHODS: At the end of the first academic year, students were asked to reflect on their experiences during the year by drawing (with brief explanations) how they saw themselves at the beginning (retrospective) and then at the end of the year. Drawings were interpreted in terms of reference to the new programme, and were categorised as disparaging, ambivalent or affirming. RESULTS: The results far exceeded expectations, providing a rich data source regarding student perceptions of their experiences in their first year. In response to the drawings, immediate remedial action was taken: for example, continuous assessment was introduced for the objective structured clinical examination (OSCE) and orientation was extended to 3 weeks to provide students with a better understanding of the PBL process. CONCLUSIONS: From this pilot study, there can be no doubt that student drawings can give us valuable insight into the world of the learner, providing us with information that cannot be gleaned from any other evaluation. We will continue to use drawings formatively, perhaps extending their use into portfolios.

Attitude of Health Personnel↗
PubMed2002

Indigenous men taking their rightful place in society? A preliminary analysis of a participatory action research process with Yarrabah Men's Health Group.

Men's groups are increasingly being accepted as an important strategy in improving health and well-being, especially in Indigenous communities. However, it is hard to find systematic documentation and evaluation of such initiatives in the literature. This paper analyses the formative stages of a participatory action research (PAR) process which aims to engage and support the members of the Yarrabah Men's Health Group plan, implement and evaluate their activities. Data for the paper are based on a combination of a review of relevant literature, analysis of project documentation, participant observation and discussion and reflection with the participants of the men's group. The paper highlights the importance of (a) using a reflective approach, such as PAR, to engage men's support groups to clearly define the principles and values which both define them and to which they aspire and (b) personal development, education and employment, as a prerequisite for Indigenous men taking greater control and responsibility for their lives. These types of micro-level studies have important implications for the way community development is perceived and approached in Indigenous settings. There are also implications for the roles that academic researchers can play in supporting and adding value to community-driven initiatives to the mutual benefit of both parties.

Community Health Planning↗
PubMed1999

Early developmental experiences of female sex workers: a comparative study.

OBJECTIVE: The aim of this paper is to explore the early family environment of a sample of female sex workers and compare the findings with a large community data set of similarly aged women. METHOD: Sex workers recruited by a snowball method were given a semi-structured interview, which included the Parental Bonding Instrument. These results were compared to those from the Otago Women's Child Sexual Abuse (OWCSA) study. RESULTS: The sex workers' families were of lower socioeconomic status and had experienced more parental separation than had the OWCSA families. The mothers of sex workers were more frequently the family's main wage earner. Sex workers described both parents as less caring than did the OWCSA women. They were significantly more likely than the OWCSA women to report childhood sexual abuse. The sex workers were more likely to have left home early, to have become pregnant before the age of 19 years and to not have completed tertiary study. CONCLUSIONS: The sex workers studied came from families with more interpersonal difficulties during childhood and adolescence than did a control community sample of similarly aged women. The relevance and generalisability of this conclusion to the wider sex worker population is difficult to determine, given the non-random selection of this sex worker sample.

Adolescent↗
PubMed2001

Depression and smoking: examining correlates in a subset of depressed patients.

OBJECTIVE: The objective of this study was to examine for associations between depression and cigarette smoking. METHOD: A sample of 92 depressed smokers was compared with a control sample of depressed non-smokers, matched for age, gender and diagnostic variables. Comparisons were made across a range of demographic, depression, family history, developmental factors, anxiety and personality style variables, as well as use of alcohol and illicit drugs. RESULTS: We failed to find any difference between smokers and non-smokers in history or severity of depression. Cigarette smokers were distinguished principally by greater exposure to aversive experiences in childhood, disordered personality function, greater use of illicit drugs, anxiolytics and alcohol. Logistic regression identified dysfunctional personality 'domains', physical violence in childhood, long-term anxiolytic use and illicit drug use as the most significant predictor set. CONCLUSIONS: Results favour a model of cigarette smoking and depression as linked by shared early deprivational variables, rather than cigarette smoking causing depression or the converse.

Adult↗
PubMed2003

Nightmares and dissociative experiences: the key role of childhood traumatic events.

In order to examine the co-occurrence of nightmares with dissociative experiences in the adolescent population and to demonstrate the impact of childhood traumatic events in this association, 292 undergraduate students were interviewed for childhood traumatic events. The Van Dream Anxiety Scale (VDAS) and Dissociative Experiences Scale (DES) were also administered to the subjects. For nightmares a 7.5% prevalence of 'often' and a 58.2% prevalence of 'sometimes' was found for college students. Nightmare prevalence was higher in women than in men. The rate of childhood traumatic experiences was higher in nightmare sufferers than in those who did not have nightmares. The subjects who had undergone physical and sexual abuse had higher VDAS global scores and item scores. When the DES scores of the subjects with nightmares were compared with that of those who had never reported nightmares, the subjects with nightmares had significantly higher scores on DES. The DES scores were also negatively correlated with duration of nightmares in subjects who had childhood traumatic experiences. These findings suggest that the subjects with childhood traumatic events failed to psychologically integrate their traumatic experiences and used dissociation as a coping strategy.

Adolescent↗
PubMedDate not supplied

Medication compliance feedback and monitoring in a clinical trial: predictors and outcomes.

OBJECTIVE: The objective of this study was to demonstrate the utility of continuous monitoring and enhancement of medication compliance during a long-term clinical trial, predictors of compliance, and relationships to drinking outcomes. METHODS: Alcohol-dependent patients enrolled in a multicenter VA cooperative study were randomly assigned to once-daily naltrexone (NTX) for 3 or 12 months (short-term or long-term NTX) or placebo for 12 months of treatment. All medications were dispensed in bottles with medication event monitoring (MEMS, AARDEX, Union City, CA) caps with a microprocessor that recorded openings as presumptive doses. Patients were trained to develop personal cues as dosing reminders. Monthly feedback sessions included review of compliance data and cues. RESULTS: There were no significant differences among short-term NTX, long-term NTX, and placebo (209 each) groups in measures of compliance. Overall compliance rates were 71% +/- 31% of doses for the first 13 weeks and 43% +/- 33% of doses over 52 weeks. Some doses were taken during 83% +/- 27% of the first 13 weeks. Higher medication compliance predicted fewer drinks per drinking day (P = .02) throughout follow-up and a lower percentage of drinking days (P = .002 during the first 13 weeks) with no significant effect for treatment group. CONCLUSIONS: The feedback and monitoring programs were important features to demonstrate that lack of treatment effect was not a result of poor compliance. Medication compliance data supported the internal validity of the trial by demonstrating that good compliers had better outcomes, irrespective of treatment with NTX or placebo. The MEMS feedback methodology is feasible for use in multicenter trials.

Alcoholism↗
PubMed1989

Estimating the incubation time distribution and expected number of cases of transfusion-associated acquired immune deficiency syndrome.

The number of cases of transfusion-associated acquired immune deficiency syndrome (TA-AIDS) that will be seen over the next few years is difficult to estimate, because of the uncertainty about the number of persons infected with the human immunodeficiency virus (HIV) via blood transfusion and about the duration of the incubation period from HIV infection via transfusion to diagnosis of AIDS. Presented here are a mathematical model and nonparametric and parametric statistical analyses of recent data on TA-AIDS that indicate clearly the existing estimability problems. The methods provide short-term projections of new TA-AIDS cases to be reported; the results suggest about 1100 new cases to be reported in the United States between July 1988 and June 1989 and about 1500 more between July 1989 and June 1990. Estimates of the number of eventual TA-AIDS cases to be seen are considerably more uncertain and require additional assumptions about the incubation distribution. Under the assumption that the probability of an infected person developing AIDS within 8 years of infection is 0.40 (an estimation derived from cohort studies in homosexual men and hemophiliacs), parametric and nonparametric analyses give, respectively, point estimates of 14,300 and 15,000 for the number of eventual cases of AIDS (in the age group 13-69) attributable to infection by blood transfusion prior to July 1985. The parametric analysis gives a corresponding 95 percent confidence interval.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The prognosis of epilepsy.

The cardinal question for a person developing seizures is 'What is the likelihood that they will go away?' 'Prognosis' refers to the possible outcomes of a disease and the frequency at which they can be expected to occur. Prognostic factors may include demographic features, disease-specific indicators (e.g. seizure frequency, aetiology of epilepsy) or co-morbidity. Such factors do not necessarily cause the outcome, but they are associated strongly with the outcome measured. They are distinct from risk factors--which are associated with the initial development of the disorder. Ideas about the outcome for epilepsy have been altered radically in the past century by study of its epidemiology. The prognosis for epilepsy comprises a number of measurable end-points: the prediction of recurrence after a single unprovoked seizure, the chance of remission after the diagnosis of epilepsy and the risk of premature death.

Epilepsy↗
PubMed2002

Coping with the challenge of transition in older adolescents with epilepsy.

Chronic illnesses, such as epilepsy, have been shown to have detrimental effects on both psychological adjustment and coping behaviour. Using the process model of coping, these effects were investigated in a patient group of 36, 16-21 year olds with epilepsy and a control group of 31 of their peers. Participants completed a postal questionnaire containing measures of psychological adjustment (self-esteem, affect, self-efficacy) and an adolescent coping questionnaire. Comparison of the two groups showed that the patient group exhibited significantly more non-productive coping than the control group. The control group exhibited significantly more problem solving coping and displayed significantly more problem solving bias than the patient group. No significant differences were found between the patient and control group on measures of psychological adjustment. However, psychological adjustment was found to be associated with coping response in the patient but not the control group.

Adaptation, Psychological↗
PubMed2002

Crossing cultures--images of East and West.

This article explores the challenges of working cross-culturally as a facilitator and teacher of imagework - an interactive imagery and personal development process. It discusses the use of imagery in different contexts and highlights the cultural background of Japan and the psychological conditions into which imagework was introduced. This unique approach demonstrates how the unconscious, through the symbolic language of images, expresses more about our humanity than it does about our cultural diversity.

Cross-Cultural Comparison↗
PubMed2001

[Treatment courses and therapeutic effectiveness of a psychogeriatric day hospital].

Since 1976, 37 psychogeriatric day hospitals have been set up in Germany. As only few empirical studies on the effectiveness of this day hospital system are available even 25 years on, the treatment course of 58 patients attending the psychogeriatric day hospital run by the Department of Psychiatry, University of Tübingen was evaluated. The course analysis was based on a series of tests comprising the following questionnaires: Social Situation Scale, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Munich Quality of Life Dimension List (MLDL), Mini Mental Status (MMS), Hamilton Depression Scale, and Cumulative Illness Rating Scale (CIRS). Women accounted for three-quarters of the sample, and men for one-quarter. The average age was 72 years. The fact that only 16% of the patients had been transferred from psychiatric hospitals and that more than half had been referred directly by their local doctors underlines the acute-psychiatric nature of the institution. More than 80% of the patients were discharged to their previous place of residence. A highly significant improvement in affective state was verified by the Hamilton Depression Scale. Significant improvements were also registered in the following items: general satisfaction with life, state of health, physical and mental performance, and scope for personal development. The quality of life, measured with the Munich Quality of Life Dimension List (MLDL), improved in nine of the nineteen items covered, with correction of the significance level alpha taken into account. The treatment outcomes confirmed the therapeutic effectiveness of this type of psychogeriatric institution from aspects of acute psychiatry too and should encourage the continued expansion of partial hospitalization facilities for the elderly.

Activities of Daily Living↗