Advancing nursing practice: redefining the theoretical and practical integration of knowledge.

Science.gov (United States)

Christensen, Martin

2011-03-01

The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is

Clinical practice: new challenges for the advanced practice nurse.

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Bartel, J C; Buturusis, B

2000-12-01

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

[Challenges and opportunities: contributions of the Advanced Practice Nurse in the chronicity. Learning from experiences].

Science.gov (United States)

Appleby, Christine; Camacho-Bejarano, Rafaela

2014-01-01

Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction. Copyright © 2013 Elsevier España, S.L. All rights reserved.

An Academic-Practice Partnership Model to Grow and Sustain Advanced Practice Nursing.

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Williams, Tracy E; Howard, Patricia B

2017-12-01

The aims of this article were to describe the implementation of an academic-practice partnership for healthcare system workforce development and provide preliminary outcomes of the associated pilot study. The demand for cross-continuum healthcare delivery models necessitates creation of workforce development structures for advanced practice nursing. An academic-practice partnership specified enrollment of 5 cohorts of BSN staff nurses in a 3-year DNP program. Qualitative methods were used to explore pilot data at midpoint of cohort 1 student progression to determine learning outcomes and DNP projects with potential for impact on organization goals. Partnership implementation experiences indicate that contractual agreements and an established evaluation plan are keys to academic-practice partnership success. Pilot study findings suggest that curriculum core courses provide a foundation for designing DNP projects congruent with acute and primary care health system goals. Implementing an academic-practice partnership is a strategy for workforce development to increase retention of advanced practice nurses. Academic-practice partnerships can serve as a catalyst for a paradigm shift for changing models of care, thus enhancing workforce development succession planning for sustainable growth in healthcare systems.

Development of advanced nursing practice in China: Act local and think global

Directory of Open Access Journals (Sweden)

Frances Kam Yuet Wong

2018-04-01

Full Text Available This paper discusses the development of advanced nursing practice in China in the context of global development. The scope of nursing is evolving over time, with increasing demands for the management of complex healthcare situations at individual, community and system levels. These demands are aggravated by the specialization of medical practice, with advanced treatment plans and patients requiring care in focused areas. The qualifications and competencies of the initial entrants into nursing practice are not adequate to deal with these demands. Advanced nursing practice (ANP developed first in response to service demands, and education programs were introduced to prepare nurses for practicing at a higher level. This paper will first review the historical development of ANP in China, followed by a discussion of the differentiation of competence levels in nursing practice and the classification of specializations. It concludes by exploring how education in combination with experience protected by regulation of practice can support nurses to gradually evolve from registered nurse, specialty nurse to advanced practiced nurse.

An American and Dutch partnership for psychiatric mental health advance nursing practice: nurturing a relationship across the ocean.

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Maas, Lillian; Ezeobele, I Ezebuiro; Tetteroo, Marieke

2012-07-01

The purpose of this article is to discuss the challenges and rewards of developing and nurturing an international clinical psychiatric mental health advanced nursing practice exchange between the Netherlands and the United States. Since 1997, Rotterdam University of Applied Sciences in the Netherlands has been participating in international clinical experiences for their psychiatric mental health (PMH) advanced practice nursing students. The international experience is mandatory prior to graduation and is the first of its kind in Europe to mandate such a unique experience. This study sample included eight Dutch PMH advanced practice nursing students enrolled in a full-time master's in advanced nursing practice program. The descriptive study included reflective reports and one-on-one discussions over a 3-year period. With proper planning, an international nursing experience provides a unique opportunity for nurses to think beyond their own culture and healthcare system. Solving problems together through different perspectives creates opportunities for creative solutions. International partnerships within PMH advanced practice nursing promotes sharing of knowledge and solutions as patients and diseases have no border. © 2011 Wiley Periodicals, Inc.

Advanced midwifery practice: An evolutionary concept analysis.

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Goemaes, Régine; Beeckman, Dimitri; Goossens, Joline; Shawe, Jill; Verhaeghe, Sofie; Van Hecke, Ann

2016-11-01

the concept of 'advanced midwifery practice' is explored to a limited extent in the international literature. However, a clear conception of advanced midwifery practice is vital to advance the discipline and to achieve both internal and external legitimacy. This concept analysis aims to clarify advanced midwifery practice and identify its components. a review of the literature was executed using Rodgers' evolutionary method of concept analysis to analyze the attributes, references, related terms, antecedents and consequences of advanced midwifery practice. an international consensus definition of advanced midwifery practice is currently lacking. Four major attributes of advanced midwife practitioners (AMPs) are identified: autonomy in practice, leadership, expertise, and research skills. A consensus was found on the need of preparation at master's level for AMPs. Such midwives have a broad and internationally varied scope of practice, fulfilling different roles such as clinicians, clinical and professional leaders, educators, consultants, managers, change agents, researchers, and auditors. Evidence illustrating the important part AMPs play on a clinical and strategic level is mounting. the findings of this concept analysis support a wide variety in the emergence, titles, roles, and scope of practice of AMPs. Research on clinical and strategic outcomes of care provided by AMPs supports further implementation of these roles. As the indistinctness of AMPs' titles and roles is one of the barriers for implementation, a clear conceptualization of advanced midwifery practice seems essential for successful implementation. an international debate and consensus on the defining elements of advanced midwifery practice could enhance the further development of midwifery as a profession and is a prerequisite for its successful implementation. Due to rising numbers of AMPs, extension of practice and elevated quality requirements in healthcare, more outcomes research exclusively

Win-win-win: collaboration advances critical care practice.

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Spence, Deb; Fielding, Sandra

2002-10-01

Against a background of increasing interest in education post registration, New Zealand nurses are working to advance their professional practice. Because the acquisition of highly developed clinical capabilities requires a combination of nursing experience and education, collaboration between clinicians and nurse educators is essential. However, the accessibility of relevant educational opportunities has been an ongoing issue for nurses outside the country's main centres. Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) developed between Auckland University of Technology and two regional health providers is one such example. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty. This paper provides an overview of the structure and pr month, distance education course focused on developing the context of critical care nursing.

Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

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Potter, Pamela J.

2013-01-01

Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions in cancer care; a description of the author’s professional experience with TT, HT, and Reiki in practice and research; an overview of the three energy healing modalities; a review of nine clinical studies related to oncology; and recommendations for EIP. These studies demonstrate a response to previous research design critiques. Findings indicate a positive benefit for oncology patients in the realms of pain, quality of life, fatigue, health function, and mood. Directionality of healing in immune response and cell line studies affirms the usual explanation that these therapies bring harmony and balance to the system in the direction of health. Foremost, the research literature demonstrates the safety of these therapies. In order to consider the varieties of evidence for TT, HT, and Reiki, EIP requires a qualitative examination of patient experiences with these modalities, exploration of where these modalities have been integrated into cancer care and how the practice works in the oncology setting, and discovery of the impact of implementation on provider practice and self-care. Next steps toward EIP require fleshing out the experience of these modalities by patients and health-care providers in the oncology care setting. PMID:25031994

Advancing work practices

DEFF Research Database (Denmark)

Noesgaard, Signe Schack

2016-01-01

-executed instructional interventions will advance work practices. Design/methodology/approach The paper synthesizes contemporary social-psychological and educational research in the creation of a model of intervention-based change. In addition, the findings from an empirical study of online teacher professional......Purpose The paper aims to discuss the effectiveness of e-Learning in advancing work practices. The paper investigates the assumption that e-Learning is as effective as face-to-face interventions when stimulating change. It also examines the assumption that well-designed and well...... development simultaneously inspire and exemplify the model. Findings The paper suggests that increased attention to individual motivational drivers is needed, especially post intervention, to help ensure meaningful learning transfer and sustainable behavior change. The importance of individualized on...

Education of advanced practice nurses in Canada.

Science.gov (United States)

Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

2010-12-01

In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.

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Schober, Madrean M; Gerrish, Kate; McDonnell, Ann

2016-06-01

To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.

Examination for the Certificate in Advanced Practice in Cervical Cytology--the first year's experience.

Science.gov (United States)

Smith, P A; Hewer, E M

2003-06-01

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required.

Leadership and management skills of general practice nurses: experience or education?

Science.gov (United States)

Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

2014-12-01

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

Supporting primary care nurses to work at an advanced level through changing practices.

Science.gov (United States)

Forsdike, Kirsty; Murphy, Tracy Ann; Hegarty, Kelsey

2018-04-06

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.

Impact of advanced pharmacy practice experience placement changes in colleges and schools of pharmacy.

Science.gov (United States)

Duke, Lori J; Staton, April G; McCullough, Elizabeth S; Jain, Rahul; Miller, Mindi S; Lynn Stevenson, T; Fetterman, James W; Lynn Parham, R; Sheffield, Melody C; Unterwagner, Whitney L; McDuffie, Charles H

2012-04-10

To document the annual number of advanced pharmacy practice experience (APPE) placement changes for students across 5 colleges and schools of pharmacy, identify and compare initiating reasons, and estimate the associated administrative workload. Data collection occurred from finalization of the 2008-2009 APPE assignments throughout the last date of the APPE schedule. Internet-based customized tracking forms were used to categorize the initiating reason for the placement change and the administrative time required per change (0 to 120 minutes). APPE placement changes per institution varied from 14% to 53% of total assignments. Reasons for changes were: administrator initiated (20%), student initiated (23%), and site/preceptor initiated (57%) Total administrative time required per change varied across institutions from 3,130 to 22,750 minutes, while the average time per reassignment was 42.5 minutes. APPE placements are subject to high instability. Significant differences exist between public and private colleges and schools of pharmacy as to the number and type of APPE reassignments made and associated workload estimates.

The Ways of Advanced Human Capital: Discussions from Experiences

Directory of Open Access Journals (Sweden)

Rayén Amanda Rovira Rubio

2015-11-01

Full Text Available The present research aimed to know the significance of academic training experienced by postgraduate students who are pursuing their studies abroad under the context of a Training Program for Advanced Human Capital promoted by the Government of Chile. A feminist epistemology of situated knowledge was used as methodological framework, and narrative productions were used as technique of data collection. With this approach, the experiences of seven graduate students in Spanish universities, mostly of them beneficiaries of scholarships from Chile, were analyzed. The main findings were: the positive assessment of the experience of studying abroad, the divergent testimonies about these experiences, which based on previous educational trajectories and the socioeconomic level of the professional. These aspects influenced the identifications with the concept of Advanced Human Capital for Chile. Also, for some participants, the Advanced Human Capital is seen as an imposed concept which does not coincide with the real opportunities for the professional practice in the country. Therefore, the participants are sceptical about the possibilities of adequate job insertion in the return to Chile.

The concept of advanced radiographic practice: An international perspective

International Nuclear Information System (INIS)

Hardy, Maryann; Legg, Jeffrey; Smith, Tony; Ween, Borgny; Williams, Imelda; Motto, Jenny

2008-01-01

Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity

Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.

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Campbell-Detrixhe, Dia D; Grassley, Jane S; Zeigler, Vicki L

2013-10-01

Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology.

Effects of RN Age and Experience on Transformational Leadership Practices.

Science.gov (United States)

Herman, Susan; Gish, Mary; Rosenblum, Ruth; Herman, Michael

2017-06-01

This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.

Experimenting with practice

DEFF Research Database (Denmark)

Knudsen, Hanne; Adriansen, Hanne Kirstine

2016-01-01

Abstract Purpose Teaching executive courses always raises the challenge of how to deal with the tension between theory and practice. The present chapter analyses the use of experiments in practice as a pedagogical approach to deal with this tension in Master’s programmes. Design/methodology/appro......Abstract Purpose Teaching executive courses always raises the challenge of how to deal with the tension between theory and practice. The present chapter analyses the use of experiments in practice as a pedagogical approach to deal with this tension in Master’s programmes. Design...... that it is important to observe the distinction between the role of the manager and the role of the student in order to meet ethical challenges, inevitably raised by experimenting with practice. Finally we argue that the experimental teaching practice can be conceptualised as a monstrous pedagogy, as the pedagogy...... pedagogy they use fort dealing with this tension. Practical implications Many Master’s programmes draw empirical data from the students’ own practice into the teaching. We argue that using experiments is highly useful to identify some of the general challenges inherent in analyses of one’s own practice...

Impact of Selection Practices on Career Advancement of African American Women in Community College Administration

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Yancy-Tooks, Barbara J.

2012-01-01

The purpose of this qualitative ethnographic study was to explore the experiences of African American women about their perceptions of factors (i.e. senior administrator selection practices, institutional practices, barriers, and coping strategies) that hinder or facilitate advancement in community college administration. The following questions…

Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.

Science.gov (United States)

O'Connell, Jane; Gardner, Glenn; Coyer, Fiona

2014-12-01

This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.

Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

Science.gov (United States)

Johnson, Charisse L; Crawford, Stephanie Y; Lin, Swu-Jane; Salmon, J Warren; Smith, Miriam Mobley

2009-02-19

To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

Delineating advanced practice nursing in New Zealand: a national survey.

Science.gov (United States)

Carryer, J; Wilkinson, J; Towers, A; Gardner, G

2018-03-01

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one-way ANOVA and post hoc between group comparisons. Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain-specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence-based nursing workforce planning and policy development. © 2017 International Council of Nurses.

Enhancing Research and Practice in Early Childhood through Formative and Design Experiments

Science.gov (United States)

Bradley, Barbara A.; Reinking, David

2011-01-01

This article describes formative and design experiments and how they can advance research and instructional practices in early childhood education. We argue that this relatively new approach to education research closes the gap between research and practice, and it addresses limitations that have been identified in early childhood research. We…

Practice and prospect of advanced fuel management and fuel technology application in PWR in China

International Nuclear Information System (INIS)

Xiao Min; Zhang Hong; Ma Cang; Bai Chengfei; Zhou Zhou; Wang Lei; Xiao Xiaojun

2015-01-01

Since Daya Bay nuclear power plant implemented 18-month refueling strategy in 2001, China has completed a series of innovative fuel management and fuel technology projects, including the Ling Ao Advanced Fuel Management (AFM) project (high-burnup quarter core refueling) and the Ningde 18-month refueling project with gadolinium-bearing fuel in initial core. First, this paper gives brief introduction to China's advanced fuel management and fuel technology experience. Second, it introduces practices of the advanced fuel management in China in detail, which mainly focuses on the implementation and progress of the Ningde 18-month refueling project with gadolinium-bearing fuel in initial core. Finally, the paper introduces the practices of advanced fuel technology in China and gives the outlook of the future advanced fuel management and fuel technology in this field. (author)

Advanced radiographic practice - the legal aspects

International Nuclear Information System (INIS)

Alderson, C.J.; Hogg, P.

2003-01-01

Allied health and nursing professionals are continuing to expand their responsibilities into clinical areas outside their traditional spheres of interest; typically, many of these new responsibilities are found within the medical (doctor) domain. Such responsibilities are often at an advanced clinical level and consequently higher demands are placed upon the professionals, not least in terms of clinical updating, competence to practice and also legal liability. This article explores the legal implications of practising at an advanced clinical level with particular reference to legal claims. The first part of the article commences with an outline of pertinent law in England and Wales. The latter part of the article explores actual cases from which allied health professionals (eg radiographers) can gain valuable information. Throughout the article suggestions for good practice are indicated. Examples of good practice include: the need to base your practice on evidence and peer practice; the need to keep detailed records (protocols) of such practice; the need to know when you are at the limit of your ability; and as such when to ask for advice from a medical practitioner/radiologist

Challenges to implementation of advance directives of will in hospital practice.

Science.gov (United States)

Cogo, Silvana Bastos; Lunardi, Valéria Lerch; Quintana, Alberto Manuel; Girardon-Perlini, Nara Marilene Oliveira; Silveira, Rosemary Silva da

2016-01-01

to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication. limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.

Analysis instruments for the performance of Advanced Practice Nursing.

Science.gov (United States)

Sevilla-Guerra, Sonia; Zabalegui, Adelaida

2017-11-29

Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Workplace discrimination: experiences of practicing physicians.

Science.gov (United States)

Coombs, Alice A Tolbert; King, Roderick K

2005-04-01

In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status.

An Academic-Practice Partnership to Advance DNP Education and Practice.

Science.gov (United States)

Howard, Patricia B; Williams, Tracy E

During the past decade, the growth of doctor of nursing practice (DNP) programs in the United States has been phenomenal, with most focusing on the preparation of advanced practice registered nurses. Simultaneously, academic-practice partnerships have been a frequent subject of discussion for nursing's leading academic, administrative, and practice organizations. Numerous reports about academic-practice partnerships concerning aspects of baccalaureate nursing education exist, but partnership accounts for DNP programs are essentially nonexistent. The purpose of this article is to describe the initial phase of an academic-practice partnership between a multisystem health care organization and a college of nursing in a public land-grant university in the southeastern United States. The 7-year partnership agreement between Norton Healthcare and the University of Kentucky College of Nursing was designed to prepare 5 cohorts of 20 to 30 baccalaureate-prepared staff nurses as DNP graduates for advanced practice registered nurse eligibility. The description of partnering institution characteristics frames an emphasis on elements of the partnership proposal, contractual agreement, and partner responsibilities along with the logic model evaluation plan. Lessons learned include the importance of proposals and contracts to sustain the partnership, frequent communication to build trust, and strategic analysis for rapid response to challenging situations. Copyright © 2016 Elsevier Inc. All rights reserved.

Management of advanced pancreatic cancer in daily clinical practice.

Science.gov (United States)

Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

2016-01-01

The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

Swedish students' and preceptors' perceptions of what students learn in a six-month advanced pharmacy practice experience.

Science.gov (United States)

Wallman, Andy; Sporrong, Sofia Kälvemark; Gustavsson, Maria; Lindblad, Asa Kettis; Johansson, Markus; Ring, Lena

2011-12-15

To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.

Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses.

Science.gov (United States)

Garrett, Bernard; Klein, Gerri

2008-08-01

The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless

Survey of advanced practice registered nurses disciplinary action.

Science.gov (United States)

Hudspeth, Randall

2007-04-02

The nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.

Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.

Science.gov (United States)

DeSocio, Janiece E

2016-07-01

The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.

Long-term intended and unintended experiences after Advanced Life Support training

DEFF Research Database (Denmark)

Rasmussen, M.B.; Dieckmann, Peter; Issenberg, Berry

2012-01-01

Highly structured simulation-based training (SBT) on managing emergency situations can have a significant effect on immediate satisfaction and learning. However, there are some indications of problems when applying learned skills to practice. The aim of this study was to identify long-term intended...... and unintended learner reactions, experiences and reflections after attending a simulation based Advanced Life Support (ALS) course....

The Competencies, Roles and Scope of Practice of Advanced Psychiatric Nursing in Indonesia

Directory of Open Access Journals (Sweden)

Yulia Wardani

2014-01-01

Full Text Available The graduate advanced psychiatric nursing (psychiatric nursing specialist from master degree in Indonesia are about 70 nurses, 67 nurses were graduated from University of Indonesia. They are working at mental health services and educational setting around Indonesia and yet seem not ready to perform some specific advanced competencies in clinical area. The mastery on mental health assessment, neurochemical perspectives, medical management and psychotherapy have not yet performed by the psychiatric nurse specialist in the clinical area or community.To have those competencies and its performances, therefore the curriculum in a psychiatric nursing graduate program must include advanced courses in physiopsychology, psychopathology, advanced psychopharmacology, neurobehavioral science, advanced mental health assessment, and advanced treatment interventions such as psychotherapy and prescription and management of psychotropic medications as their core and major courses in the curriculum. Those courses should be performed in their clinical practice courses or other related learning experiences. When those qualifications are met, then they are competent to be called advanced psychiatric nurse.As advanced practice registered nurses, the advanced psychiatric nurses should be able to demonstrate their direct expertise and roles in advanced mental health assessment, diagnostic evaluation, psychopharmacology management, psychotherapy with individuals, group and families, case management, millieu management, liason and counselling from prevention, promotion until psychiatric rehabilitation. Meanwhile the skill such as psycho-education, teaching, unit management, research and staff development can be added as their indirect roles.

Experience Practices on Decontamination Activity in NPP Decommissioning

Energy Technology Data Exchange (ETDEWEB)

Yoon, Suk Bon; Kim, Jeongju; Sohn, Wook [Korea Hydro and Nuclear Power Co., Daejeon (Korea, Republic of)

2016-10-15

Decommissioning of a nuclear power plant (NPP) involves various technical and administrative activities for a utility to terminate its license, which allows the plant site to be released from the regulatory control (site release). Decontamination activity in NPP decommissioning is one of the main technical activities to be performed during the decommissioning. The decontamination at decommissioning sites is usually performed due to several reasons such as reducing personnel dose and disposal costs, and cleanup to meet license termination requirements by using physical or chemical removal techniques proven through the previous experience practices. This paper introduces the best and worst practices for the decontamination activities collected from the decommissioning operational experiences through the implementation of nuclear decommissioning projects around the world. Review of the experiences of decontamination shows that it is important to conduct an advanced planning for optimized implementation of decontamination taking into considering site specific conditions such as operating time, reactor type, system, and so on. Also, a review of newer decontamination methods is necessary to safely and economically decommission the nuclear facility.

Computational experiment approach to advanced secondary mathematics curriculum

CERN Document Server

Abramovich, Sergei

2014-01-01

This book promotes the experimental mathematics approach in the context of secondary mathematics curriculum by exploring mathematical models depending on parameters that were typically considered advanced in the pre-digital education era. This approach, by drawing on the power of computers to perform numerical computations and graphical constructions, stimulates formal learning of mathematics through making sense of a computational experiment. It allows one (in the spirit of Freudenthal) to bridge serious mathematical content and contemporary teaching practice. In other words, the notion of teaching experiment can be extended to include a true mathematical experiment. When used appropriately, the approach creates conditions for collateral learning (in the spirit of Dewey) to occur including the development of skills important for engineering applications of mathematics. In the context of a mathematics teacher education program, this book addresses a call for the preparation of teachers capable of utilizing mo...

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

Science.gov (United States)

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-06-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

Learning to Facilitate Advance Care Planning: The Novice Social Worker's Experience

Science.gov (United States)

Washington, Karla; Bowland, Sharon; Mueggenburg, Kay; Pederson, Margaret; Otten, Sheila; Renn, Tanya

2014-01-01

Professional leaders have identified clear roles for social workers involved in advance care planning (ACP), a facilitated process whereby individuals identify their preferences for future medical care; yet information about effective teaching practices in this area is scant. This study reports on the experiences of 14 social workers who…

Description and evaluation of an initiative to develop advanced practice nurses in mainland China.

Science.gov (United States)

Wong, Frances Kam Yuet; Peng, Gangyi; Kan, Eva C; Li, Yajie; Lau, Ada T; Zhang, Liying; Leung, Annie F; Liu, Xueqin; Leung, Vilna O; Chen, Weiju; Li, Ming

2010-05-01

This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs. Copyright 2009 Elsevier Ltd. All rights reserved.

Advancing Evaluation Theory and Practice in South Asia ...

International Development Research Centre (IDRC) Digital Library (Canada)

Advancing Evaluation Theory and Practice in South Asia: Community of ... evidence-based policy development, decision-making, and practice in South Asia. ... International Water Resources Association, in close collaboration with IDRC, ...

Reflective practice in sport coaching: an autoethnographic exploration into the lived experiences of one coach

OpenAIRE

Ang, Denis

2017-01-01

This study seeks to contribute to the growing pool of knowledge on the use of alternative representation of lived experiences to advance practical understandings in sport coaching. Documenting a self-inquiry into my coaching practice, this study demonstrates the value of autoethnography as a methodology to deepen knowledge from experiences. By illuminating my coach-researcher voice through a self-narrative, this study shows how autoethnography is able to immerse the sport researcher in his or...

Advancing Work Practices Through Online Professional Development

DEFF Research Database (Denmark)

Noesgaard, Signe Schack

The natural expectation for professional development courses is that they will improve a participant’s work performance, but do they? This PhD research challenges several assumptions underlying the design of online professional development courses, revealing that it is after such interventions...... was not effective and subsequently terminate change that could have advanced their practices. This underlines the need to think beyond the course format to make online professional development interventions continuous, committing, and contextual. The research suggests rethinking online professional development...... as adaptive “just-in-time” technologies and proposes a design theory called “situated online professional development,” entailing six design principles for advancing work practices....

Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean.

Science.gov (United States)

Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth

2017-06-08

SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

Establishing philanthropic funds for advanced practice scholarships.

Science.gov (United States)

Neumann, T

1997-01-01

Because of decreased tuition assistance at some hospitals, experienced nurses interested in advanced roles may quit rather than stay and expand their roles. This author describes how a hospital based philanthropic community group has helped provide scholarships for nurses interested in advanced practice and how to set up a similar scholarship program that will retain these experienced and motivated nurses.

Blending work-integrated learning with distance education in an Australian radiation therapy advanced practice curriculum

International Nuclear Information System (INIS)

Matthews, Kristie; Wright, Caroline; Osborne, Catherine

2014-01-01

Advanced practice for radiation therapists has been a part of the international landscape for several years; however formal implementation into the Australian health care system is yet to happen. Despite this, three short course radiation therapy advanced practitioner programs have been established by an Australian tertiary institution in response to clinical service needs at several organisations. This paper describes the rationale for curriculum design and development of the program materials, the small-scale implementation of the programs at pilot sites, and the evolution of the curriculum to be available to registered radiation therapists nationally. Each program has been designed around a specific clinical role, where flexibility of delivery to busy practitioners was central to the decision to offer them via distance education. The curriculum comprises theoretical units of study which run in parallel to and underpin clinical practice units, where advanced competence in the specific area of practice is overseen by an experienced radiation oncologist mentor. Given the nature of the disparate clinical services requiring an advanced radiation therapy practitioner, the workplace learning component of the course is individually negotiated at a local level. Outcomes suggest that the flexible clinically based training underpinned by a distance education academic curriculum is able to support the development of advanced radiation therapy practitioners responsive to local service need, and ultimately may improve the patient experience

The AGREE Enterprise: a decade of advancing clinical practice guidelines.

Science.gov (United States)

Makarski, Julie; Brouwers, Melissa C

2014-08-15

The original AGREE (Appraisal of Guidelines for REsearch and Evaluation) Instrument was published in 2003, and its revision, the AGREE II, in 2009. Together, they filled an important gap in the guideline and quality of care fields. Ten years later, the AGREE Enterprise reflects on a trajectory of projects and international collaboration that have contributed to advancing the science and quality of practice guidelines and the uptake of AGREE/AGREE II. The AGREE Enterprise has undertaken activities to improve the tool and to develop resources to support its use. Since 2003, the uptake and adoption of AGREE by the international community has been swift and broad. A total of 33 language translations of the original AGREE Instrument and the current AGREE II are available and were initiated by the international community. A recent scan of the published literature identified over 600 articles that referenced the AGREE tools. The AGREE tools have been widely received and applied, with several organizations having incorporated the AGREE as part of their formal practice guideline programs. Since its redevelopment in 2010, the AGREE Enterprise website (www.agreetrust.org) continues to experience steady increases in visitors per month and currently has over 10,000 registered users. The AGREE Enterprise has contributed to the advancements of guidelines through research activities and international participation by scientific and user communities. As we enter a new decade, we look forward to ongoing collaborations and contributing to further advancements to improve quality of care and health care systems.

Procedure competencies and job functions of the urologic advanced practice nurse.

Science.gov (United States)

Kleier, Jo Ann

2009-01-01

A 2-round modified Delphi study recruited a panel urologic advanced practice nurse experts to identify the procedure competencies and job functions unique to the role of the advanced practice nurse specializing in the care of urology patients.

Doctor of Nursing Practice: The Role of the Advanced Practice Nurse.

Science.gov (United States)

Walker, Deborah Kirk; Polancich, Shea

2015-11-01

To explore the evolution and emerging roles of the Doctor of Nursing Practice (DNP) Advanced Practice Nurse (APN). Published peer reviewed literature, cancer-related professional resources, and Web-based resources. The DNP education has prepared the APN for process improvement initiatives, providing quality care, and evidence-based practice translation, which are critical with the emerging trends in this complex health care environment. DNP-prepared APNs have the opportunity to impact oncology care across the cancer trajectory, in various settings, and in various innovative roles as entrepreneurs. Copyright © 2015 Elsevier Inc. All rights reserved.

Establishing radiation therapy advanced practice in New Zealand

Energy Technology Data Exchange (ETDEWEB)

Coleman, Karen; Jasperse, Marieke; Herst, Patries [Department of Radiation Therapy, University of Otago, Wellington (New Zealand); Yielder, Jill [University of Auckland, Auckland (New Zealand); Department of Radiation Therapy, University of Otago, Wellington (New Zealand)

2014-02-15

Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board.

Establishing radiation therapy advanced practice in New Zealand

International Nuclear Information System (INIS)

Coleman, Karen; Jasperse, Marieke; Herst, Patries; Yielder, Jill

2014-01-01

Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board

Advance care planning for nursing home residents with dementia: policy vs. practice.

Science.gov (United States)

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

Science.gov (United States)

Hanley, Mary Anne; Coppa, Denise; Shields, Deborah

2017-08-01

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

Impact of postgraduate education on advanced practice nurse activity - a national survey.

Science.gov (United States)

Wilkinson, J; Carryer, J; Budge, C

2018-03-22

There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

Strategic directions and actions for advanced practice nursing in China

Directory of Open Access Journals (Sweden)

Martha N. Hill

2017-01-01

Full Text Available There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs improve health care and outcomes. The China Medical Board (CMB China Nursing Network (CCNN began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities. This paper presents the discussion, recommendations and action plans developed at the inaugural planning meeting on June 26, 2015 at Fudan University in Shanghai. The recommendations are: Develop standards for advanced nursing practice; Develop Master's level curricula based on the standards; Commence pilot projects across a number of University affiliated hospitals; and Prepare clinical tutors and faculty. The strategic directions and actions are: Develop a clinical career ladder system; Expand the nursing role from hospital to community; and Build a specialty nurse accreditation system.

Intimate partner violence: advanced practice nurses clinical stories of success and challenge.

Science.gov (United States)

Brykczynski, Karen A; Crane, Patricia; Medina, Cindy K; Pedraza, Dora

2011-03-01

This qualitative study presents knowledge from clinical experiences of advanced practice nurses (APNs) working with women who have experienced intimate partner violence (IPV). Face-to-face interviews were conducted with ten APNs to discover their ways of being with, supporting, and helping women who have experienced IPV. Interviews were transcribed and analyzed using interpretive phenomenology. Analysis proceeded from whole to parts and back to whole with ongoing attention to maintaining the situational context to guide interpretation of meanings. APNs experience both challenges and successes in caring for women who live with IPV. Findings consist of interpretations of clinical stories to uncover knowledge embedded in practice. Healing practices and ways of being survival facilitators for women and children are identified and described. APNs are in a unique position to help families who live with abuse, but may lack resources and knowledge about the most effective interventions. They may become cynical and frustrated with feelings of futility when faced with the repeating patterns associated with the cycle of violence. The goals of this study are to promote more comprehensive understanding of IPV and stimulate changes in education, practice, research, and health policy. ©2011 The Author(s) Journal compilation © 2011 American Academy of Nurse Practitioners.

Advanced quantum mechanics a practical guide

CERN Document Server

Nazarov, Yuli V

2013-01-01

An accessible introduction to advanced quantum theory, this graduate-level textbook focuses on its practical applications and treats real-life examples to equip readers with an operational toolbox of theoretical techniques. It features case studies from different topics and 70 end-of-chapter problems, with solutions for instructors available online.

Harnessing competence and confidence: Dimensions in education and development for advanced and consultant practice

International Nuclear Information System (INIS)

Price, Richard C.; Edwards, Hazel M.

2008-01-01

Consultant and advanced practice are relatively new concepts in radiography. There is evidence to show that as the career progression framework is being adopted the numbers of consultant and advanced practitioners in radiography are growing with the latter growing at a faster rate. The article considers the concept of advanced and consultant practice and the education requirements to support development. Preparation for an advanced practice role begins at the practitioner stage. Masters' level programmes are available to support the development of advanced practice. Education needs to be flexible as new advanced practice roles emerge. It is necessary to take practitioners beyond a defined modality to include leadership and people skills. These are essential for those aspiring to become consultants. Consultants require a high level of clinical knowledge for expert practice but also strategic vision and interpersonal intelligence to facilitate leadership and practice innovation. A model for developing leadership skills for consultants focussing on competence, confidence and capacity is proposed

Measuring the impact of the advanced practitioner role: a practical approach.

Science.gov (United States)

Neville, Lillian; Swift, Juliette

2012-04-01

This paper aims to illuminate difficulties in evaluating the advanced practitioner role and to offer a practical solution. The advanced practice role has been part of the workforce strategy in the Northwest of England since 2005. However capturing hard evidence of the impact of this role has been problematic. Current restrictions on resources require the provision of evidence of the value of roles and services. Critical analysis of literature has identified challenges in evaluating the advanced practice role. The case study design takes account of current policy initiatives, notably QIPP. There is no common approach to evaluating the role of advanced practitioners. The case study has the potential to be a useful tool to organise evidence of the impact of advanced practitioner roles. Advanced practitioners need to have appropriate knowledge and skills to provide evidence of the impact of their role. There is potential for this work to be applied to other roles across the NHS. Managers need to work in partnership with workforce planners and educationalists to support advanced practitioners to utilise their skills in methods of providing evidence that they do work of value. Clear strategic direction for advanced practitioners is advised as part of the workforce strategy. © 2012 Blackwell Publishing Ltd.

Experiment and practice on signal processing

International Nuclear Information System (INIS)

2002-11-01

The contents of this book contains basic practice of CEM Tool, discrete time signal and experiment and practice of system, experiment and practice of discrete time signal sampling, practice of frequency analysis, experiment of digital filter design, application of digital signal processing, project related voice, basic principle of signal processing, the technique of basic image signal processing, biology astronomy and Robot soccer with apply of image signal processing technique, control video signal and project related image. It also has an introduction of CEM Linker I. O in the end.

Experiment and practice on signal processing

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-11-15

The contents of this book contains basic practice of CEM Tool, discrete time signal and experiment and practice of system, experiment and practice of discrete time signal sampling, practice of frequency analysis, experiment of digital filter design, application of digital signal processing, project related voice, basic principle of signal processing, the technique of basic image signal processing, biology astronomy and Robot soccer with apply of image signal processing technique, control video signal and project related image. It also has an introduction of CEM Linker I. O in the end.

Practical Implementations of Advanced Process Control for Linear Systems

DEFF Research Database (Denmark)

Knudsen, Jørgen K . H.; Huusom, Jakob Kjøbsted; Jørgensen, John Bagterp

2013-01-01

This paper describes some practical problems encountered, when implementing Advanced Process Control, APC, schemes on linear processes. The implemented APC controllers discussed will be LQR, Riccati MPC and Condensed MPC controllers illustrated by simulation of the Four Tank Process and a lineari......This paper describes some practical problems encountered, when implementing Advanced Process Control, APC, schemes on linear processes. The implemented APC controllers discussed will be LQR, Riccati MPC and Condensed MPC controllers illustrated by simulation of the Four Tank Process...... on pilot plant equipment on the department of Chemical Engineering DTU Lyngby....

[Advanced nursing practice: a must for the quality of care and mental health services].

Science.gov (United States)

Ricard, Nicole; Page, Claire; Laflamme, France

2014-01-01

supported the development of new models of advanced practice in mental health. These developments have been particularly significant in the United States and Australia. In United States, during the 1990s, at least four models of advanced practice in mental health nursing have been developed leading to wide variations in the roles, education, job titles, scope of practice and legal authorizations. Consequently, a consensus model of uniform standards of practice, accreditation and education has been proposed. This LACE model (Licensure, Accreditation, Certification, Education) will be in effect in 2015. Australia has adopted a more systematic approach, unified and progressive to facilitate the development of advanced mental health nursing practice. Australia who, through their many publications, retains more attention since a clear definition of the role of the nurse practitioner in mental health and a legal framework has been adopted at the national level. The Australian experience and the finding from studies suggest that mental health nurse practitioners and nurses who are specialized in mental health have the potential to make a significant contribution to enhancing access to and quality of mental health care through flexible an innovative approaches. So there are more and more evidence and indications that Quebec should invest in enhancing the skills of mental health nurses through the development of advanced nursing practice and integration of this new model in primary care. In addition, researches, funded by the Canadian Services Research Foundation (CHSRF, 2010), shows that the contribution of advanced nursing practice has never been stronger and there is a broad consensus to its value for the Canadian health care system (Dicenso.et Lukosius-Briant, 2010). The implementation of advanced practice nursing role in mental health is part of best practices required to improve care and mental health services and should be taken into account in future Action Plan 2014-2020.

Developing advanced clinical practice skills in gastrointestinal consequences of cancer treatment.

Science.gov (United States)

Gee, Caroline; Andreyev, Jervoise; Muls, Ann

2018-03-08

This article explores the transition from a clinical nurse specialist (CNS) towards developing advanced clinical practice skills within a gastrointestinal consequences of cancer clinic. It presents data on the first 50 patients assessed by the CNS from a prospective service evaluation, demonstrating how this informed the nurse's future learning. There is high demand for advanced clinical practice skills to address unmet health needs and improve the quality, efficiency, and sustainability of healthcare services. However, a literature review found no literature on developing advanced clinical practice skills in this setting. Emerging themes from the service evaluation focused on barriers and enablers, ongoing support, organisational commitment and working in a multidisciplinary team. Blended learning provided both structured and opportunistic learning, embedding both formal and tacit knowledge, as roles require increasing flexibility. Clinical supervision and reflective practice were key in maintaining professional and peer support.

[Competencies and professional profile of the advanced practice nurse].

Science.gov (United States)

del Barrio-Linares, M

2014-01-01

The advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile. A review of the literature. The following databases were used: CINAHL, PubMed and Medline. Search terms were 'clinical nurse specialist,' 'implementation,' and 'advanced practice nursing.' The sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization. CNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leader National policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards. Copyright © 2012 Elsevier España, S.L. y SEEIUC. All rights reserved.

Experiment-Based Teaching in Advanced Control Engineering

Science.gov (United States)

Precup, R.-E.; Preitl, S.; Radac, M.-B.; Petriu, E. M.; Dragos, C.-A.; Tar, J. K.

2011-01-01

This paper discusses an experiment-based approach to teaching an advanced control engineering syllabus involving controlled plant analysis and modeling, control structures and algorithms, real-time laboratory experiments, and their assessment. These experiments are structured around the representative case of the longitudinal slip control of an…

From challenges to advanced practice registered nursing role development: Qualitative interview study.

Science.gov (United States)

Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija

2015-12-01

The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.

Advanced nursing experience is beneficial for lowering the peritonitis rate in patients on peritoneal dialysis.

Science.gov (United States)

Yang, Zhikai; Xu, Rong; Zhuo, Min; Dong, Jie

2012-01-01

We explored the relationship between the experience level of nurses and the peritonitis risk in peritoneal dialysis (PD) patients. Our observational cohort study followed 305 incident PD patients until a first episode of peritonitis, death, or censoring. Patients were divided into 3 groups according to the work experience in general medicine of their nurses-that is, least experience (biochemistry, and residual renal function were also recorded. Multivariate Cox regression was used to analyze the association of risks for all-cause and gram-positive peritonitis with patient training provided by nurses at different experience levels. Of the 305 patients, 91 were trained at the initiation of PD by nurses with advanced experience, 100 by nurses with moderate experience, and 114 by nurses with the least experience. Demographic and clinical variables did not vary significantly between the groups. During 13 582 patient-months of follow-up, 129 first episodes of peritonitis were observed, with 48 episodes being attributed to gram-positive organisms. Kaplan-Meier analysis showed that training by nurses with advanced experience predicted the longest period free of first-episode gram-positive peritonitis. After adjustment for some recognized confounders, the advanced experience group was still associated with the lowest risk for first-episode gram-positive peritonitis. The level of nursing experience was not significantly correlated with all-cause peritonitis risk. The experience in general medicine of nurses might help to lower the risk of gram-positive peritonitis among PD patients. These data are the first to indicate that nursing experience in areas other than PD practice can be vital in the training of PD patients.

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

Science.gov (United States)

Schoonover, Heather

The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Student nurses' experiences of community-based practice placement learning: a qualitative exploration.

Science.gov (United States)

Baglin, M R; Rugg, Sue

2010-05-01

United Kingdom (UK) health policy has adopted an increasing community and primary care focus over recent years (Department of Health, 1997; Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visitor Contribution to Health and Health Care. Department of Health, London; Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London). Nursing practice, education and workforce planning are called upon to adapt accordingly (Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London; Kenyon, V., Smith, E., Hefty, L., Bell, M., Martaus, T., 1990. Clinical competencies for community health nursing. Public Health Nursing 7(1), 33-39; United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986. Project 2000: A New Preparation for Practice. UKCC, London). Such changes have major implications for pre-registration nursing education, including its practice placement element. From an educational perspective, the need for increased community nursing capacity must be balanced with adequate support for student nurses' learning needs during community-based placements. This qualitative study explored six second year student nurses' experiences of 12 week community-based practice placements and the extent to which these placements were seen to meet their perceived learning needs. The data came from contemporaneous reflective diaries, completed by participants to reflect their 'lived experience' during their practice placements (Landeen, J., Byrne, Brown, B., 1995. Exploring the lived experiences of psychiatric nursing students through self-reflective journals. Journal of Advanced Nursing 21(5), 878-885; Kok, J., Chabeli, M.M., 2002. Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective. Curationis 25(3), 35-42; Löfmark, A., Wikblad, K., 2001. Facilitating and

Advanced technologies related to a high temperature superconductor for small laboratory experiments

International Nuclear Information System (INIS)

Ogawa, Yuichi; Mito, Toshiyuki; Yanagi, Nagato

2006-01-01

Advanced technologies related to a high temperature superconductor materials and small refrigerator are reviewed. Mini-RT/RT-1 is designed and constructed as a plasma examination device. The element technology of low temperature apparatus, the results of performance tests and application examples are explained. The superconductors such as Bi 2 Sr 2 CaCu 2 O 8 (Bi-2212) for the low temperature phase, Bi 2 Sr 2 Ca 2 Cu 3 O 10 (Bi-2223) for the high temperature phase, and YBa 2 Cu 3 O y (YBCO or Y123) are described. Advanced 4K-Giford-Mcmahon (GM) refrigerator on the market put superconductor coil made of low temperature superconductor metals to practical use and extends its application field. Small laboratory is able to experiment on the high temperature superconductor materials. (S.Y.)

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.

Science.gov (United States)

Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna

2016-06-01

To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

Advancing practice relating to SEA alternatives

International Nuclear Information System (INIS)

González, Ainhoa; Thérivel, Riki; Fry, John; Foley, Walter

2015-01-01

Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues have resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary

Advancing practice relating to SEA alternatives

Energy Technology Data Exchange (ETDEWEB)

González, Ainhoa, E-mail: agonzal@tcd.ie [School of Natural Sciences, Trinity College Dublin, Dublin 2 (Ireland); Thérivel, Riki, E-mail: levett-therivel@phonecoop.coop [Levett-Therivel Sustainability Consultants (United Kingdom); Fry, John, E-mail: john.fry@ucd.ie [School of Agriculture and Food Science, University College Dublin, Dublin 4 (Ireland); Foley, Walter, E-mail: walterfoley@gmail.com [School of Geography, Planning and Environmental Policy, University College Dublin, Dublin 4 (Ireland)

2015-07-15

Developing and assessing alternatives is a key and central stage to Strategic Environmental Assessment (SEA). However, research has repeatedly reported this stage as one of the most poorly undertaken aspects of the SEA process. Current practice limitations include belated consideration of reasonable alternatives, narrow scope of alternatives that often include unrealistic or retrofitted options, limited stakeholder and public involvement in their identification, assessment and selection, lack of systematic approaches to their assessment and comparison, and inadequate reporting of the ‘storyline’ on how they were identified, what the potential impacts are and why the preferred alternative was selected. These issues have resulted in objections and judicial reviews. On the positive side, a number of good practice case studies enable extraction of key lessons and formulation of a set of general recommendations to advance practice in SEA alternatives. In this paper, practical guidance on the identification and development of alternatives, their assessment and comparison, selection of the preferred option, and documentation of the process and the reasons for selection is provided and discussed to frame good practice approaches. - Highlights: • Alternatives are one of the most poorly completed aspects of Strategic Environmental Assessment. • Current practice limitations need to be addressed to enhance SEA effectiveness. • A set of recommendations are extracted from good practice case studies. • These recommendations can be applied across jurisdictions and sectors and tailored as necessary.

Advanced Liquid Feed Experiment

Science.gov (United States)

Distefano, E.; Noll, C.

1993-06-01

The Advanced Liquid Feed Experiment (ALFE) is a Hitchhiker experiment flown on board the Shuttle of STS-39 as part of the Space Test Payload-1 (STP-1). The purpose of ALFE is to evaluate new propellant management components and operations under the low gravity flight environment of the Space Shuttle for eventual use in an advanced spacecraft feed system. These components and operations include an electronic pressure regulator, an ultrasonic flowmeter, an ultrasonic point sensor gage, and on-orbit refill of an auxiliary propellant tank. The tests are performed with two transparent tanks with dyed Freon 113, observed by a camera and controlled by ground commands and an on-board computer. Results show that the electronic pressure regulator provides smooth pressure ramp-up, sustained pressure control, and the flexibility to change pressure settings in flight. The ultrasonic flowmeter accurately measures flow and detects gas ingestion. The ultrasonic point sensors function well in space, but not as a gage during sustained low-gravity conditions, as they, like other point gages, are subject to the uncertainties of propellant geometry in a given tank. Propellant transfer operations can be performed with liquid-free ullage equalization at a 20 percent fill level, gas-free liquid transfer from 20-65 percent fill level, minimal slosh, and can be automated.

Establishing advanced practice for medical imaging in New Zealand

International Nuclear Information System (INIS)

Yielder, Jill; Young, Adrienne; Park, Shelley; Coleman, Karen

2014-01-01

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ

Establishing advanced practice for medical imaging in New Zealand

Energy Technology Data Exchange (ETDEWEB)

Yielder, Jill, E-mail: j.yielder@auckland.ac.nz [University of Auckland, Auckland (New Zealand); Young, Adrienne; Park, Shelley; Coleman, Karen [University of Otago, Wellington (New Zealand); University of Auckland, Auckland (New Zealand)

2014-02-15

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention.

Science.gov (United States)

Cooke, Liz; Gemmill, Robin; Grant, Marcia

2008-01-01

The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

Science.gov (United States)

Batra, U; Parikh, P M; Prabhash, K; Tongaonkar, H B; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, S K; Rajappa, S; Rajendranath, R; Rawal, S K; Singh, Manisha; Singh, R; Somashekhar, S P; Sood, R

2016-01-01

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis.

Science.gov (United States)

De Geest, Sabina; Moons, Philip; Callens, Betty; Gut, Chris; Lindpaintner, Lyn; Spirig, Rebecca

2008-11-01

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

Transcendental experiences during meditation practice.

Science.gov (United States)

Travis, Frederick

2014-01-01

This article explores transcendental experiences during meditation practice and the integration of transcendental experiences and the unfolding of higher states of consciousness with waking, dreaming, and sleeping. The subject/object relationship during transcendental experiences is characterized by the absence of time, space, and body sense--the framework that gives meaning to waking experiences. Physiologically, transcendental experiences during Transcendental Meditation practice are marked by slow inhalation, along with autonomic orientation at the onset of breath changes and heightened α1 (8-10 Hz) frontal coherence. The integration of transcendental experiences with waking, dreaming, and sleeping is also marked by distinct subjective and objective markers. This integrated state, called Cosmic Consciousness in the Vedic tradition, is subjectively marked by inner self-awareness coexisting with waking, sleeping, and dreaming. Physiologically, Cosmic Consciousness is marked by the coexistence of α1 electroencephalography (EEG) with delta EEG during deep sleep, and higher brain integration, greater emotional stability, and decreased anxiety during challenging tasks. Transcendental experiences may be the engine that fosters higher human development. © 2013 New York Academy of Sciences.

Advanced practice nursing in child maltreatment: practice characteristics.

Science.gov (United States)

Hornor, Gail; Herendeen, Pamela

2014-01-01

Child maltreatment is a problem of epidemic proportions in the United States. Pediatric nurse practitioners and other advanced practice nurses (APNs) have been caring for maltreated children for decades, yet to date no comprehensive assessment of their practice characteristics or their clinical and academic contributions to the field has been performed. The purpose of this study is to describe the practice characteristics of APNs who care for maltreated children. A descriptive design was used for this study. Child advocacy centers and children's hospitals were contacted to inquire about employment of child maltreatment APNs in their institution, and contact information for the lead APN was obtained. The Nurse Practitioner Survey was then sent to lead APNs by e-mail. The majority of APNs who work primarily in child maltreatment are pediatric nurse practitioners who work in child advocacy centers. They are providing care to children with physical and/or sexual abuse concerns; however, APNs provide care for children with all types of child maltreatment concerns. APNs play a vital role in the care of abused/neglected children. Their important contributions include not only clinical care but also the provision of clinical and didactic education to other professionals, parents, and the public. Research and publication are also essential to their role. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

Science.gov (United States)

Morgan, Brianna; Tarbi, Elise

2016-02-01

To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

Advances and Best Practices in Airborne Gravimetry from the U.S. GRAV-D Project

Science.gov (United States)

Diehl, Theresa; Childers, Vicki; Preaux, Sandra; Holmes, Simon; Weil, Carly

2013-04-01

The Gravity for the Redefinition of the American Vertical Datum (GRAV-D) project, an official policy of the U.S. National Geodetic Survey as of 2007, is working to survey the entire U.S. and its holdings with high-altitude airborne gravimetry. The goal of the project is to provide a consistent, high-quality gravity dataset that will become the cornerstone of a new gravimetric geoid and national vertical datum in 2022. Over the last five years, the GRAV-D project has surveyed more than 25% of the country, accomplishing almost 500 flights on six different aircraft platforms and producing more than 3.7 Million square km of data thus far. This wealth of experience has led to advances in the collection, processing, and evaluation of high-altitude (20,000 - 35,000 ft) airborne gravity data. This presentation will highlight the most important practical and theoretical advances of the GRAV-D project, giving an introduction to each. Examples of innovation include: 1. Use of navigation grade inertial measurement unit data and precise lever arm measurements for positioning; 2. New quality control tests and software for near real-time analysis of data in the field; 3. Increased accuracy of gravity post-processing by reexamining assumptions and simplifications that were inconsistent with a goal of 1 mGal precision; and 4. Better final data evaluation through crossovers, additional statistics, and inclusion of airborne data into harmonic models that use EGM08 as a base model. The increases in data quality that resulted from implementation of the above advances (and others) will be shown with a case study of the GRAV-D 2008 southern Alaska survey near Anchorage, over Cook Inlet. The case study's statistics and comparisons to global models illustrate the impact that these advances have had on the final airborne gravity data quality. Finally, the presentation will summarize the best practices identified by the project from its last five years of experience.

Experience related to the safety of advanced LMFBR fuel elements

International Nuclear Information System (INIS)

Kerrisk, J.F.

1975-07-01

Experiments and experience relative to the safety of advanced fuel elements for the liquid metal fast breeder reactor are reviewed. The design and operating parameters and some of the unique features of advanced fuel elements are discussed breifly. Transient and steady state overpower operation and loss of sodium bond tests and experience are discussed in detail. Areas where information is lacking are also mentioned

Student and Preceptor Advancement in a Dedicated Education Site: Innovation in Clinical Education for Advanced Practice Nurses.

Science.gov (United States)

Hall, Katherine C; Diffenderfer, Sandy K; Stidham, April; Mullins, Christine M

2018-04-19

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Nurse leaders' experiences of implementing regulatory changes in sexual health nursing practice in British Columbia, Canada.

Science.gov (United States)

Bungay, Vicky; Stevenson, Janine

2013-05-01

Most research about regulatory policy change concerning expanded nursing activities has emphasized advanced practice roles and acute care settings. This study is a contribution to the small pool of research concerned with regulatory policy implementation for nurses undertaking expanded nursing practice activities in a public health context. Using the regulatory changes in certified nursing practice in one Canadian province as our starting point, we investigated the experiences of nurse leaders in implementing this change. Using a qualitative interpretive descriptive approach informed by tenets of complexity theory, we examined the experiences of 16 nurse leaders as situated within the larger public health care system in which nurses practice. Two interrelated themes, (a) preparing for certification and (b) the certification process, were identified to illustrate how competing and contrasting demands between health care and regulatory organizations created substantial barriers to policy change. Implications for health service delivery and future research are discussed.

How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data.

Science.gov (United States)

Etkind, Simon Noah; Bristowe, Katherine; Bailey, Katharine; Selman, Lucy Ellen; Murtagh, Fliss Em

2017-02-01

Uncertainty is common in advanced illness but is infrequently studied in this context. If poorly addressed, uncertainty can lead to adverse patient outcomes. We aimed to understand patient experiences of uncertainty in advanced illness and develop a typology of patients' responses and preferences to inform practice. Secondary analysis of qualitative interview transcripts. Studies were assessed for inclusion and interviews were sampled using maximum-variation sampling. Analysis used a thematic approach with 10% of coding cross-checked to enhance reliability. Qualitative interviews from six studies including patients with heart failure, chronic obstructive pulmonary disease, renal disease, cancer and liver failure. A total of 30 transcripts were analysed. Median age was 75 (range, 43-95), 12 patients were women. The impact of uncertainty was frequently discussed: the main related themes were engagement with illness, information needs, patient priorities and the period of time that patients mainly focused their attention on (temporal focus). A typology of patient responses to uncertainty was developed from these themes. Uncertainty influences patient experience in advanced illness through affecting patients' information needs, preferences and future priorities for care. Our typology aids understanding of how patients with advanced illness respond to uncertainty. Assessment of these three factors may be a useful starting point to guide clinical assessment and shared decision making.

Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice.

Science.gov (United States)

Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

2016-08-08

to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. identificar o estado atual da regulação, educação e prática do enfermeiro de prática avançada na América Latina e no Caribe e a percepção de líderes de enfermagem na região quanto ao papel da enfermagem de prática avançada na atenção primaria à saúde em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde. o estudo descritivo transversal utilizou um survey online com 173 líderes de enfermagem questionando suas percepções sobre o estado atual da pr

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma

Directory of Open Access Journals (Sweden)

U Batra

2016-01-01

Full Text Available The Oncology Gold Standard (OGS Expert Group on renal cell carcinoma (RCC developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

Treatment of advanced breast cancer. An experience

Energy Technology Data Exchange (ETDEWEB)

Magnoni, G; Corcione, S; Api, P

1984-01-01

The Authors report their experience about the efficacy of the association surgery-radiotherapy-polichemotherapy, in the treatment of advanced breast cancer, emphasizing the importance of this association in the survival rate.

Adopting an Advanced Community Pharmacy Practice Experiential Educational Model Across Colleges of Pharmacy

Directory of Open Access Journals (Sweden)

Jennifer L. Rodis

2011-01-01

Full Text Available Objective: To discuss the experience of sharing an experiential model of education and practice development between two colleges of pharmacy and to provide a framework to guide faculty in this type of collaboration. Case Study: The Ohio State University College of Pharmacy (OSU COP Partner for Promotion (PFP program was developed in response to the need for advancing practice in the community pharmacy setting. After successful implementation of this program, the PFP program design and materials were shared, adapted, and implemented at the University of Utah College of Pharmacy (Utah COP. Collaborating faculty developed a framework based on lessons learned through this experience which proposes key guiding strategies as considerations to address prior to embarking on sharing any aspect of an educational program or model between institutions. Each step of the framework is described and applied to the process followed by The OSU COP and Utah COP in sharing the PFP program. Additional considerations related to transfer of educational models are discussed. Results/Conclusion: Sharing the education model and materials associated with the PFP program between institutions has enhanced experiential opportunities for students and helped develop residency training sites in the community setting. In addition, the relationship between the two colleges has contributed to faculty development, as well as an increase in community pharmacy service development with community pharmacy partners at each institution. It is hoped this experience will help guide collaborations between other colleges of pharmacy to enhance education of future pharmacists while positively impacting pharmacy practice, teaching, and research by faculty.   Type: Case Study

Adopting an Advanced Community Pharmacy Practice Experiential Educational Model Across Colleges of Pharmacy

Directory of Open Access Journals (Sweden)

Jennifer L. Rodis, Pharm.D., BCPS

2011-01-01

Full Text Available Objective: To discuss the experience of sharing an experiential model of education and practice development between two colleges of pharmacy and to provide a framework to guide faculty in this type of collaboration.Case Study: The Ohio State University College of Pharmacy (OSU COP Partner for Promotion (PFP program was developed in response to the need for advancing practice in the community pharmacy setting. After successful implementation of this program, the PFP program design and materials were shared, adapted, and implemented at the University of Utah College of Pharmacy (Utah COP. Collaborating faculty developed a framework based on lessons learned through this experience which proposes key guiding strategies as considerations to address prior to embarking on sharing any aspect of an educational program or model between institutions. Each step of the framework is described and applied to the process followed by The OSU COP and Utah COP in sharing the PFP program. Additional considerations related to transfer of educational models are discussed.Results/Conclusion: Sharing the education model and materials associated with the PFP program between institutions has enhanced experiential opportunities for students and helped develop residency training sites in the community setting. In addition, the relationship between the two colleges has contributed to faculty development, as well as an increase in community pharmacy service development with community pharmacy partners at each institution. It is hoped this experience will help guide collaborations between other colleges of pharmacy to enhance education of future pharmacists while positively impacting pharmacy practice, teaching, and research by faculty.

Advanced I and C systems for nuclear power plants feedback of experience

International Nuclear Information System (INIS)

Prehler Heinz Josef

2001-01-01

Advanced I and C systems for nuclear power plants have to meet increasing demands for safety and availability. Additionally specific requirements arising from nuclear qualification have to be fulfilled. To meet both subjects adequately in the future, Siemens has developed advanced I and C technology consisting of the two complementary I and C systems TELEPERM XP and TELEPERM XS. TELEPERM XP is primarily oriented to automation of the non safety related part of the power plant process. Such applications involve extensive open and closed loop control systems and encompass all tasks required for process control via the man-machine interface. Therefore the TELEPERM XP system consists of the AS 620 automation system, the OM 690 process control and management system, the ES 680 engineering system, the DS 670 diagnostic system and the SIMATIC NET bus system. Three versions of automation systems are available: for standard automation, for fail safe automation of safety related tasks and for turbine automation. TELEPERM XS is designed to meet all the requirements on I and C important to safety in nuclear power plants. Typical applications include reactor protection (RPS) and Engineered Safety Features Actuation System functions (ESFAS). TELEPERM XS has been rapidly accepted by the market and has accumulated an extensive operational experience. The expected advantages, namely, reduced space requirements, consistent documentation, improved ergonomics, reduced testing effort, less repair have been confirmed by the operation. The new possibilities to apply intelligent diagnostic methods have been only applied in few cases. Very good service records from a broad field of safety application prove that it is right to use digital I and C systems for safety tasks. The expected advantages such as reduced space requirements, less repairs and less effort for periodic tests, have been confirmed by practical experience. For the future, use of digital I and C systems for safety

Constructing an Ethical Training for Advanced Nursing Practice: An Interactionist and Competency-Based Approach.

Science.gov (United States)

Pariseau-Legault, Pierre; Lallier, Melisa

2016-07-01

Advanced practice nurses are working in a highly interdisciplinary and political context. Such situations can influence the deliberative and ethical decision-making processes in which they are also involved. This can subsequently compromise their abilities to protect their moral integrity, to find innovative and nondualistic solutions to complex ethical problems, and to collaborate with other health professionals. The authors constructed a training program inspired by discourse and narrative ethics. The objective pursued was to develop advanced practice nurses' moral integrity, highlight the ethical component of their clinical judgement, and foster the development of their deliberative competencies. The pedagogical process proposed exposes how an ethical curriculum adapted to the context in which advanced practice nurses evolve can address power relationships inherent in ethical decision making. The authors suggest that this pedagogical approach has the potential to optimize the consolidation of ethical, reflective, and deliberative competencies among advanced practice nurses. [J Nurs Educ. 2016;55(7):399-402.]. Copyright 2016, SLACK Incorporated.

Drivers Advancing Oral Health in a Large Group Dental Practice Organization.

Science.gov (United States)

Simmons, Kristen; Gibson, Stephanie; White, Joel M

2016-06-01

Three change drivers are being implemented to high standards of patient centric and evidence-based oral health care within the context of a large multispecialty dental group practice organization based on the commitment of the dental hygienist chief operating officer and her team. A recent environmental scan elucidated 6 change drivers that can impact the provision of oral health care. Practitioners who can embrace and maximize aspects of these change drivers will move dentistry forward and create future opportunities. This article explains how 3 of these change drivers are being applied in a privately held, accountable risk-bearing entity that provides individualized treatment programs for more than 417,000 members. To facilitate integration of the conceptual changes related to the drivers, a multi-institutional, multidisciplinary, highly functioning collaborative work group was formed. The document Dental Hygiene at a Crossroads for Change(1) inspired the first author, a dental hygienist in a unique position as chief operating officer of a large group practice, to pursue evidence-based organizational change and to impact the quality of patient care. This was accomplished by implementing technological advances including dental diagnosis terminology in the electronic health record, clinical decision support, standardized treatment guidelines, quality metrics, and patient engagement to improve oral health outcomes at the patient and population levels. The systems and processes used to implement 3 change drivers into a large multi-practice dental setting is presented to inform and inspire others to implement change drivers with the potential for advancing oral health. Technology implementing best practices and improving patient engagement are excellent drivers to advance oral health and are an effective use of oral health care dollars. Improved oral health can be leveraged through technological advances to improve clinical practice. Copyright © 2016 Elsevier Inc

Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms.

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Parsons, Thomas D; McMahan, Timothy; Kane, Robert

2018-01-01

Clinical neuropsychologists have long underutilized computer technologies for neuropsychological assessment. Given the rapid advances in technology (e.g. virtual reality; tablets; iPhones) and the increased accessibility in the past decade, there is an on-going need to identify optimal specifications for advanced technologies while minimizing potential sources of error. Herein, we discuss concerns raised by a joint American Academy of Clinical Neuropsychology/National Academy of Neuropsychology position paper. Moreover, we proffer parameters for the development and use of advanced technologies in neuropsychological assessments. We aim to first describe software and hardware configurations that can impact a computerized neuropsychological assessment. This is followed by a description of best practices for developers and practicing neuropsychologists to minimize error in neuropsychological assessments using advanced technologies. We also discuss the relevance of weighing potential computer error in light of possible errors associated with traditional testing. Throughout there is an emphasis on the need for developers to provide bench test results for their software's performance on various devices and minimum specifications (documented in manuals) for the hardware (e.g. computer, monitor, input devices) in the neuropsychologist's practice. Advances in computerized assessment platforms offer both opportunities and challenges. The challenges can appear daunting but are a manageable and require informed consumers who can appreciate the issues and ask pertinent questions in evaluating their options.

Primary care providers' lived experiences of genetics in practice.

Science.gov (United States)

Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

2018-04-26

To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

A System Approach to Advanced Practice Clinician Standardization and High Reliability.

Science.gov (United States)

Okuno-Jones, Susan; Siehoff, Alice; Law, Jennifer; Juarez, Patricia

Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs.

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

Science.gov (United States)

O'Connor, Laserina; Casey, Mary; Smith, Rita; Fealy, Gerard M; Brien, Denise O'; O'Leary, Denise; Stokes, Diarmuid; McNamara, Martin S; Glasgow, Mary Ellen; Cashin, Andrew

2018-03-01

To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D." © 2017 John Wiley & Sons Ltd.

Preservice teachers’ objectives and their experience of practical work

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V. Nivalainen

2013-01-01

Full Text Available This study explores third-year preservice physics teachers’ (n=32 views concerning the objectives of practical work at school and university. Content analysis of their essays about practical work revealed not only the objectives of the practical work undertaken but also how they had experienced teaching as school and university students. The objectives most commonly referred to were related to the connections between theory and practice, motivation, understanding phenomena, learning how to observe, and learning how to report. In contrast, some objectives were recognized only rarely, which is an important issue for discussion as a future challenge. Preservice teachers’ positive experiences of practical work resulted from the successful implementation of practical work. According to our findings, practical work can in many cases be regarded as successful, especially when the participants understand the objectives of the teaching. In contrast, negative experiences reflected failures or difficulties in implementation. We conclude by suggesting that preservice teachers should be offered opportunities to reflect on their previous experiences and to see and experience in practice the advantages of practical work.

Kayenta advanced series compensation operational experience

Energy Technology Data Exchange (ETDEWEB)

1994-01-01

The world's first three-phase, thyristor-controlled series compensation scheme with continuously variable impedance has been introduced into a transmission system. Energized and dedicated in September 1992, the installation was placed into commercial operation in January 1993 and has provided over one year of operating experience. This paper describes the 230 kV, 330 MVAr (60 Hz) advanced series compensation (ASC) project, located in north-eastern Arizona at Kayenta Substation on the 320 km Glen Canyon-Shiprock transmission line. The paper describes operating experiences, coordination with phase shifting transformer, phase shifter failure, platform power, system disturbances, and future plans.

The Effect of Advanced Management Accounting Practices on the Competitive Strategies and Performance

OpenAIRE

Rahmi Yücel; Kayhan Ahmetoğulları

2015-01-01

This study is based on a sample of 300 managers from the production industry of West Marmara Region. The goal of this study is to examine the interaction among advanced management accounting practices, competitive strategies and company performance. As a result of study, it is found that advanced accounting management practices have a positive effect on the company performance and competitive strategies. In addition, competitive strategies have an effect on the company performance positively....

An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.

Science.gov (United States)

Williams, Angela; Taylor, Cathy

2008-11-01

Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research

Motivational interviewing: a valuable tool for the psychiatric advanced practice nurse.

Science.gov (United States)

Karzenowski, Abby; Puskar, Kathy

2011-01-01

Motivational Interviewing (MI) is well known and respected by many health care professionals. Developed by Miller and Rollnick (2002) , it is a way to promote behavior change from within and resolve ambivalence. MI is individualized and is most commonly used in the psychiatric setting; it is a valuable tool for the Psychiatric Advanced Nurse Practice Nurse. There are many resources that talk about what MI is and the principles used to apply it. However, there is little information about how to incorporate MI into a clinical case. This article provides a summary of articles related to MI and discusses two case studies using MI and why advanced practice nurses should use MI with their patients.

Experience about the treatment of advanced breast cancer

Energy Technology Data Exchange (ETDEWEB)

Api, P; Corcione, S; Magnoni, G

1985-01-01

The authors report their experience about the efficacy of the association surgery-radiotherapy-polichemotheraphy, in the treatment of advanced breast cancer, emphasizing the importance of this association in the survival rate.

Pharmacists' experience of conflict in community practice.

Science.gov (United States)

Austin, Zubin; Gregory, Paul A M; Martin, J Craig

2010-03-01

Interpersonal conflict may be characterized as intellectual disagreement with emotional entanglement. While interpersonal conflict has been studied and described in different health care settings, there is little research that focuses on community pharmacists and the ways in which they experience conflict in professional practice. To describe and characterize the experience of interpersonal conflict within community pharmacy practice. A self-reporting narrative log was developed in which actively recruited pharmacists reported and reflected upon their day-to-day experiences of interpersonal conflict in professional practice. Focus groups of pharmacists were convened following data analysis to provide context and confirmation of identified themes. Based on this analysis, an explanatory model for interpersonal conflict in community pharmacy practice was generated. Participants were actively recruited from community pharmacy settings in the Toronto (Canada) area. A total of 41 community pharmacists participated. Interpersonal conflict in pharmacy practice is ubiquitous and results from diverse triggers. A conflict stance model was developed, based on the worldview and the communication style of the individual pharmacist. Specific conflict stances identified were: imposing, thwarting, settling, and avoiding. Further testing and refinement of this model is required. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.

Advancing the practice of systems engineering at JPL

Science.gov (United States)

Jansma, Patti A.; Jones, Ross M.

2006-01-01

In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of

The Importance of Reflective Practice in Nursing

Directory of Open Access Journals (Sweden)

Lauren Caldwell

2013-01-01

Full Text Available Reflection is an essential attribute for the development of autonomous, critical, and advanced practitioners (Mantzoukas & Jasper, 2004. According to Chong (2009, “Reflective practice should be a continuous cycle in which experience and reflection on experiences are inter-related” (p. 112. Studies have shown that nurses who take the time to reflect on their daily experiences provide enhanced nursing care, have a better understanding of theiractions, which in return develops their professional skills (Hansebo & Kihlgren, 2001. Reflective practice is the ability to examine ones actions and experiences with the outcome of developing their practice and enhancing clinicalknowledge. Reflective practice affects all levels of nursing, from students, to advanced practice nursing students, aswell as practicing nurses. Reflective practice is an important component of the nursing curriculum. Research has shown the relationship between student nurses and their mentors is vital. In order for reflection to be effective open-mindedness, courage, and a willingness to accept, and act on, criticism must be present (Bulmam, Lathlean, & Gobbi, 2012. This paper will explore the current literature and implications related to reflective practice in nursing.

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.

Science.gov (United States)

Christiansen, Angela; Vernon, Veronica; Jinks, Annette

2013-04-01

The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work. Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses. The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study. Responses to two open questions posed in the questionnaire were the subject of a content analysis. A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong. Education of the public concerning the implementation of such roles is of crucial importance. Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong. © 2012 Blackwell Publishing Ltd.

Advanced practice nursing for enduring health needs management: a global perspective.

Science.gov (United States)

Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D; Richardson, Jim; Savage, Eileen; Schorn, Mavis

2012-07-01

Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Advanced psychiatric nurse practitioners' ideas and needs for supervision in private practice in South Africa.

Science.gov (United States)

Temane, Annie M; Poggenpoel, Marie; Myburgh, Chris P H

2014-04-07

Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field. The aim of this study was to explore and describe advanced psychiatric nursepractitioners' ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa. A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch's method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. The data analysis generated the following themes - that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

Integrating Social Neuroscience and Social Work: Innovations for Advancing Practice-Based Research

Science.gov (United States)

Matto, Holly C.; Strolin-Goltzman, Jessica

2010-01-01

Throughout the social work profession, there is ongoing interest in building a social science agenda that can address the complex practice-based questions faced by social work professionals today. Methodological innovations and unique funding opportunities have already significantly advanced research on social work practice. Still, there is…

Advanced Tools for Smartphone-Based Experiments: Phyphox

Science.gov (United States)

Staacks, S.; Hütz, S.; Stampfer, C.; Heinke, H.

2018-01-01

The sensors in modern smartphones are a promising and cost-effective tool for experimentation in physics education, but many experiments face practical problems. Often the phone is inaccessible during the experiment and the data usually needs to be analyzed subsequently on a computer. We address both problems by introducing a new app, called…

Management of advanced pancreatic cancer with gemcitabine plus erlotinib: efficacy and safety results in clinical practice.

Science.gov (United States)

Diaz Beveridge, Robert; Alcolea, Vicent; Aparicio, Jorge; Segura, Ángel; García, Jose; Corbellas, Miguel; Fonfría, María; Giménez, Alejandra; Montalar, Joaquin

2014-01-10

The combination of gemcitabine and erlotinib is a standard first-line treatment for unresectable, locally advanced or metastatic pancreatic cancer. We reviewed our single centre experience to assess its efficacy and toxicity in clinical practice. Clinical records of patients with unresectable, locally advanced or metastatic pancreatic cancer who were treated with the combination of gemcitabine and erlotinib were reviewed. Univariate survival analysis and multivariate analysis were carried out to indentify independent predictors factors of overall survival. Our series included 55 patients. Overall disease control rate was 47%: 5% of patients presented complete response, 20% partial response and 22% stable disease. Median overall survival was 8.3 months). Cox regression analysis indicated that performance status and locally advanced versus metastatic disease were independent factors of overall survival. Patients who developed acne-like rash toxicity, related to erlotinib administration, presented a higher survival than those patients who did not develop this toxicity. Gemcitabine plus erlotinib doublet is active in our series of patients with advanced pancreatic cancer. This study provides efficacy and safety results similar to those of the pivotal phase III clinical trial that tested the same combination.

Specific problems and practical experience of regulatory inspection during commissioning in the United Kingdom

International Nuclear Information System (INIS)

Lewis, G.

1977-01-01

The commissioning of nine Magnox and two Advanced Gas-cooled Reactor Nuclear Power Plants in the United Kingdom during the last sixteen years under the regulatory control of the Nuclear Installations Inspectorate of the Health and Safety Executive has been based on a Stage Approval Philosophy starting with proof-testing of the primary gas circuit and concluding with tests on the reactor at full power. The practical experience gained during this period has enabled the Nuclear Installations Inspectorate to rationalise the procedures and test requirements without comporomising safety standards. The Operating Rules and Maintenance Schedules are approved for commissioning and during this period are reviewed for their adequacy for future power operation of the plant. The organisation, documentation, test procedures and the commissioning programme used for the Advanced Gas-cooled Reactors are briefly explained. (author)

Building research capacity and productivity among advanced practice nurses: an evaluation of the Community of Practice model.

Science.gov (United States)

Gullick, Janice G; West, Sandra H

2016-03-01

The aim of this study was to evaluate Wenger's Community of Practice as a framework for building research capacity and productivity. While research productivity is an expected domain in influential models of advanced nursing practice, internationally it remains largely unmet. Establishment of nursing research capacity precedes productivity and consequently, there is a strong imperative to identify successful capacity-building models for nursing-focussed research in busy clinical environments. Prospective, longitudinal, qualitative descriptive design was used in this study. Bruyn's participant observation framed evaluation of a Community of Practice comprising 25 advanced practice nurses. Data from focus groups, education evaluations, blog/email transcripts and field observations, collected between 2007 and 2014, were analysed using a qualitative descriptive method. The Community of Practice model invited differing levels of participation, allowed for evolution of the research community and created a rhythm of research-related interactions and enduring research relationships. Participants described the value of research for their patients and families and the significance of the developing research culture in providing richness to their practice and visibility of their work to multidisciplinary colleagues. Extensive examples of research dissemination and enrolment in doctoral programmes further confirmed this value. A Community of Practice framework is a powerful model enabling research capacity and productivity evidenced by publication. In developing a solid foundation for a nursing research culture, it should be recognized that research skills, confidence and growth develop over an extended period of time and success depends on skilled coordination and leadership. © 2015 John Wiley & Sons Ltd.

Testing theory in practice: a simple experiment

NARCIS (Netherlands)

Terpstra, R.; Brezocnik, Z.; Kapus, T.; Ferreira Pires, Luis; Heerink, A.W.; Tretmans, G.J.

1996-01-01

In this paper we discuss the experiences gained in conducting a simple testing experiment. The goal of this experiment is to apply the abstract, formal testing framework [8] in a practical setting, and to indicate the critical aspects in its application to realistic testing situations. For that

Advanced tools for smartphone-based experiments: phyphox

OpenAIRE

Staacks, Sebastian; Hütz, Simon; Heinke, Heidrun; Stampfer, Christoph

2018-01-01

The sensors in modern smartphones are a promising and cost-effective tool for experimentation in physics education, but many experiments face practical problems. Often the phone is inaccessible during the experiment and the data usually needs to be analyzed subsequently on a computer. We address both problems by introducing a new app, called "phyphox", which is specifically designed for utilizing experiments in physics teaching. The app is free and designed to offer the same set of features o...

Educational Changes to Support Advanced Practice Nursing Education.

Science.gov (United States)

LeFlore, Judy L; Thomas, Patricia E

2016-01-01

Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system.

Developing an advanced practice nurse-led liver clinic.

Science.gov (United States)

McAfee, Jean L

2012-01-01

End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

Human Factors Engineering (HFE) insights for advanced reactors based upon operating experience

International Nuclear Information System (INIS)

Higgins, J.; Nasta, K.

1997-01-01

The NRC Human Factors Engineering Program Review Model (HFE PRM, NUREG-0711) was developed to support a design process review for advanced reactor design certification under 10CFR52. The HFE PRM defines ten fundamental elements of a human factors engineering program. An Operating Experience Review (OER) is one of these elements. The main purpose of an OER is to identify potential safety issues from operating plant experience and ensure that they are addressed in a new design. Broad-based experience reviews have typically been performed in the past by reactor designers. For the HFE PRM the intent is to have a more focussed OER that concentrates on HFE issues or experience that would be relevant to the human-system interface (HSI) design process for new advanced reactors. This document provides a detailed list of HFE-relevant operating experience pertinent to the HSI design process for advanced nuclear power plants. This document is intended to be used by NRC reviewers as part of the HFE PRM review process in determining the completeness of an OER performed by an applicant for advanced reactor design certification. 49 refs

Correlates of Teacher Practices Influencing Student Outcomes in Reading Instruction for Advanced Readers

Science.gov (United States)

Hunsaker, Scott L.; Nielsen, Aubree; Bartlett, Brianne

2010-01-01

In a professional development project, six teaching practices were posited as necessary for improving affective and cognitive outcomes for identified advanced readers. These practices were identification, organization for instruction, content, instructional strategies, continuous improvement assessment, and ambassadorship. Sixty-one teachers…

The role of advanced practice providers in pediatric otolaryngology academic practices.

Science.gov (United States)

Reilly, Brian K; Brandon, Gretchen; Shah, Rahul; Preciado, Diego; Zalzal, George

2013-01-01

The goal of this study was to examine the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) in pediatric academic otolaryngology programs to provide a better understanding of their scope of practice, levels of autonomy, clinical duties, teaching opportunities and research participation. An anonymous web-based electronic survey tool was sent to all pediatric otolaryngology fellowship program directors in the United States. Nurse Practitioners and Physician Assistants are utilized in approximately 3 out of every 4 pediatric otolaryngology practices. The top three job activities of both the PA and NP were: (1) seeing patients independently, (2) working alongside doctors in clinic, and (3) answering phone lines/parental calls. A higher percentage of PAs (83%), worked alongside doctors in clinic, as compared to NPs, where only 55% work alongside MDs. Over half of PAs round with the in-patient team and see consults as compared to just over one third of NPs who participate in such activities. Twenty-five percent of practices reported that PAs cover call and assist in the OR. Most PAs/NPs saw between 11 and 15 patients per clinic which provides a clear productivity advantage when looking to screen patients, provide medical care, generate surgical cases, and maximize billings. NPs and PAs have complimentary skill sets ideal for the pediatric otolaryngology workplace, although job activities and "best fit" are hospital and practice dependent. Our study suggests that the use of PAs and NPs will continue to grow to meet increased demand for services in the field of pediatric otolaryngology. Employing advanced practice providers enables academic centers to improve access, provide additional financial remuneration, reduce wait times for new patients, and allow attending physicians to meet increased practice demands. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient.

Science.gov (United States)

Hayden, Anna C; Pichert, James W; Fawcett, Jodi; Moore, Ilene N; Hickson, Gerald B

2010-07-01

Service recovery refers to an organizations entire process for facilitating resolution of dissatisfactions, whether or not visible to patients and families. Patients are an important resource for reporting miscommunications, provider inattention, rudeness, or delays, especially if they perceive a connection to misdiagnosis or failed treatment. Health systems that encourage patients to be "the eyes and ears" of individual and team performance capitalize on a rich source of data for quality improvement and risk prevention. Effective service recovery requires organizations (1) to learn about negative perceptions and experiences and (2) to create an infrastructure that supports staff's ability to respond. Service recovery requires the exercise of both basic and advanced skills. We term certain skills as advanced because of the significant variation in their use or endorsement among 30 health care organizations in the United States. On the basis of our work with the 30 organizations, a mnemonic, HEARD, incorporates best practices for basic service recovery processes: Hearing the person's concern; Empathizing with the person raising the issue; Acknowledging, expressing appreciation to the person for sharing, and Apologizing when warranted; Responding to the problem, setting time lines and expectations for follow-up; and Documenting or Delegating the documentation to the appropriate person. Impartiality, chain of command, setting boundaries, and Documentation represent four advanced service recovery skills critical for addressing challenging situations. Using best practices in service recovery enables the organization to do its best to make right what patients and family members experience as wrong.

Nursing Student Teachers' experiences during teaching practice:

African Journals Online (AJOL)

Mary

Teaching practice experiences of nursing student provide greater insight to develop effective classroom and clinical teaching ... expectations and benefits are significantly derived from teaching practice although contingent on the mode of entry into the ...... Participation in and Leadership of. Continual Improvement.

Nurse Leaders' Experiences of Implementing Career Advancement Programs for Nurses in Iran.

Science.gov (United States)

Sheikhi, Mohammad Reza; Fallahi Khoshknab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

2015-02-24

Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses' Career Advancement Pathway. The purpose of this study was to explore nurse leaders' experiences about implementing the Nurses' Career Advancement Pathway program in Iran. This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin, and Iran Universities of Medical Sciences in Iran. Participants were recruited using purposive sampling method. Study data were collected through in-depth semi-structured interviews. The conventional content analysis approach was used for data analysis. participants' experiences about implementing the Nurses' Career Advancement Pathway fell into three main categories including: a) the shortcomings of performance evaluation, b) greater emphasis on point accumulation, c) the advancement-latitude mismatch. The Nurses' Career Advancement pathway has several shortcomings regarding both its content and its implementation. Therefore, it is recommended to revise the program.

Nurse Leaders’ Experiences of Implementing Career Advancement Programs for Nurses in Iran

Science.gov (United States)

Sheikhi, Mohammad Reza; Khoshknab, Masoud Fallahi; Mohammadi, Farahnaz; Oskouie, Fatemeh

2015-01-01

Background and purpose: Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses’ Career Advancement Pathway. The purpose of this study was to explore nurse leaders’ experiences about implementing the Nurses’ Career Advancement Pathway program in Iran. Methods: This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin, and Iran Universities of Medical Sciences in Iran. Participants were recruited using purposive sampling method. Study data were collected through in-depth semi-structured interviews. The conventional content analysis approach was used for data analysis. Results: participants’ experiences about implementing the Nurses’ Career Advancement Pathway fell into three main categories including: a) the shortcomings of performance evaluation, b) greater emphasis on point accumulation, c) the advancement-latitude mismatch. Conclusion: The Nurses’ Career Advancement pathway has several shortcomings regarding both its content and its implementation. Therefore, it is recommended to revise the program. PMID:26156907

Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

Science.gov (United States)

Mboineki, Joanes Faustine; Zhang, Weihong

The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

Using advanced mobile devices in nursing practice--the views of nurses and nursing students.

Science.gov (United States)

Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla

2014-09-01

Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research. © The Author(s) 2013.

Neonatal resuscitation: advances in training and practice

Directory of Open Access Journals (Sweden)

Sawyer T

2016-12-01

Full Text Available Taylor Sawyer, Rachel A Umoren, Megan M Gray Department of Pediatrics, Division of Neonatology, Neonatal Education and Simulation-based Training (NEST Program, University of Washington School of Medicine, Seattle, WA, USA Abstract: Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

Progress towards advanced practice roles in Australia, New Zealand and the Western Pacific

International Nuclear Information System (INIS)

Smith, Tony; Yielder, Jill; Ajibulu, Olusegun; Caruana, Edward

2008-01-01

This paper describes the evolution and current status of advanced practice in medical imaging and radiation therapy in the Oceania region. To date development has been slow, largely ad hoc and based on local needs. Most advanced practice is informal or is regarded as part of the core skills of some individual practitioners. However, recently, there have been signs of change taking place, with a more coordinated and collaborative approach to role development becoming evident. In Australia, although a number of reports and papers have discussed extended clinical roles, especially for diagnostic Radiographers, no concrete action has yet taken place in either discipline. Stakeholders apparently agree that existing extended roles should be formalised, however, and that continuing education must underpin future role extension initiatives. A three-level professional structure, including an advanced practitioner level, has been accepted by the New Zealand Institute of Medical Radiation Technology (NZIMRT), with the support of the District Health Boards of New Zealand (DHBNZ). Implementation is expected to begin before the end of 2008. Meanwhile, recognition of the serious lack of Radiologists in Western Pacific Island Nations led to the training of some Radiographers in radiological interpretation of images between 2004 and 2006. The aim was to up-skill the Radiographers so that they could more reliably flag abnormalities to doctors, a model that may be applicable elsewhere. It is argued that future practice models must include advanced practice roles in order to safely meet the growing demand for medical radiation services. Local factors, such as the structure of the health care system and the depth of engagement of the key stakeholders in planning and implementation, however, are expected to influence the evolution of new clinical practice models in the region

Does advanced practice in radiography benefit the healthcare system? A literature review.

Science.gov (United States)

Thom, S E

2018-02-01

With ever-increasing demands on the National Health Service (NHS), members of staff are blurring their professional boundaries in the attempt to benefit the healthcare system. This review aims to establish whether advancing practice within radiography does benefit the healthcare system by examining published literature. Key words were input into databases such as: CINAHL, Science Direct and PubMed. Various filters were applied to narrow down the articles. Key themes were identified within the literature: cost, job satisfaction, patient benefits, restrictions and workload. Having advanced practitioners undertake some of the radiologists' workload was potentially cost effective whilst continuing/increasing the standard of quality. Patients benefitted from the quality of their examinations, the high accuracy of their reports and the speed those reports were attained. Evidence within the literature emphasises that advanced practice does benefit the healthcare system by means of: cost reduction, job satisfaction, patient benefits and workload. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Advancing Evaluation Theory and Practice in South Asia : Building a ...

International Development Research Centre (IDRC) Digital Library (Canada)

Advancing Evaluation Theory and Practice in South Asia : Building a Community of Experts. This grant will allow the Association for ... to other evaluation practitioners in the region. It is expected that the project will help strengthen evaluation in South Asia, leading to more effective and efficient development interventions.

Advancing Empirical Scholarship to Further Develop Evaluation Theory and Practice

Science.gov (United States)

Christie, Christina A.

2011-01-01

Good theory development is grounded in empirical inquiry. In the context of educational evaluation, the development of empirically grounded theory has important benefits for the field and the practitioner. In particular, a shift to empirically derived theory will assist in advancing more systematic and contextually relevant evaluation practice, as…

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar.

Science.gov (United States)

Scott-Jones, Joseph; Lucas, Sarah

2013-09-01

Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

Science.gov (United States)

Dreher, Melanie C; Clinton, Patricia; Sperhac, Arlene

2014-01-01

The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate. © 2014.

Master’s programs in advanced nursing practice: new strategies to enhance course design for subspecialty training in neonatology and pediatrics

Directory of Open Access Journals (Sweden)

Morgan C

2012-12-01

Full Text Available Colin Morgan,1,2 Catherine Barry,1,2 Katie Barnes2,31Liverpool Women’s Hospital, Crown Street, Liverpool, UK; 2Liverpool John Moores University, Liverpool, UK; 3Liverpool Community Health, Liverpool, UKAbstract: The advanced nurse practitioner (ANP role first developed in the USA in the 1960s in primary care. Since then, it has evolved in many different countries and subspecialties, creating a variety of challenges for those designing and implementing master’s programs for this valuable professional group. We focus on ANPs in the neonatal and pediatric intensive care setting to illustrate the complexity of issues faced by both faculty and students in such a program. We review the impact of limited resources, faculty recruitment/accreditation, and the relationship with the medical profession in establishing a curriculum. We explore the evidence for the importance of ANP role definition, supervision, and identity among other health professionals to secure a successful role transition. We describe how recent advances in technology can be used to innovate with new styles of teaching and learning to overcome some of the difficulties in running master’s programs for small subspecialties. We illustrate, through our own experience, how a thorough assessment of the available literature can be used to innovate and develop strategies to create an individual MSc programs that are designed to meet the needs of highly specialized advanced neonatal and pediatric nursing practice.Keywords: master’s program, advanced nurse practitioner, advanced practice, neonatal, pediatric, intensive care

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

Science.gov (United States)

Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

2017-05-01

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar

Directory of Open Access Journals (Sweden)

Scott-Jones J

2013-09-01

Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

International practice experiences in pharmacy education.

Science.gov (United States)

Cisneros, Robert M; Jawaid, Sarah Parnapy; Kendall, Debra A; McPherson, Charles E; Mu, Keli; Weston, Grady Scott; Roberts, Kenneth B

2013-11-12

To identify reasons for inclusion of international practice experiences in pharmacy curricula and to understand the related structure, benefits, and challenges related to the programs. A convenience sample of 20 colleges and schools of pharmacy in the United States with international pharmacy education programs was used. Telephone interviews were conducted by 2 study investigators. University values and strategic planning were among key driving forces in the development of programs. Global awareness and cultural competency requirements added impetus to program development. Participants' advice for creating an international practice experience program included an emphasis on the value of working with university health professions programs and established travel programs. Despite challenges, colleges and schools of pharmacy value the importance of international pharmacy education for pharmacy students as it increases global awareness of health needs and cultural competencies.

Advanced Smart Structures Flight Experiments for Precision Spacecraft

Science.gov (United States)

Denoyer, Keith K.; Erwin, R. Scott; Ninneman, R. Rory

2000-07-01

This paper presents an overview as well as data from four smart structures flight experiments directed by the U.S. Air Force Research Laboratory's Space Vehicles Directorate in Albuquerque, New Mexico. The Middeck Active Control Experiment $¯Flight II (MACE II) is a space shuttle flight experiment designed to investigate modeling and control issues for achieving high precision pointing and vibration control of future spacecraft. The Advanced Controls Technology Experiment (ACTEX-I) is an experiment that has demonstrated active vibration suppression using smart composite structures with embedded piezoelectric sensors and actuators. The Satellite Ultraquiet Isolation Technology Experiment (SUITE) is an isolation platform that uses active piezoelectric actuators as well as damped mechanical flexures to achieve hybrid passive/active isolation. The Vibration Isolation, Suppression, and Steering Experiment (VISS) is another isolation platform that uses viscous dampers in conjunction with electromagnetic voice coil actuators to achieve isolation as well as a steering capability for an infra-red telescope.

Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

Science.gov (United States)

Chang, Angela T; Gavaghan, Belinda; O'Leary, Shaun; McBride, Liza-Jane; Raymer, Maree

2017-05-15

Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re

The emergence of forensic nursing and advanced nursing practice in Switzerland: an innovative case study consultation.

Science.gov (United States)

Romain-Glassey, Nathalie; Ninane, Françoise; de Puy, Jacqueline; Abt, Maryline; Mangin, Patrice; Morin, Diane

2014-01-01

The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

Nurse Leaders? Experiences of Implementing Career Advancement Programs for Nurses in Iran

OpenAIRE

Sheikhi, Mohammad Reza; Khoshknab, Masoud Fallahi; Mohammadi, Farahnaz; Oskouie, Fatemeh

2015-01-01

Background and purpose: Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses? Career Advancement Pathway. The purpose of this study was to explore nurse leaders? experiences about implementing the Nurses? Career Advancement Pathway program in Iran. Methods: This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin,...

Nursing care dependence in the experiences of advanced cancer inpatients.

Science.gov (United States)

Piredda, Michela; Bartiromo, Chiara; Capuzzo, Maria Teresa; Matarese, Maria; De Marinis, Maria Grazia

2016-02-01

Increasing burden of cancer in Europe and socio-demographic trends imply that more cancer patients will face high levels of dependency. Care dependency is often perceived as a distressing experience by cancer patients who are concerned about becoming a burden to others. The experience of care dependence has been scarcely investigated in advanced cancer patients, especially in the hospital setting. This study aimed at describing advanced cancer patients' experiences of care dependence in hospital and of the factors perceived by them as contributing to decrease or increase this dependence. The study used a descriptive phenomenological approach based on Husserl's (1913) life world perspective. Data collection and analysis followed Giorgi's (1997) five basic methodological steps. Data were gathered by semi-structured interviews with thirteen advanced cancer adult inpatients of a teaching hospital. The interviews were audio-recorded and the recordings transcribed word for word. Three themes emerged: 'dependency discovers new meanings of life', 'active coping with dependency' and 'the care cures the dependent person'. The essential meaning of care dependency was the possibility to become aware of being a person as both an object and subject of care. Dependence appears as an experience with strong relational connotations, which enable patients to see differently their life, themselves, the world and others. Dependency is revealed as a natural experience, only partly in accordance with previous studies. Deeper insight into the meaning patients attach to care dependency can enable nurses to better meet the patient's needs, e.g. by improving caring relationships with patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Gender Creative or Transgender Youth and Advanced Nursing Practice.

Science.gov (United States)

Kirouac, Nicole; Tan, Mabel

2017-06-01

The World Professional Association for Transgender Health (WPATH) defines gender dysphoria as "Discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)" (WPATH, 2016). Gender creative (GC) and transgender (TG) youth are at high risk for severe mental health disparities if they don't receive competent and timely gender transitioning care. Although awareness and early care of TG youth in specialty clinics is improving and increasing, there is still much effort that is required to eliminate barriers to care at many levels and thus improve outcomes. Nurses, particularly advanced practice nurses, are poised to lead the way in creating safe, inclusive, family centered spaces for TG and GC children, youth and their families as well as acting as vital mentors for other nurses. The purpose of this paper is to discuss the increasing prevalence of GC and TG youth, the significance of inclusive care for GC and TG youth, treatment guidelines, and the impact parents and advanced practice nurses can have on the journey of these youth as they explore and find their place on the gender spectrum. Copyright© of YS Medical Media ltd.

Advancing the practice of health impact assessment in Canada: Obstacles and opportunities

Energy Technology Data Exchange (ETDEWEB)

McCallum, Lindsay C., E-mail: lindsay.mccallum@mail.utoronto.ca [University of Toronto, Department of Physical and Environmental Sciences, 1265 Military Trail, Toronto, Ontario M1C 1A4 (Canada); Intrinsik Environmental Sciences Inc., 6605 Hurontario Street, Mississauga, Ontario L5T0A3 (Canada); Ollson, Christopher A., E-mail: collson@intrinsik.com [Intrinsik Environmental Sciences Inc., 6605 Hurontario Street, Mississauga, Ontario L5T0A3 (Canada); Stefanovic, Ingrid L., E-mail: fenvdean@sfu.ca [Simon Fraser University, Faculty of Environment, 8888 University Drive, Burnaby, British Columbia V5A 1S6 (Canada)

2015-11-15

Health Impact Assessment (HIA) is recognized as a useful tool that can identify potential health impacts resulting from projects or policy initiatives. Although HIA has become an established practice in some countries, it is not yet an established practice in Canada. In order to enable broader support for HIA, this study provides a comprehensive review and analysis of the peer-reviewed and gray literature on the state of HIA practice. The results of this review revealed that, although there is an abundance of publications relating to HIA, there remains a lack of transparent, consistent and reproducible approaches and methods throughout the process. Findings indicate a need for further research and development on a number of fronts, including: 1) the nature of HIA triggers; 2) consistent scoping and stakeholder engagement approaches; 3) use of evidence and transparency of decision-making; 4) reproducibility of assessment methods; 5) monitoring and evaluation protocols; and, 6) integration within existing regulatory frameworks. Addressing these issues will aid in advancing the more widespread use of HIA in Canada. - Highlights: • Reviewed current state of practice in the field of HIA • Identified key obstacles and opportunities for HIA advancement • Major issues include lack of consistent approach and methodology. • No national regulatory driver hinders opportunity for widespread use of HIA. • Identified research opportunities vital to developing HIA practice in Canada.

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

Science.gov (United States)

Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

2015-12-01

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may

Research for Foreign Advanced Ports for Protection and Development Experience

Science.gov (United States)

Zhang, Lu; Tian, Mingjing; Zhao, Junjie; Shou, Youping; Wang, Ning; Qiao, Jianzhe; Li, Guanglou

2018-04-01

Into the twenty-first century, the process globalization of economic and trade is getting faster and faster, As of 2014, China's annual port trading amount topped the world, But in the port of environmental protection sustainable development approach with foreign advanced port environmental management concept has a big gap. Combined with the present situation of modern ports in China. Drawing lessons from foreign advanced environmental protection idea of port, in order to promote the protection of port environment in our country. The experience of protection and development of foreign advanced port environment will be discussed and discussed.

User Experience in Mobile Augmented Reality: Emotions, Challenges, Opportunities and Best Practices

Directory of Open Access Journals (Sweden)

Amir Dirin

2018-05-01

Full Text Available Mobile Augmented Reality (MAR is gaining a strong momentum to become a major interactive technology that can be applied across domains and purposes. The rapid proliferation of MAR applications in global mobile application markets has been fueled by a range of freely-available MAR software development kits and content development tools, some of which enable the creation of MAR applications even without programming skills. Despite the recent advances of MAR technology and tools, there are still many challenges associated with MAR from the User Experience (UX design perspective. In this study, we first define UX as the emotions that the user encounters while using a service, a product or an application and then explore the recent research on the topic. We present two case studies, a commercial MAR experience and our own Virtual Campus Tour MAR application, and evaluate them from the UX perspective, with a focus on emotions. Next, we synthesize the findings from previous research and the results of the case study evaluations to form sets of challenges, opportunities and best practices related to UX design of MAR applications. Based on the identified best practices, we finally present an updated version of the Virtual Campus Tour. The results can be used for improving UX design of future MAR applications, thus making them emotionally engaging.

Pain experiences of patients with advanced cancer: A qualitative descriptive study.

Science.gov (United States)

Erol, Ozgul; Unsar, Serap; Yacan, Lale; Pelin, Meryem; Kurt, Seda; Erdogan, Bülent

2018-04-01

Uncontrolled pain, especially in patients with advanced cancer, affects quality of life negatively and causes negative physical and psychological conditions. The aim of this study was to explore the pain experiences of patients with advanced cancer and how they manage with pain, and to present a view of pain management approaches of nurses from the perspectives of the patients. This was a qualitative descriptive study of sixteen hospitalized patients with advanced cancer. Data were collected using semi-structured interviews with patients. Data were analysed by Colaizzi's phenomenological method. This study found that patients with advanced cancer who had pain experienced anxiety, helplessness, hopelessness and many restrictions in daily life as well as inability to manage with pain. Most of the patients with advanced cancer were not satisfied with their nursing care with regard to pain management. The themes that emerged were pain perception and experiences, effects of pain on daily life, pain management and management strategies and the patients' perspectives about nursing approaches to pain. This study demonstrated the difficulties of patients with advanced cancer who experienced pain in their daily lives, yet lack pain management strategies. Furthermore, nurses' caring approaches to patients with advanced cancer who experienced pain was found inadequate. Oncology nurses should provide educational interventions in order to enhance knowledge and skills about pain assessment and non-pharmacologic and pharmacologic strategies used in pain management. Copyright © 2018 Elsevier Ltd. All rights reserved.

Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

Science.gov (United States)

Leggat, Sandra G; Balding, Cathy; Schiftan, Dan

2015-06-01

To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. A pre-postlongitudinal intervention study. Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in

Embodied Experience in Educational Practice and Research

Science.gov (United States)

Bengtsson, Jan

2013-01-01

The intention of this article is to make an educational analysis of Merleau-Ponty's theory of experience in order to see what it implicates for educational practice as well as educational research. In this way, we can attain an understanding what embodied experience might mean both in schools and other educational settings and in researching…

Workplace culture and the practice experience of midwifery students: A meta-synthesis.

Science.gov (United States)

Arundell, Fiona; Mannix, Judy; Sheehan, Athena; Peters, Kath

2018-04-01

To describe midwifery students' practice experience and to explore facilitators and barriers to positive clinical learning experiences. Practice experience is a vital component of every midwifery course. Course dissatisfaction and attrition of midwifery students has been attributed to sub-optimal practice experiences. Events or actions experienced by midwifery students that trigger dissatisfaction and attrition need to be identified. A meta-synthesis was based on that developed by Noblit and Hare. Students perceive workplaces as poorly prepared for their arrival and subsequent support. Students' experience in the practice setting is influenced by the existing workplace culture. Workplace culture influences institutional functioning and individuals within the culture. Enculturation of students into the midwifery culture and subsequent learning is affected by the support received. The practice experience of midwifery students was profoundly influenced by workplace culture. Students tended to have polarized accounts of their experience that were predominantly negative. To provide an optimal environment for midwifery students; midwifery managers and individual midwives need to be aware of the facilitators and barriers to midwifery student development in the practice setting. © 2017 John Wiley & Sons Ltd.

Experiences of Practice-Based Learning in Phenomenographic Perspective

Science.gov (United States)

Rovio-Johansson, Airi

2018-01-01

Purpose: The paper aims to examine, within the context of professional practice and learning, how designers collaboratively working in international teams experience practice-based learning and how such occasions contribute to professional development. Design/methodology/approach: The paper introduces the cooperation project between Tibro Training…

Developing a professional poster: four "ps" for advanced practice nurses to consider.

Science.gov (United States)

Bindon, Susan L; Davenport, Joan M

2013-01-01

Professional posters play an important role in the dissemination of knowledge and the professional development of advanced practice nurses, graduate students, and clinical faculty. Posters should be considered an integral component in communication of professional work in practice, research, and education. The invitation to submit a poster abstract is an important opportunity for clinicians and faculty alike to consider. Though sometimes misperceived as less prestigious than a podium presentation, posters add a unique element to professional and academic events. The argument is made for posters as an equal among scholarly presentation formats. The poster serves as a tremendous opportunity for collaboration between partners and a way to communicate important findings and advertise the presenters' work. For the advanced practice nurse who is a novice in presenting best practice or evidence from research trials, the poster format may be less intimidating while allowing the invaluable sharing of results. Four critical elements of professional poster development are deciding on a clear Purpose, targeting the right People, outlining key steps in the Process, and delivering a memorable Presentation. Using the "4 Ps" as cornerstones for the work of developing, preparing, and delivering the poster to an audience, the authors aim to help organize the entire process into these essential considerations. The poster, as a means of scholarly work, is a viable and essential activity, as interdisciplinary collaboration and sharing of best practice becomes the expectation for all professional development.

Update on Common-Cause Failure Experience and Mitigation Practices

Energy Technology Data Exchange (ETDEWEB)

Wood, Richard Thomas [ORNL; Muhlheim, Michael David [ORNL; Pullum, Laura L [ORNL; Smith, Cyrus M [ORNL; Holcomb, David Eugene [ORNL; Korsah, Kofi [ORNL

2014-04-01

Experience in other industries has shown that digital technology can provide substantial benefits in terms of performance and reliability. However, the U.S. nuclear power industry has been slow to adopt the technology extensively in its instrumentation and control (I&C) applications because of inhibiting factors such as regulatory uncertainty, insufficient technological experience base, implementation complexity, limited availability of nuclear-qualified products and vendors, and inadequate definition of modernization cost recapture. Although there have been examples of digital technology usage in the nuclear power industry, challenges to the qualification of digital technology for high-integrity nuclear power plant (NPP) applications have severely constrained more widespread progress in achieving the benefits that are possible through the transition to digital. The U.S. Department of Energy (DOE) Office of Nuclear Energy (NE) established the Advanced Sensors and Instrumentation (ASI) technology area under the Nuclear Energy Enabling Technologies (NEET) Program to coordinate the instrumentation and controls (I&C) research across DOE NE and to identify and lead efforts to address common needs. As part of the NEET ASI research program, the Digital Technology Qualification project was established. Under this project, the Oak Ridge National Laboratory (ORNL) is leading the investigation into mitigation of digital common-cause failure (CCF) vulnerabilities for nuclear-qualified applications. This technical report documents updated and expanded findings from research activities by ORNL. Specifically, the report describes CCF experience in the nuclear and nonnuclear industries, identifies the state of the practice for CCF mitigation through key examples, and presents conclusions from the determination of knowledge gaps.

A healthful experience? A patient practice development journey

Directory of Open Access Journals (Sweden)

Erna Snelgrove Clarke

2016-05-01

Full Text Available While facilitating the first practice development school for our local healthcare authorities in Nova Scotia, Canada, recently, I was simultaneously preparing for my second hip replacement. Focusing workshop participants on the principles of practice development, collaboration, inclusion and participation, I wondered if, in my upcoming journey through the healthcare system, I would experience the processes and outcomes we were promoting in the school. I would like to share this commentary as a reflection of my practice development experience as a patient. Overall, I received care that was inclusive and collaborative – as well as care that was provider focused and system driven. It goes without saying that as a patient, I felt valued when I was included and felt part of the team when my wishes and expectations were taken into consideration. For me, inclusion in care correlates with valuing that patient as a participant in their care journey, as set out by practice development principle 6 (Manley, McCormack and Wilson, 2008 (Table 1. My recent healthcare experience has led me to reflect further on the principles of practice development and its implications and challenges for local healthcare authorities. For example, my anaesthetist comes to mind as embodying practice development principles 2, 4, 6 and 8. The anaesthetist supported my wishes surrounding narcotics, and provided research- and practice-based evidence for each of his actions. Although the offering of additional narcotics is routine practice in hip surgery, I did not want this, so we discussed my expectations and developed a plan together that reflected my wishes. He actually chatted throughout the entire two-hour procedure. I was pleasantly surprised when he told me he provides care that focuses on the patient (practice development principle 1. Nevertheless, inconsistencies in the attention to person-centred practices across the microsystem reminded me that the system is not yet set

Experiences from introduction of peer-to-peer teaching methods in Advanced Biochemistry E2010

DEFF Research Database (Denmark)

Brodersen, Ditlev; Etzerodt, Michael; Rasmussen, Jan Trige

2012-01-01

During the autumn semester 2010, we experimented with a range of active teaching methods on the course, Advanced Biochemistry, at the Department of Molecular Biology and Genetics.......During the autumn semester 2010, we experimented with a range of active teaching methods on the course, Advanced Biochemistry, at the Department of Molecular Biology and Genetics....

Advanced practice nurses: starting an independent practice.

Science.gov (United States)

Lambert, V A; Lambert, C E

1996-01-01

Independent or private practice is the delivery of nursing services provided by nurses over which nurses have full control. With a changing healthcare system, nurses are in a prime position to negotiate the delivery of appropriate, acceptable, and cost-effective health care as independent practitioners. This article addresses the mission and goals of independent practice, community need, business structure of the practice, housing the practice, legal considerations, financing the practice, marketing issues, clientele, record keeping, and reimbursement.

Advanced detection techniques for educational experiments in cosmic ray physics

International Nuclear Information System (INIS)

Aiola, Salvatore; La-Rocca, Paola; Riggi, Francesco; Riggi, Simone

2013-06-01

In this paper we describe several detection techniques that can be employed to study cosmic ray properties and carry out training activities at high school and undergraduate level. Some of the proposed devices and instrumentation are inherited from professional research experiments, while others were especially developed and marketed for educational cosmic ray experiments. The educational impact of experiments in cosmic ray physics in high-school or undergraduate curricula will be exploited through various examples, going from simple experiments carried out with small Geiger counters or scintillation devices to more advanced detection instrumentation which can offer starting points for not trivial research work. (authors)

Advanced Communication Technology Satellite (ACTS) multibeam antenna technology verification experiments

Science.gov (United States)

Acosta, Roberto J.; Larko, Jeffrey M.; Lagin, Alan R.

1992-01-01

The Advanced Communication Technology Satellite (ACTS) is a key to reaching NASA's goal of developing high-risk, advanced communications technology using multiple frequency bands to support the nation's future communication needs. Using the multiple, dynamic hopping spot beams, and advanced on board switching and processing systems, ACTS will open a new era in communications satellite technology. One of the key technologies to be validated as part of the ACTS program is the multibeam antenna with rapidly reconfigurable hopping and fixed spot beam to serve users equipped with small-aperature terminals within the coverage areas. The proposed antenna technology experiments are designed to evaluate in-orbit ACTS multibeam antenna performance (radiation pattern, gain, cross pol levels, etc.).

Incorporating full-scale experience into advanced limestone wet FGD designs

International Nuclear Information System (INIS)

Rader, P.C.; Bakke, E.

1992-01-01

Utilities choosing flue gas desulfurization as a strategy for compliance with Phase I of the 1990 Clean Air Act Amendments will largely turn to limestone wet scrubbing as the most cost-effective, least-risk option. State-of-the-art single absorber wet scrubbing systems can be designed to achieve: SO 2 removal efficiencies in excess of 95 %, system availabilities in excess of 98%, and byproducts which can be marketed or land filled. As a result of varying fuel characteristics, site considerations, and owner preferences, FGD plants for large central power stations are typically custom-designed. To avoid the risks associated with new, first-of-a-kind technologies, utilities have preferred to purchase FGD systems from suppliers with proven utility experience and reference plants as close as possible to the design envisioned. As the market for FGD systems is regulatory driven, the demand has shifted geographically in response to national environmental policies. Although limestone wet scrubbing has emerged as the overwhelming choice for SO 2 emission control in coal-fired power stations, the technology has evolved and been adapted to suit local and regional technical and economic situations. Global suppliers are able to benefit from experience and technological advances in the world market. With market units in the U.S., Denmark, Italy, Sweden, and Germany active in the design and supply of wet FGD plants, ABB has a unique ability to incorporate knowledge and experience gained throughout the industrialized world to acid rain retrofit projects in the U.S. This paper describes the design of advanced limestone wet scrubbing systems for application to acid rain retrofits. Specifically, the evolution of advanced design concepts from a global experience base is discussed

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

Energy Technology Data Exchange (ETDEWEB)

Smith, Tony [University of Newcastle Department of Rural Health, Taree, New South Wales (Australia); Harris, Jillian [Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales (Australia); Woznitza, Nick [Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University, Canterbury (Australia); Maresse, Sharon [Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia (Australia); Sale, Charlotte [School of Medical Science, RMIT University, Melbourne, Victoria (Australia); University of Newcastle Department of Rural Health, Taree, New South Wales (Australia)

2015-09-15

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

International Nuclear Information System (INIS)

Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte

2015-01-01

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities

Power and promise of narrative for advancing physical therapist education and practice.

Science.gov (United States)

Greenfield, Bruce H; Jensen, Gail M; Delany, Clare M; Mostrom, Elizabeth; Knab, Mary; Jampel, Ann

2015-06-01

This perspective article provides a justification for and an overview of the use of narrative as a pedagogical tool for educators to help physical therapist students, residents, and clinicians develop skills of reflection and reflexivity in clinical practice. The use of narratives is a pedagogical approach that provides a reflective and interpretive framework for analyzing and making sense of texts, stories, and other experiences within learning environments. This article describes reflection as a well-established method to support critical analysis of clinical experiences; to assist in uncovering different perspectives of patients, families, and health care professionals involved in patient care; and to broaden the epistemological basis (ie, sources of knowledge) for clinical practice. The article begins by examining how phronetic (ie, practical and contextual) knowledge and ethical knowledge are used in physical therapy to contribute to evidence-based practice. Narrative is explored as a source of phronetic and ethical knowledge that is complementary but irreducible to traditional objective and empirical knowledge-the type of clinical knowledge that forms the basis of scientific training. The central premise is that writing narratives is a cognitive skill that should be learned and practiced to develop critical reflection for expert practice. The article weaves theory with practical application and strategies to foster narrative in education and practice. The final section of the article describes the authors' experiences with examples of integrating the tools of narrative into an educational program, into physical therapist residency programs, and into a clinical practice. © 2015 American Physical Therapy Association.

Advanced Reactor Licensing: Experience with Digital I&C Technology in Evolutionary Plants

Energy Technology Data Exchange (ETDEWEB)

Wood, RT

2004-09-27

This report presents the findings from a study of experience with digital instrumentation and controls (I&C) technology in evolutionary nuclear power plants. In particular, this study evaluated regulatory approaches employed by the international nuclear power community for licensing advanced l&C systems and identified lessons learned. The report (1) gives an overview of the modern l&C technologies employed at numerous evolutionary nuclear power plants, (2) identifies performance experience derived from those applications, (3) discusses regulatory processes employed and issues that have arisen, (4) captures lessons learned from performance and regulatory experience, (5) suggests anticipated issues that may arise from international near-term deployment of reactor concepts, and (6) offers conclusions and recommendations for potential activities to support advanced reactor licensing in the United States.

AdvancED Flex 4

CERN Document Server

Tiwari, Shashank; Schulze, Charlie

2010-01-01

AdvancED Flex 4 makes advanced Flex 4 concepts and techniques easy. Ajax, RIA, Web 2.0, mashups, mobile applications, the most sophisticated web tools, and the coolest interactive web applications are all covered with practical, visually oriented recipes. * Completely updated for the new tools in Flex 4* Demonstrates how to use Flex 4 to create robust and scalable enterprise-grade Rich Internet Applications.* Teaches you to build high-performance web applications with interactivity that really engages your users.* What you'll learn Practiced beginners and intermediate users of Flex, especially

Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance.

Science.gov (United States)

Louridas, M; Bonrath, E M; Sinclair, D A; Dedy, N J; Grantcharov, T P

2015-01-01

Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario. Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool. An improvement in OSATS (P = 0.003) and BOSATS (P = 0.003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0.011), but not in the conventional group (P = 0.083). No differences in objective or subjective stress levels or non-technical skills were evident. Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Practical analog electronics for technicians

CERN Document Server

Kimber, W A

2013-01-01

'Practical Analog Electronics for Technicians' not only provides an accessible introduction to electronics, but also supplies all the problems and practical activities needed to gain hands-on knowledge and experience. This emphasis on practice is surprisingly unusual in electronics texts, and has already gained Will Kimber popularity through the companion volume, 'Practical Digital Electronics for Technicians'. Written to cover the Advanced GNVQ optional unit in electronics, this book is also ideal for BTEC National, A-level electronics and City & Guilds courses. Together with 'Practical Digit

Advanced gamma ray balloon experiment ground checkout and data analysis

Science.gov (United States)

Blackstone, M.

1976-01-01

A software programming package to be used in the ground checkout and handling of data from the advanced gamma ray balloon experiment is described. The Operator's Manual permits someone unfamiliar with the inner workings of the software system (called LEO) to operate on the experimental data as it comes from the Pulse Code Modulation interface, converting it to a form for later analysis, and monitoring the program of an experiment. A Programmer's Manual is included.

Safety Assurance for Irradiating Experiments in the Advanced Test Reactor

Energy Technology Data Exchange (ETDEWEB)

T. A. Tomberlin; S. B. Grover

2004-11-01

The Advanced Test Reactor (ATR), located at the Idaho National Engineering and Environmental Laboratory (INEEL), was specifically designed to provide a high neutron flux test environment for conducting a variety of experiments. This paper addresses the safety assurance process for two general types of experiments conducted in the ATR facility and how the safety analyses for experiments are related to the ATR safety basis. One type of experiment is more routine and generally represents greater risks; therefore, this type of experiment is addressed in more detail in the ATR safety basis. This allows the individual safety analysis for this type of experiment to be more standardized. The second type of experiment is defined in more general terms in the ATR safety basis and is permitted under more general controls. Therefore, the individual safety analysis for the second type of experiment tends to be more unique and is tailored to each experiment.

Safety Assurance for Irradiating Experiments in the Advanced Test Reactor

International Nuclear Information System (INIS)

T. A. Tomberlin; S. B. Grover

2004-01-01

The Advanced Test Reactor (ATR), located at the Idaho National Engineering and Environmental Laboratory (INEEL), was specifically designed to provide a high neutron flux test environment for conducting a variety of experiments. This paper addresses the safety assurance process for two general types of experiments conducted in the ATR facility and how the safety analyses for experiments are related to the ATR safety basis. One type of experiment is more routine and generally represents greater risks; therefore, this type of experiment is addressed in more detail in the ATR safety basis. This allows the individual safety analysis for this type of experiment to be more standardized. The second type of experiment is defined in more general terms in the ATR safety basis and is permitted under more general controls. Therefore, the individual safety analysis for the second type of experiment tends to be more unique and is tailored to each experiment

Information on the Advanced Plant Experiment (APEX) Test Facility

International Nuclear Information System (INIS)

Smith, Curtis Lee

2015-01-01

The purpose of this report provides information related to the design of the Oregon State University Advanced Plant Experiment (APEX) test facility. Information provided in this report have been pulled from the following information sources: Reference 1: R. Nourgaliev and et.al, 'Summary Report on NGSAC (Next-Generation Safety Analysis Code) Development and Testing,' Idaho National Laboratory, 2011. Note that this is report has not been released as an external report. Reference 2: O. Stevens, Characterization of the Advanced Plant Experiment (APEX) Passive Residual Heat Removal System Heat Exchanger, Master Thesis, June 1996. Reference 3: J. Reyes, Jr., Q. Wu, and J. King, Jr., Scaling Assessment for the Design of the OSU APEX-1000 Test Facility, OSU-APEX-03001 (Rev. 0), May 2003. Reference 4: J. Reyes et al, Final Report of the NRC AP600 Research Conducted at Oregon State University, NUREG/CR-6641, July 1999. Reference 5: K. Welter et al, APEX-1000 Confirmatory Testing to Support AP1000 Design Certification (non-proprietary), NUREG-1826, August 2005.

Tokamak advanced pump limiter experiments and analysis

International Nuclear Information System (INIS)

Conn, R.W.

1983-06-01

Experiments with pump limiter modules on several operating tokamaks establish such limiters as efficient collectors of particles and has demonstrated the importance of ballistic scattering as predicted theoretically. Plasma interaction with recycling neutral gas appears to become important as the plasma density increases and the effective ionization mean free path within the module decreases. In limiters with particle collection but without active internal pumping, the neutral gas pressure is found to vary nonlinearly with the edge plasma density at the highest densities studies. Both experiments and theory indicate that the energy spectrum of gas atoms in the pump ducting is non-thermal, consistent with the results of Monte Carlo neutral atom transport calculations. The distribution of plasma power over the front surface of such modules has been measured and appears to be consistent with the predictions of simple theory. Initial results from the latest experiment on the ISX-B tokamak with an actively pumped limiter module demonstrates that the core plasma density can be controlled with a pump limiter and that the scrape-off layer plasma can partially screen the core plasma from gas injection. The results from module pump limiter experiments and from the theory and design analysis of advanced pump limiters for reactors are used to suggest the major features of a definitive, axisymmetric, toroidal belt pump limiter experiment

Integrating advanced practice providers into medical critical care teams.

Science.gov (United States)

McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

2013-03-01

Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

The role of practical wisdom in nurse manager practice: why experience matters.

Science.gov (United States)

Cathcart, Eloise Balasco; Greenspan, Miriam

2013-10-01

To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning. Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations. © 2013 John Wiley & Sons Ltd.

Goals and potential career advancement of licensed practical nurses in Japan.

Science.gov (United States)

Ikeda, Mari; Inoue, Katsuya; Kamibeppu, Kiyoko

2008-10-01

To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova) and discriminative analysis were used. We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Our results indicate that the 'image of RNs', and 'role-acceptance factors' have an effect on career advancement intentions of LPNs. Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.

Unpacking University-Community Partnerships to Advance Scholarship of Practice.

Science.gov (United States)

Suarez-Balcazar, Yolanda; Mirza, Mansha Parven; Hansen, Anne Marie Witchger

2015-01-01

Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university-community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors' collective experiences developing and sustaining successful university-community partnerships.

Book Review "Advances on remote laboratories and e-learning experiences"

Directory of Open Access Journals (Sweden)

Jesús A. del Alamo

2007-08-01

Full Text Available Book Review "Advances on remote laboratories and e-learning experiences", book editors: Luís Gomes and Javier García-Zubía, University of Deusto, Spain. Reviewed by Jesús A. del Alamo, Massachusetts Institute of Technology, M.I.T.

The problem of studying the best educational experience

Directory of Open Access Journals (Sweden)

Tkach A.V.

2011-07-01

Full Text Available In this paper the peculiarities of the views of scientists on the issues of determining the essence of good teaching experience, its dissemination and implementation in practice of education. The main stages of studying advanced pedagogical experience. It is shown the features of each stage. It is given the definition of best educational experience. Highlighted key terms that are used in the theory and practice work with the best educational experience.

Refugee experiences of general practice in countries of resettlement: a literature review.

Science.gov (United States)

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Advanced Reactor Fuels Irradiation Experiment Design Objectives

Energy Technology Data Exchange (ETDEWEB)

Chichester, Heather Jean MacLean [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hayes, Steven Lowe [Idaho National Lab. (INL), Idaho Falls, ID (United States); Dempsey, Douglas [Idaho National Lab. (INL), Idaho Falls, ID (United States); Harp, Jason Michael [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2016-09-01

This report summarizes the objectives of the current irradiation testing activities being undertaken by the Advanced Fuels Campaign relative to supporting the development and demonstration of innovative design features for metallic fuels in order to realize reliable performance to ultra-high burnups. The AFC-3 and AFC-4 test series are nearing completion; the experiments in this test series that have been completed or are in progress are reviewed and the objectives and test matrices for the final experiments in these two series are defined. The objectives, testing strategy, and test parameters associated with a future AFC test series, AFC-5, are documented. Finally, the future intersections and/or synergies of the AFC irradiation testing program with those of the TREAT transient testing program, emerging needs of proposed Versatile Test Reactor concepts, and the Joint Fuel Cycle Study program’s Integrated Recycle Test are discussed.

Advanced Reactor Fuels Irradiation Experiment Design Objectives

International Nuclear Information System (INIS)

Chichester, Heather Jean MacLean; Hayes, Steven Lowe; Dempsey, Douglas; Harp, Jason Michael

2016-01-01

This report summarizes the objectives of the current irradiation testing activities being undertaken by the Advanced Fuels Campaign relative to supporting the development and demonstration of innovative design features for metallic fuels in order to realize reliable performance to ultra-high burnups. The AFC-3 and AFC-4 test series are nearing completion; the experiments in this test series that have been completed or are in progress are reviewed and the objectives and test matrices for the final experiments in these two series are defined. The objectives, testing strategy, and test parameters associated with a future AFC test series, AFC-5, are documented. Finally, the future intersections and/or synergies of the AFC irradiation testing program with those of the TREAT transient testing program, emerging needs of proposed Versatile Test Reactor concepts, and the Joint Fuel Cycle Study program’s Integrated Recycle Test are discussed.

Medical student attachments in private practice – The experience ...

African Journals Online (AJOL)

Background: Medical student attachments with family/general practitioners (GPs) in non-academic or private practice are a valued resource in the undergraduate teaching of Family Medicine. This study describes the experience and views of GPs in private practice with final-year medical student attachments from the ...

An Experimental Study of Advanced Receivers in a Practical Dense Small Cells Network

DEFF Research Database (Denmark)

Assefa, Dereje; Berardinelli, Gilberto; Tavares, Fernando Menezes Leitão

2016-01-01

leads to significant limitations on the network throughput in such deployments. In addition, network densification introduces difficulty in network deployment. This paper presents a study on the benefits of advanced receiver in a practical uncoordinated dense small cells deployment. Our aim is to show...

Advanced nursing practice and Newton's three laws of motion.

Science.gov (United States)

Sturgeon, David

This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

Subjective Experiences of Older Adults Practicing Taiji and Qigong

Directory of Open Access Journals (Sweden)

Yang Yang

2011-01-01

Full Text Available This article presents a qualitative study following a 6-month Taiji (T'ai Chi/Qigong (Ch'i Kung intervention for older adults. The researchers conducted in-depth interviews of eight selected participants who elected to continue practicing Taiji after the intervention ended, in order to explore their subjective experiences of Taiji's effects and their motivations for continuing to practice. We created a Layers Model to capture the significance and meaning of the multidimensionality of their reported experiences. Participants not only reported simple benefits along five dimensions of experience (physical, mental, emotional, social and spiritual but also described complex multidimensional experiences. Overall findings indicate that participants derived a very wide variety of perceived benefits, the most meaningful being a felt sense of body-mind-spirit integration. Our results support the important role of qualitative studies in researching the effects of Taiji and Qigong.

An ethnographic study of nurses' experience with nursing research and its integration in practice.

Science.gov (United States)

Dupin, Cécile Marie; Borglin, Gunilla; Debout, Christophe; Rothan-Tondeur, Monique

2014-09-01

To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice. Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking. The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber. Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis. Three beliefs were identified: being a unified part of a research team, being an integral part of 'crosswise - across' activities and being part of research activities. Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research. © 2014 John Wiley & Sons Ltd.

Conditions for building a community of practice in an advanced physics laboratory

Science.gov (United States)

Irving, Paul W.; Sayre, Eleanor C.

2014-06-01

We use the theory of communities of practice and the concept of accountable disciplinary knowledge to describe how a learning community develops in the context of an upper-division physics laboratory course. The change in accountable disciplinary knowledge motivates students' enculturation into a community of practice. The enculturation process is facilitated by four specific structural features of the course and supported by a primary instructional choice. The four structural features are "paucity of instructor time," "all in a room together," "long and difficult experiments," and "same experiments at different times." The instructional choice is the encouragement of the sharing and development of knowledge and understanding by the instructor. The combination of the instructional choice and structural features promotes the development of the learning community in which students engage in authentic practices of a physicist. This results in a classroom community that can provide students with the opportunity to have an accelerated trajectory towards being a more central participant of the community of a practice of physicists. We support our claims with video-based observations of laboratory classroom interactions and individual, semistructured interviews with students about their laboratory experiences and physics identity.

Stakeholder experiences with general practice pharmacist services: a qualitative study.

Science.gov (United States)

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of

Connecting to Experience: High-Impact Practices for Leadership Development.

Science.gov (United States)

Priest, Kerry L; Clegorne, Nicholas A

2015-01-01

Leadership educators can leverage high-impact experiences to enhance student leadership development. This chapter describes three key practices--sociocultural conversations with peers, mentoring, and membership in off-campus organizations--as levers of leadership learning. Illustrations of the practice in context and reflections from practitioners and students are also included. The chapter concludes with considerations of context, developmental readiness, and best practices of experiential education. © 2015 Wiley Periodicals, Inc., A Wiley Company.

Advanced practice nursing students' knowledge, self-efficacy, and attitudes related to depression in older adults: teaching holistic depression care.

Science.gov (United States)

Delaney, Colleen; Barrere, Cynthia

2012-01-01

The aim of this study was to examine the knowledge, attitudes, and self-efficacy of advanced practice nursing students toward depression in older adults. Findings suggest that advanced practice nursing students are interested in caring for the whole person and desired more information on the physical and emotional-spiritual needs of older patients with depression. Suggestions for holistic nursing depression care education are presented.

Innovative Approach to the Organization of Future Social Workers' Practical Training: Foreign Experience

Science.gov (United States)

Polishchuk, Vira; Slozanska, Hanna

2014-01-01

Innovative approaches to practical training of future social workers in higher educational establishments have been defined. Peculiarities of foreign experience of social workers' practical training in higher educational establishments have been analyzed. Experience of organizing practice for bachelor students studying at "Social Work"…

Practical experience with digital I and C retrofit projects gathered by independent experts

International Nuclear Information System (INIS)

Zeck, Kurt; Schildheuer, Reinhard; Weich, Alfred

2005-01-01

As independent experts, we have accompanied a series of major projects where plant control systems have been retrofitted with digital I and C technology. As General Expert Inspectors of our authority, we have investigated, inspected and certified such projects - from defining the tasks at hand trough planning, approving, implementing and commissioning down to the regular operation of the equipment. Our special focus has been on the proper adherence to the relevant safety issues in nuclear plants in accordance with the current state-of-the-art in science and technology, and to the applicable codes of practice. In September 2004, at the international 'Nuclear Plant Instrumentation, Control and Human Machine Interface Technology' meeting in Columbus/Ohio, we presented some major retrofit projects and reported about how we, as independent official experts, accompany and monitor the activities of retrofitting plants with advanced digital safety I and C equipment, from the safety point of view. With current report, we would like to provide more detailed information about the practical experience gained with digital safety I and C retrofits and the conclusions drawn for currently ongoing retrofit projects. We will look at both the technical and licensing aspects of implementing such projects

Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

Energy Technology Data Exchange (ETDEWEB)

Page, Barbara A, E-mail: barbpage09@gmail.com [School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, New South Wales (Australia); Bernoth, Maree [School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Wagga Wagga, New South Wales (Australia); Davidson, Rob [School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, New South Wales (Australia)

2014-09-15

The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs and timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.

Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

International Nuclear Information System (INIS)

Page, Barbara A; Bernoth, Maree; Davidson, Rob

2014-01-01

The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs and timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia

Medical students, early general practice placements and positive supervisor experiences.

Science.gov (United States)

Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

2018-03-01

Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

Advanced unambiguous state discrimination attack and countermeasure strategy in a practical B92 QKD system

Science.gov (United States)

Ko, Heasin; Choi, Byung-Seok; Choe, Joong-Seon; Youn, Chun Ju

2018-01-01

Even though unconditional security of B92 quantum key distribution (QKD) system is based on the assumption of perfect positive-operator-valued measures, practical B92 systems only utilize two projective measurements. Unfortunately, such implementation may degrade the security of the B92 QKD system due to Eve's potential attack exploiting the imperfection of system. In this paper, we propose an advanced attack strategy with an unambiguous state discrimination (USD) measurement which makes practical B92 QKD systems insecure even under a lossless channel. In addition, we propose an effective countermeasure against the advanced USD attack model by monitoring double-click events. We further address a fundamental approach to make the B92 QKD system tolerable to attack strategies with USD measurements using a multi-qubit scheme.

Determination of the Performance Parameters of a Spectrophotometer: An Advanced Experiment.

Science.gov (United States)

Cope, Virgil W.

1978-01-01

Describes an advanced analytical chemistry laboratory experiment developed for the determination of the performance parameters of a spectrophotometer. Among the parameters are the baseline linearity with wavelength, wavelength accuracy and respectability, stray light, noise level and pen response time. (HM)

Innovative practice: exploring acculturation theory to advance rehabilitation from pediatric to adult "cultures" of care.

Science.gov (United States)

Nguyen, Tram; Baptiste, Sue

2015-01-01

This perspective paper explores the application of acculturation and the inherent concepts and ideas associated with this theory in rehabilitation to provide a framework for interpreting patient circumstances, responses and behaviours as they move from one culture to the next. Traditionally acculturation theory has been use to examine changes in culture in an ethnic or country sense, however, this paper is among the first to apply acculturation theory to the rehabilitation service cultures from pediatric to adult care for youth with chronic health conditions. The objectives of this paper are threefold: (1) to critically appraise key literature in the development of acculturation theory, (2) to discuss how acculturation theory can be applied in rehabilitation practice through a clinical vignette, and finally (3) to discuss how acculturation theory can advance rehabilitation by enhancing client-centered practice. Acculturation theory can provide insight into how patients are experiencing a change in health care "cultures", in the context of their overarching life circumstances. This, coming from a broader societal perspective can in turn inform an optimal approach to client-centered practice, and the application of rehabilitation-specific team inputs. This theoretical framework can heighten practitioners' awareness of patients' unique worldviews related to their expectations for care and treatment thus reducing fear of diversity to establish positive partnerships between patients and clinicians. An understanding of patients' acculturation processes will add new insight into how we can best deliver services and supports to optimise health, opportunities and experiences for youth with chronic conditions.

Thermal-Hydraulic Experiments and Modelling for Advanced Nuclear Reactor Systems

International Nuclear Information System (INIS)

Song, C. H.; Baek, W. P.; Chung, M. K.

2007-06-01

The objectives of the project are to study thermal hydraulic characteristics of advanced nuclear reactor system for evaluating key thermal-hydraulic phenomena relevant to new safety concepts. To meet the research goal, several thermal hydraulic experiments were performed and related thermal hydraulic models were developed with the experimental data which were produced through the thermal hydraulic experiments. The Followings are main research topics: - Multi-dimensional Phenomena in a Reactor Vessel Downcomer - Condensation-induced Thermal Mixing in a Pool - Development of Thermal-Hydraulic Models for Two-Phase Flow - Construction of T-H Data Base

Implementation of a professional portfolio: a tool to demonstrate professional development for advanced practice.

Science.gov (United States)

Chamblee, Tracy B; Dale, Juanita Conkin; Drews, Barbie; Spahis, Joanna; Hardin, Teri

2015-01-01

The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.

A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach.

Science.gov (United States)

Sherman, Deborah W; McGuire, Deborah B; Free, David; Cheon, Joo Young

2014-09-01

Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role. To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population. This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed. The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs. Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the

Advanced Reactor Licensing: Experience with Digital I and C Technology in Evolutionary Plants

International Nuclear Information System (INIS)

Wood, RT

2004-01-01

This report presents the findings from a study of experience with digital instrumentation and controls (I and C) technology in evolutionary nuclear power plants. In particular, this study evaluated regulatory approaches employed by the international nuclear power community for licensing advanced l and C systems and identified lessons learned. The report (1) gives an overview of the modern l and C technologies employed at numerous evolutionary nuclear power plants, (2) identifies performance experience derived from those applications, (3) discusses regulatory processes employed and issues that have arisen, (4) captures lessons learned from performance and regulatory experience, (5) suggests anticipated issues that may arise from international near-term deployment of reactor concepts, and (6) offers conclusions and recommendations for potential activities to support advanced reactor licensing in the United States

The uniqueness of elderly care: registered nurses' experience as preceptors during clinical practice in nursing homes and home-based care.

Science.gov (United States)

Carlson, Elisabeth; Bengtsson, Mariette

2014-04-01

The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. © 2013.

Advancing technician practice: Deliberations of a regulatory board.

Science.gov (United States)

Adams, Alex J

2018-01-01

In 2016, the Idaho State Board of Pharmacy (U.S.) undertook a major rulemaking initiative to advance pharmacy practice by broadening the ability of pharmacists to delegate tasks to pharmacy technicians. The new rules of the Board thus moved the locus of control in technician scope of practice from law to pharmacist delegation. Pharmacist delegation is individualistic and takes into account the individual technician's capabilities, the pharmacist's comfort level, facility policies, and the risk mitigation strategies present at the facility, among other factors. State law limits, by contrast, are rigid and can mean that pharmacists are unable to delegate tasks that are or could otherwise be within the abilities of their technicians. The expanded technician duties are in two domains: 1) medication dispensing support (e.g., tech-check-tech, accepting verbal prescriptions, transferring prescriptions, and performing remote data entry); and 2) technical support for pharmacist clinical services (e.g., administering immunizations). This commentary reviews the evidence behind these expanded duties, as well as the key regulatory decision points for each task. The Board's rules and approach may prove useful to other states and even other governing bodies outside the U.S. as they consider similar issues. Copyright © 2017 Elsevier Inc. All rights reserved.

Experiments in physical chemistry

CERN Document Server

Wilson, J M; Denaro, A R

1968-01-01

Experiments in Physical Chemistry, Second Edition provides a compilation of experiments concerning physical chemistry. This book illustrates the link between the theory and practice of physical chemistry. Organized into three parts, this edition begins with an overview of those experiments that generally have a simple theoretical background. Part II contains experiments that are associated with more advanced theory or more developed techniques, or which require a greater degree of experimental skill. Part III consists of experiments that are in the nature of investigations wherein these invest

AWAKE, The Advanced Proton Driven Plasma Wakefield Acceleration Experiment at CERN

CERN Document Server

Gschwendtner, E.; Amorim, L.; Apsimon, R.; Assmann, R.; Bachmann, A.M.; Batsch, F.; Bauche, J.; Berglyd Olsen, V.K.; Bernardini, M.; Bingham, R.; Biskup, B.; Bohl, T.; Bracco, C.; Burrows, P.N.; Burt, G.; Buttenschon, B.; Butterworth, A.; Caldwell, A.; Cascella, M.; Chevallay, E.; Cipiccia, S.; Damerau, H.; Deacon, L.; Dirksen, P.; Doebert, S.; Dorda, U.; Farmer, J.; Fedosseev, V.; Feldbaumer, E.; Fiorito, R.; Fonseca, R.; Friebel, F.; Gorn, A.A.; Grulke, O.; Hansen, J.; Hessler, C.; Hofle, W.; Holloway, J.; Huther, M.; Jaroszynski, D.; Jensen, L.; Jolly, S.; Joulaei, A.; Kasim, M.; Keeble, F.; Li, Y.; Liu, S.; Lopes, N.; Lotov, K.V.; Mandry, S.; Martorelli, R.; Martyanov, M.; Mazzoni, S.; Mete, O.; Minakov, V.A.; Mitchell, J.; Moody, J.; Muggli, P.; Najmudin, Z.; Norreys, P.; Oz, E.; Pardons, A.; Pepitone, K.; Petrenko, A.; Plyushchev, G.; Pukhov, A.; Rieger, K.; Ruhl, H.; Salveter, F.; Savard, N.; Schmidt, J.; Seryi, A.; Shaposhnikova, E.; Sheng, Z.M.; Sherwood, P.; Silva, L.; Soby, L.; Sosedkin, A.P.; Spitsyn, R.I.; Trines, R.; Tuev, P.V.; Turner, M.; Verzilov, V.; Vieira, J.; Vincke, H.; Wei, Y.; Welsch, C.P.; Wing, M.; Xia, G.; Zhang, H.

2016-01-01

The Advanced Proton Driven Plasma Wakefield Acceleration Experiment (AWAKE) aims at studying plasma wakefield generation and electron acceleration driven by proton bunches. It is a proof-of-principle R&D experiment at CERN and the world's first proton driven plasma wakefield acceleration experiment. The AWAKE experiment will be installed in the former CNGS facility and uses the 400 GeV/c proton beam bunches from the SPS. The first experiments will focus on the self-modulation instability of the long (rms ~12 cm) proton bunch in the plasma. These experiments are planned for the end of 2016. Later, in 2017/2018, low energy (~15 MeV) electrons will be externally injected to sample the wakefields and be accelerated beyond 1 GeV. The main goals of the experiment will be summarized. A summary of the AWAKE design and construction status will be presented.

Medical students' experience in practical skills is far from stakeholders' expectations

DEFF Research Database (Denmark)

Ringsted, Charlotte; Schroeder, Torben V.; Henriksen, Jørgen

2001-01-01

This study compares medical graduates' experience in practical skills with a range of stakeholders' expectations. A questionnaire listing 58 practical skills was sent out to a group of graduating medical students. The medical students were asked to indicate their experience in each skill during...... medical school. A similar questionnaire was sent out to five groups of stakeholders asking for their expectations regarding graduates' experience. The stakeholders were: faculty members; consultants at clinical departments with interns in training; general practitioners; nurses; recently graduated junior...... doctors. A total of 472 questionnaires were sent out and 315 (67%) were returned. Medical graduates showed substantial variation in level of experience, and their experience was substantially lower than the expectations of the stakeholders. Nurses and junior doctors tended to have higher expectations...

Interim Service ISDN Satellite (ISIS) network model for advanced satellite designs and experiments

Science.gov (United States)

Pepin, Gerard R.; Hager, E. Paul

1991-01-01

The Interim Service Integrated Services Digital Network (ISDN) Satellite (ISIS) Network Model for Advanced Satellite Designs and Experiments describes a model suitable for discrete event simulations. A top-down model design uses the Advanced Communications Technology Satellite (ACTS) as its basis. The ISDN modeling abstractions are added to permit the determination and performance for the NASA Satellite Communications Research (SCAR) Program.

Experience, theory, and practical wisdom in teaching and teacher education

NARCIS (Netherlands)

Lunenberg, Mieke; Korthagen, Fred

In this contribution, we discuss what it means to be a professional teacher with practical wisdom, and how practical wisdom is related to theory and experience. These questions are especially relevant as nowadays, in many countries, teacher education becomes more school?based. Building on theories

Experience, theory, and practical wisdom in teaching and teacher education

NARCIS (Netherlands)

Lunenberg, Mieke; Korthagen, Fred

2009-01-01

In this contribution, we discuss what it means to be a professional teacher with practical wisdom, and how practical wisdom is related to theory and experience. These questions are especially relevant as nowadays, in many countries, teacher education becomes more school-based. Building on theories

The Design, Experience and Practice of Networked Learning

DEFF Research Database (Denmark)

. The Design, Experience and Practice of Networked Learning will prove indispensable reading for researchers, teachers, consultants, and instructional designers in higher and continuing education; for those involved in staff and educational development, and for those studying post graduate qualifications...

Advanced divertor experiments on DIII-D

International Nuclear Information System (INIS)

Schaffer, M.J.; Mahdavi, M.A.; Osborne, T.; Petrie, T.W.; Stambaugh, R.D.; Buchenauer, D.; Hill, D.N.; Klepper, C.C.

1991-04-01

The poloidal divertor is presently favored for next-step, high-power tokamaks. The DIII-D Advanced Divertor Program (ADP) aims to gain increased control over the divertor plasma and tokamak boundary conditions. This paper reports experiments done in the first phase of the ADP. The DIII-D lower divertor was modified by the addition of a toroidally symmetric, graphite-armoured, water-cooled divertor-biasing ring electrode at the entrance to a gas plenum. The plenum will eventually contain a He cryogenic loop for active divertor pumping. The separatrix ''strike'' position is controlled by the lower poloidal field shaping coils and can be varied smoothly from the ring electrode upper surface to the divertor floor far from the entrance aperture. External power, at up to 550 V and 8 kA separately, has been applied to the electrode to date. 5 refs., 5 figs

Attributes of advanced practice registered nurse care coordination for children with medical complexity.

Science.gov (United States)

Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

2014-01-01

Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Advanced domestic digital satellite communications systems experiments

Science.gov (United States)

Iso, A.; Izumisawa, T.; Ishida, N.

1984-02-01

The characteristics of advanced digital transmission systems were measured, using newly developed small earth stations and a K-band and C-band communication satellite. Satellite link performance for data, facsimile, video and packet switching information transmission at bit rates ranging from 6.4 kbit/s to 6.3 Mbit/s have been confirmed, using a small K-band earth station and a demand-assignment time division multiple access system. A low-capacity omni-use C-band terminal experiment has verified a telephone channel transmission performance by spread-spectrum multiple access. Single point to multipoint transmission characteristics of the 64 kbit/s data signals from the computer center were tested, using a receive-only 4 GHz earth terminal. Basic satellite link performance was confirmed under clear-sky conditions. Precise satellite orbit and attitude keeping experiments were carried out to obtain precise satellite antenna pointing accuracy for development of K-band earth stations that do not require satellite tracking equipment. Precise station keeping accuracy of 0.02 degrees was obtained.

U.S. Experience and practices associated with the use of centralized rad waste processing centers

International Nuclear Information System (INIS)

Gibson, James D.

1994-01-01

This paper presents the experience and current practices employed within the United States (US) associated with the use of Centralized Rad waste Processing Centers for the processing of Low Level Radioactive Wastes (LLRW). Information is provided on the methods, technologies, and practices employed by Scientific Ecology Group, Inc. (SEG), which is the worlds largest processor of LLRW. SEG processes over 80,000 cubic meters of waste annually and achieves an overall volume reduction of 12 : 1. LLRW processing in the United States is currently performed primarily at Centralized Rad waste Processing Centers, such as SEG's Central Volume Reduction Facility (CVRF) in Oak Ridge, Tennessee. This is primarily due to the superior economical application of advanced waste processing technologies, equipment, and personnel maintained at these centers. Information is provided on how SEG uses supercompaction, incineration, metals recycling, vitrification, and various other waste processing techniques to process both dry and wet wastes from over 90 commercial nuclear power plants, government operated facilities, hospitals, universities, and various small generators of radioactive waste

Exploring nursing students’ experience of peer learning in clinical practice

Science.gov (United States)

Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

2015-01-01

Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

Joint crisis plans and psychiatric advance directives in German psychiatric practice.

Science.gov (United States)

Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

2014-05-01

This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

Multisectoral Strategies for Advancing Girls' Education: Principles and Practice. SAGE Technical Report.

Science.gov (United States)

Williams, Howard

This paper describes issues, experiences, and strategies used in developing successful multisectoral partnerships to advance girls' education, using Guinea and Morocco as examples. Chapter 1 introduces the issue, discussing barriers to girls' education and describing the multisectoral response to interrelated barriers. Chapter 2 defines the…

A practical appreciation of the implementation of a fully computerized monitoring and control system in N4 NFP series: An advanced instrumentation and control system

Energy Technology Data Exchange (ETDEWEB)

DaCruz, P. [Atos Origin, 4, Triton Square, Regent' s Place, London NW1 3HG (United Kingdom)

2006-07-01

Sema Group (acquired in February 2004 by Atos Origin) was selected by EDF to design, develop and supply this system, based on their product Advanced Data Acquisition and Control System (ADACS). The purpose of this paper is to give a practical appreciation from both the demand and supply perspectives of the implementation of the fully computerized Monitoring and Control systems. This is a joint presentation by EDF and Atos Origin based on their experiences of the N4 programme.

Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

Science.gov (United States)

Gallagher, Nancy

2012-01-01

Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

Professional Learning Experiences and Administrator Practice: Is There a Connection?

Science.gov (United States)

Bickmore, Dana L.

2012-01-01

This study identified the formal and informal professional learning experiences in which school administrators engaged and the relationship between these professional learning experiences and administrator practice. The researcher developed an instrument that solicited school administrators' engagement and perceived value of formal and informal…

Advanced plant design recommendations from Cook Nuclear Plant experience

International Nuclear Information System (INIS)

Zimmerman, W.L.

1993-01-01

A project in the American Electric Power Service Corporation to review operating and maintenance experience at Cook Nuclear Plant to identify recommendations for advanced nuclear plant design is described. Recommendations so gathered in the areas of plant fluid systems, instrument and control, testing and surveillance provisions, plant layout of equipment, provisions to enhance effective maintenance, ventilation systems, radiological protection, and construction, are presented accordingly. An example for a design review checklist for effective plant operations and maintenance is suggested

Advance Care Planning: Experience of Women With Breast Cancer

Science.gov (United States)

2006-07-01

recorded along with other characteristics. Inclusion criteria for the primary studies required that women with breast cancer be at least 21 years of age; cog ...W81XWH-04-1-0469 TITLE: Advance Care Planning: Experience of Women with Breast Cancer PRINCIPAL INVESTIGATOR: Ardith Z. Doorenbos...with Breast Cancer 5b. GRANT NUMBER W81XWH-04-1-0469 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Ardith Z. Doorenbos, Ph.D

Comparison of patients' expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences.

Science.gov (United States)

Kassam, Rosemin; Collins, John B; Berkowitz, Jonathan

2010-06-15

To compare patients' expectations and experiences at pharmacies offering traditional APPE learning opportunities with those offering enhanced APPEs that incorporate pharmaceutical care activities. A survey of anchored measures of patient satisfaction was conducted in 2 groups of APPE- affiliated community pharmacies: those participating in an enhanced APPE model versus those participating in the traditional model. The enhanced intervention included preceptor training, a comprehensive student orientation, and an extended experience at a single pharmacy rather than the traditional 2 x 4-week experience at different pharmacies. While patient expectations were similar in both traditional and enhanced APPE pharmacies, patients in enhanced pharmacies reported significantly higher in-store satisfaction and fewer service gaps. Additionally, satisfaction was significantly higher for patients who had received any form of consultation, from either pharmacist or students, than those reporting no consultations. Including provision of pharmaceutical care services as part of APPEs resulted in direct and measurable improvements in patient satisfaction.

A definition, description, and framework for advanced practice in dietetics.

Science.gov (United States)

Wildish, Deborah Ellen Boyko; Evers, Susan

2010-01-01

We explored advanced practice (AP) across the diversity of dietetics to develop a definition, description, and framework for guiding future education, research agendas, and policy development. The process began with a literature review and discussion with dietitians exploring AP in other countries. Various concepts were identified, and these informed the phase 1 survey questions. Phase 1 was a 36-item survey created in SurveyMonkey, engaging a purposeful sample of key stakeholders (n=136). A modified Delphi approach, involving seven dietitians from different geographical locations and practice areas, finalized the phase 2 survey. An e-mail link to this 50-item survey was sent to a random sample of dietitians (n=885). The proposed AP framework entailed an iterative approach, integrating survey results with AP literature. Response rates were 40% for phase 1 and 35% for phase 2. In phase 1, 83% of respondents agreed that a depth and breadth definition captured all dietetic job roles, and 95% agreed that it differentiated AP from entry-level practice. Descriptive statistics are presented to provide demographic information and level of agreement with themes relevant to AP. A framework is presented, and discrepancies with phase 2 results indicate areas for professional development, such as leadership, mentorship, and outcome measurement.

Relationships among factors affecting advanced practice registered nurses' job satisfaction and intent to leave: A systematic review.

Science.gov (United States)

Han, Robin M; Carter, Patricia; Champion, Jane Dimmitt

2018-02-01

This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention. A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review. The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave. Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens.

Science.gov (United States)

Lewis, Robin; Kelly, Shona

2018-04-05

The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. The CoP that is emerging through the ATPS placements appear to be

Laravel design patterns and best practices

CERN Document Server

Kilicdagi, Arda

2014-01-01

This book is a practical guide packed with clear examples that will help you get to grips with the best practices in Laravel design patterns to create advanced web applications. This book is intended for web application developers working with Laravel who want to increase the efficiency of their web applications. It assumes that you have some experience with the Laravel PHP framework and are familiar with coding OOP methods.

Combine EPR and two-slit experiments: Interference of advanced waves

Science.gov (United States)

Klyshko, D. N.

1988-10-01

A nonclassical interference effect, using two-photon correlations in nonlinear optical interactions, is discussed. The apparent nonlocality could be conveniently interpreted in terms of advanced waves, emitted by one detector toward the other. A new Bell-type experiment is proposed, in which the measured photon's parameter is the wave-vector (instead of the polarisation), so that the observable can take more than two possible values.

Strategic decisions on research for advanced reactors: USNRS perspective

International Nuclear Information System (INIS)

Johnson, M.

2008-01-01

This document provided a perspective on strategic decision on research for advanced reactors. He pointed out that advanced reactors are fundamentally different from LWR and that regulatory tools currently available (e.g. codes and data) will not be applicable to advanced designs. He stated that international co-operation is the only practical way to work together for identifying needed capabilities and tools, including the use of industry facilities. He proposed that, in consideration of its good experience at coordinating research, the CSNI establishes a task group to identify and prioritize research needs. (author)

Advanced grammar in use a self-study reference and practice book for advanced students of English : with answers and CD-ROM

CERN Document Server

Hewings, Martin

2013-01-01

An updated version of the highly successful Advanced Grammar in Use. This third edition, with answers and CD-ROM, is ideal for self-study. The book contains 100 units of grammar reference and practice materials, with illustrations in full colour and a user-friendly layout. It is ideal for learners preparing for the Cambridge Advanced, Proficiency or IELTS examinations, and is informed by the Cambridge International Corpus, which ensures the language is authentic and up-to-date. The CD-ROM includes 200 interactive exercises to reinforce the language learned in the book, plus customised tests and audio recordings to accompany the main exercises. Versions without answers and without the CD-ROM are available to purchase separately.

Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies.

Science.gov (United States)

Ke, Li-Shan; Huang, Xiaoyan; Hu, Wen-Yu; O'Connor, Margaret; Lee, Susan

2017-05-01

Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

Science.gov (United States)

Choma, Kim; McKeever, Amy E

2015-02-01

The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.

Autopsy practice in forensic pathology - Evidence-based or experience-based?

DEFF Research Database (Denmark)

Colville-Ebeling, Bonnie; Freeman, Michael; Banner, Jytte

2014-01-01

Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case......-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy...

Advanced divertor experiments on DIII-D

International Nuclear Information System (INIS)

Schaffer, M.J.; Mahdavi, M.A.; Osborne, T.; Petrie, T.W.; Stambaugh, R.D.; Buchenauer, D.; Hill, D.N.; Klepper, C.C.

1991-01-01

The poloidal divertor is presently favored for next-step, high-power tokamaks. The DIII-D Advanced Divertor Program (ADP) aims to gain increased control over the divertor plasma and tokamak boundary conditions. This paper reports experiments done in the first phase of the ADP. The DIII-D lower divertor was modified by the addition of a toroidally symmetric, graphite-armoured, water-cooled divertor-biasing ring electrode at the entrance to a gas plenum. (In the past DIII-D operated with an open divertor.) The plenum will eventually contain a He cryogenic loop for active divertor pumping. The separatrix 'strike' position is controlled by the lower poloidal field shaping coils and can be varied smoothly from the ring electrode upper surface to the divertor floor far from the entrance aperture. External power, at up to 550 V and 8 kA separately, has been applied to the electrode to date. (author) 5 refs., 5 figs

Evaluation of information display at advanced main control room

Energy Technology Data Exchange (ETDEWEB)

Min, Dae Hwan; Yu, Seon Jae; Choi, Eui Sun [Korea Univ., Seoul (Korea, Republic of)

2000-03-15

This year we plan to survey information in order to have basic understanding of digital information display and control at the advanced MCR. At first we collect different ways of presenting information at the advanced MCR. Secondly, we conduct literature survey on studies that have investigated information representation techniques and their effects. Then, we need compare differences between conventional NPPs and advanced NPPs. Thirdly, we need to check HMI styles and evaluation techniques that are used currently at foreign NPPs. Indeed, HMI at the advanced MCR is quite different from that at a conventional MCR. It is not desirable to apply the same evaluation technique that has veen used at the conventional MCR. We need to develop an evaluation technique that is valid in theory and applicable in practice. Finally, we identify the requirements for a support system for an HMI evaluator, since it is not easy to carry out an evaluation task even though one has firm background on cognitive engineering theories and practical experiences.

Evaluation of information display at advanced main control room

International Nuclear Information System (INIS)

Min, Dae Hwan; Yu, Seon Jae; Choi, Eui Sun

2000-03-01

This year we plan to survey information in order to have basic understanding of digital information display and control at the advanced MCR. At first we collect different ways of presenting information at the advanced MCR. Secondly, we conduct literature survey on studies that have investigated information representation techniques and their effects. Then, we need compare differences between conventional NPPs and advanced NPPs. Thirdly, we need to check HMI styles and evaluation techniques that are used currently at foreign NPPs. Indeed, HMI at the advanced MCR is quite different from that at a conventional MCR. It is not desirable to apply the same evaluation technique that has veen used at the conventional MCR. We need to develop an evaluation technique that is valid in theory and applicable in practice. Finally, we identify the requirements for a support system for an HMI evaluator, since it is not easy to carry out an evaluation task even though one has firm background on cognitive engineering theories and practical experiences

Postural and Object-Oriented Experiences Advance Early Reaching, Object Exploration, and Means-End Behavior

Science.gov (United States)

Lobo, Michele A.; Galloway, James C.

2008-01-01

The effects of 3 weeks of social (control), postural, or object-oriented experiences on 9- to 21-week-old infants' (N = 42) reaching, exploration, and means-end behaviors were assessed. Coders recorded object contacts, mouthing, fingering, attention, and affect from video. Postural and object-oriented experiences advanced reaching, haptic…

Cash Advance Accounting: Accounting Regulations and Practices

Directory of Open Access Journals (Sweden)

Aristita Rotila

2012-12-01

Full Text Available It is known the fact that often the entities offer to staff or third parties certain amounts of money, in order to make payments for the entities, such sums being registered differently in the accounting as cash advances. In the case in which the advances are offered in a foreign currency, there is the problem of the exchange rate used when justifying the advance, for the conversion in lei of payments that were carried out. In this article we wanted to signal the effect that the exchange rate, used in the assessment for reflecting in the accounting operations concerning cash advance reimbursements in a foreign currency, has on the information presented in the financial statement. Therewith, we signal some aspects from the content of the accounting regulations, with reference at defining the cash advances, meaning, and the presentation in the balance sheet of cash advances, which, in our opinion, impose clarifications.

Computer-Assisted Foreign Language Teaching and Learning: Technological Advances

Science.gov (United States)

Zou, Bin; Xing, Minjie; Wang, Yuping; Sun, Mingyu; Xiang, Catherine H.

2013-01-01

Computer-Assisted Foreign Language Teaching and Learning: Technological Advances highlights new research and an original framework that brings together foreign language teaching, experiments and testing practices that utilize the most recent and widely used e-learning resources. This comprehensive collection of research will offer linguistic…

Determinants of completion of advance directives: a cross-sectional comparison of 649 outpatients from private practices versus 2158 outpatients from a university clinic.

Science.gov (United States)

Pfirstinger, Jochen; Bleyer, Bernhard; Blum, Christian; Rechenmacher, Michael; Wiese, Christoph H; Gruber, Hans

2017-12-21

To compare outpatients from private practices and outpatients from a university clinic regarding the determinants of completion of advance directives (AD) in order to generalise results of studies from one setting to the other. Five determinants of completion of AD were studied: familiarity with AD, source of information about AD, prior experiences with own life-threatening diseases or family members in need of care and motives in favour and against completion of AD. Observational cross-sectional study. Private practices and a university clinic in Germany in 2012. 649 outpatients from private practices and 2158 outpatients from 10 departments of a university clinic. Completion of AD, familiarity with AD, sources of information about AD (consultation), prior experiences (with own life-threatening disease and family members in need of care), motives in favour of or against completion of AD, sociodemographic data. Determinants of completion of AD did not differ between outpatients from private practices versus university clinic outpatients. Prior experience with severe disease led to a significantly higher rate of completion of AD (33%/36% with vs 24%/24% without prior experience). Participants with completion of AD had more often received legal than medical consultation before completion, but participants without completion of AD are rather aiming for medical consultation. The motives in favour of or against completion of AD indicated inconsistent patterns. Determinants of completion of AD are comparable in outpatients from private practices and outpatients from a university clinic. Generalisations from university clinic samples towards a broader context thus seem to be legitimate. Only one-third of patients with prior experience with own life-threatening diseases or family members in need of care had completed an AD as expression of their autonomous volition. The participants' motives for or against completion of AD indicate that ADs are considered a kind of

The experiences of student nurses on placements with practice nurses: A pilot study.

Science.gov (United States)

Gale, Julia; Ooms, Ann; Sharples, Kath; Marks-Maran, Di

2016-01-01

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected by the London GP Deanery and the university as having fulfilled the criteria to support student nurses in placements. A mentorship preparation programme was provided to prepare practice nurses for mentoring these students. An evaluation study was undertaken of this pilot project. Findings showed that students were highly positive about the experience; the majority rated this placement as being as good as or better than previous placement experiences. The evaluation also explored the impact on student learning and the value that the placement had. There was a positive impact on students' knowledge and skills in certain clinical areas especially related to health promotion. Students also indicated that they would like to have additional placements with practice nurses and would consider a career as a practice nurse in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

Advanced clinical practice for radiographers in Great Britain: professional roles, accountability and the educational provision

International Nuclear Information System (INIS)

Hogg, P.

2004-01-01

A change in British health care has resulted in a broadening of roles and responsibilities beyond 'traditional boundaries' for a range of health care professionals. This has occurred because of staff shortages (particularly within the medical profession) and the recognition that many 'non-doctor' health care staff can make safe, competent and effective contributions outside their 'normal' sphere of responsibilities. In the context of advanced clinical practice, this paper will explain the current arrangements for radiographers' roles and responsibilities, their accountability and the educational provision that underpins the development of competencies at these higher clinical levels. Some advanced roles that British radiographers perform, within their current normal responsibilities, will be identified and some British legislation and professional body guidance that make role advancement possible will be outlined. The article will conclude with an indication of the educational level at which the advanced competencies are learned and assessed. (author)

Camtasia Studio 8 advanced editing and publishing techniques

CERN Document Server

Dixon, Claire Broadley

2013-01-01

A practical guide packed with examples that will show you how to implement the different features of Camtasia Studio 8 and create professional looking projects.If you are familiar with Camtasia Studio and you want to experiment with more advanced techniques, then this is the guide you have been looking for!

Pedagogical Practices and Students' Experiences in Eritrean Higher Education Institutions

Science.gov (United States)

Tsegay, Samson Maekele; Zegergish, Mulgeta Zemuy; Ashraf, Muhammad Azeem

2018-01-01

Using semi-structured interview and review of documents, this study analyzes the pedagogical practices and students' experiences in Eritrean Higher Education Institutions (HEIs). The study indicated that pedagogical practices are affected by instructors' pedagogical skills and perceptions, and the teaching-learning environment. Moreover, the…

A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health.

Science.gov (United States)

Norton, Wynne E; McCannon, C Joseph; Schall, Marie W; Mittman, Brian S

2012-12-06

Although significant advances have been made in implementation science, comparatively less attention has been paid to broader scale-up and spread of effective health programs at the regional, national, or international level. To address this gap in research, practice and policy attention, representatives from key stakeholder groups launched an initiative to identify gaps and stimulate additional interest and activity in scale-up and spread of effective health programs. We describe the background and motivation for this initiative and the content, process, and outcomes of two main phases comprising the core of the initiative: a state-of-the-art conference to develop recommendations for advancing scale-up and spread and a follow-up activity to operationalize and prioritize the recommendations. The conference was held in Washington, D.C. during July 2010 and attended by 100 representatives from research, practice, policy, public health, healthcare, and international health communities; the follow-up activity was conducted remotely the following year. Conference attendees identified and prioritized five recommendations (and corresponding sub-recommendations) for advancing scale-up and spread in health: increase awareness, facilitate information exchange, develop new methods, apply new approaches for evaluation, and expand capacity. In the follow-up activity, 'develop new methods' was rated as most important recommendation; expanding capacity was rated as least important, although differences were relatively minor. Based on the results of these efforts, we discuss priority activities that are needed to advance research, practice and policy to accelerate the scale-up and spread of effective health programs.

Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

Science.gov (United States)

Bryant-Lukosius, Denise; Spichiger, Elisabeth; Martin, Jacqueline; Stoll, Hansruedi; Kellerhals, Sabine Degen; Fliedner, Monica; Grossmann, Florian; Henry, Morag; Herrmann, Luzia; Koller, Antje; Schwendimann, René; Ulrich, Anja; Weibel, Lukas; Callens, Betty; De Geest, Sabina

2016-03-01

To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes. © 2016 Sigma Theta Tau International.

Identity and home: Understanding the experience of people with advanced cancer.

Science.gov (United States)

Maersk, Jesper Larsen; Cutchin, Malcolm P; la Cour, Karen

2018-05-01

The purpose of this study was to explore how the identity of people with advanced cancer is influenced by their experiences of living at home. A total of 28 in-depth interviews were conducted with 22 people with advanced cancer and four spouses. Grounded theory guided the collection and analysis of data. Home tours and associated field notes augmented the interview data. The analysis revealed that support of participants' identity was reflected in their abilities to live and occupy the home during daily activities, and in the ways the home and objects functioned as referents to themselves and their past. Threats to their identity ensued as the home environment became unmanageable during daily activities and as homecare professionals and assistive devices entered the home. By supporting people with advanced cancer in maintaining daily activities in the home and reducing changes in the home caused by homecare it is possible to reduce loss of identity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Experiences of Supervision at Practice Placement Sites

Directory of Open Access Journals (Sweden)

Lesley Diack

2014-01-01

Full Text Available Background. Whilst placement supervision and clinical education programmes are of significant value in shaping the behaviours of undergraduate healthcare students, appropriate provisions which are efficacious to the learner are somewhat lacking, particularly for students studying on UK MPharm programmes. Objectives. To explore and explain the value of placement supervision to the personal development and employability of undergraduate pharmacy students. Methods. Students participated in a week long community pharmacy pilot programme, a result of a collaborative effort between the School of Pharmacy and Life Sciences and a small consortium of community pharmacies. Students and stakeholders were asked to evaluate their experiences via separate questionnaires which had been developed to elicit views and attitudes. Key Findings. Feedback from students and stakeholders towards the experience was overwhelmingly positive with multiple benefits being reported. Of particular prominence was the emphasis in student feedback on the value of placement supervision to their professional and personal development. Findings were indicative of a development in clinical practice proficiencies, core skills, and improvement in decision-making practice. Conclusions. The benefits of clinical supervision to the professional and personal development of MPharm students are well documented, although attracting professional pharmacy supervisors is proving a problematic task for educational providers in the UK.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

LENUS (Irish Health Repository)

Fennelly, Orna

2018-06-01

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Investigating the experiences of New Zealand MRI technologists: Exploring intra-orbital metallic foreign body safety practices

Energy Technology Data Exchange (ETDEWEB)

Jacobs, Philippa K [River Radiology, Victoria Clinic, 750 Victoria Street, Hamilton, Waikato (New Zealand); Henwood, Suzanne [Unitec - Medical Imaging, Unitec Ratanui Street Henderson, Auckland (New Zealand); River Radiology, Victoria Clinic, 750 Victoria Street, Hamilton, Waikato (New Zealand)

2013-12-15

Qualitative research is lacking regarding the experiences of magnetic resonance imaging (MRI) technologists and their involvement in workplace safety practices. This article provides a gateway to explore, describe and document experiences of MRI technologists in New Zealand (NZ) pertaining to intra-orbital metallic foreign body (IMFB) safety practices. This phenomenological study describes the experiences of seven MRI technologists all with a minimum of 5 years' NZ work experience in MRI. The MRI technologists were interviewed face-to-face regarding their professional IMFB workplace experiences in order to explore historical, current and potential issues. Findings demonstrated that aspects of organization and administration are fundamentally important to MRI technologists. Varying levels of education and knowledge, as well as experience and skills gained, have significantly impacted on MRI technologists’ level of confidence and control in IMFB practices. Participants’ descriptions of their experiences in practice regarding decision-making capabilities further highlight the complexity of these themes. A model was developed to demonstrate the interrelated nature of the themes and the complexity of the situation in totality. Findings of this study have provided insight into the experiences of MRI technologists pertaining to IMFB safety practices and highlighted inconsistencies. It is hoped that these findings will contribute to and improve the level of understanding of MRI technologists and the practices and protocols involved in IMFB safety screening. The scarcity of available literature regarding IMFB safety practices highlights that more research is required to investigate additional aspects that could improve MRI technologists’ experiences.

Investigating the experiences of New Zealand MRI technologists: Exploring intra-orbital metallic foreign body safety practices

International Nuclear Information System (INIS)

Jacobs, Philippa K; Henwood, Suzanne

2013-01-01

Qualitative research is lacking regarding the experiences of magnetic resonance imaging (MRI) technologists and their involvement in workplace safety practices. This article provides a gateway to explore, describe and document experiences of MRI technologists in New Zealand (NZ) pertaining to intra-orbital metallic foreign body (IMFB) safety practices. This phenomenological study describes the experiences of seven MRI technologists all with a minimum of 5 years' NZ work experience in MRI. The MRI technologists were interviewed face-to-face regarding their professional IMFB workplace experiences in order to explore historical, current and potential issues. Findings demonstrated that aspects of organization and administration are fundamentally important to MRI technologists. Varying levels of education and knowledge, as well as experience and skills gained, have significantly impacted on MRI technologists’ level of confidence and control in IMFB practices. Participants’ descriptions of their experiences in practice regarding decision-making capabilities further highlight the complexity of these themes. A model was developed to demonstrate the interrelated nature of the themes and the complexity of the situation in totality. Findings of this study have provided insight into the experiences of MRI technologists pertaining to IMFB safety practices and highlighted inconsistencies. It is hoped that these findings will contribute to and improve the level of understanding of MRI technologists and the practices and protocols involved in IMFB safety screening. The scarcity of available literature regarding IMFB safety practices highlights that more research is required to investigate additional aspects that could improve MRI technologists’ experiences

Factors influencing advanced practice nurses' ability to promote evidence-based practice among frontline nurses.

Science.gov (United States)

Gerrish, Kate; Nolan, Mike; McDonnell, Ann; Tod, Angela; Kirshbaum, Marilyn; Guillaume, Louise

2012-02-01

Advanced practice nurses (APNs) have an important role in promoting evidence-based practice (EBP) among frontline nurses (FLNs). Factors influencing FLNs' engagement with EBP are well documented but little is known about factors that affect APNs' ability to facilitate evidence in practice. To identify factors that influence APNs' ability to promote EBP among FLNs. A multiple case study of 23 APNs from hospital and primary care settings across seven English health authorities was undertaken. Data collection comprised interviews and observation of APNs and interviews with FLNs and other healthcare professionals. Data were analysed using the Framework approach. Four groups of influencing factors were identified: (1) Personal attributes of APNs included knowledge and skills in EBP, clinical credibility with frontline staff and leadership style. (2) Relationships with stakeholders included APNs' interactions with FLNs and the level of support from managers and medical colleagues. (3) Aspects of the APN role included their sphere of responsibility and workload. (4) Organisational context included the organisational culture, FLNs' workload, professional networks and available resources. Educational preparation for APNs should enable them to develop expertise in EBP plus interpersonal and leadership skills to manage relational dynamics in clinical settings. APN role specifications should provide the opportunity to promote EBP. The organisational culture should be conducive to enabling EBP with managers supportive of this aspect of the APNs' role. APNs need to be supported to address the individual, interpersonal and organisational factors, which influence their ability to promote EBP. Organisational commitment at the highest level is key to APNs' ability to fulfil this aspect of their role. ©2011 Sigma Theta Tau International.

Advanced test reactor testing experience-past, present and future

International Nuclear Information System (INIS)

Marshall, Frances M.

2006-01-01

The Advanced Test Reactor (ATR), at the Idaho National Laboratory (INL), is one of the world's premier test reactors for providing the capability for studying the effects of intense neutron and gamma radiation on reactor materials and fuels. The physical configuration of the ATR, a 4-leaf clover shape, allows the reactor to be operated at different power levels in the corner 'lobes' to allow for different testing conditions for multiple simultaneous experiments. The combination of high flux (maximum thermal neutron fluxes of 1E15 neutrons per square centimeter per second and maximum fast [E>1.0 MeV] neutron fluxes of 5E14 neutrons per square centimeter per second) and large test volumes (up to 122 cm long and 12.7 cm diameter) provide unique testing opportunities. The current experiments in the ATR are for a variety of test sponsors - US government, foreign governments, private researchers, and commercial companies needing neutron irradiation services. There are three basic types of test configurations in the ATR. The simplest configuration is the sealed static capsule, which places the capsule in direct contact with the primary coolant. The next level of experiment complexity is an instrumented lead experiment, which allows for active control of experiment conditions during the irradiation. The most complex experiment is the pressurized water loop, in which the test sample can be subjected to the exact environment of a pressurized water reactor. For future research, some ATR modifications and enhancements are currently planned. This paper provides more details on some of the ATR capabilities, key design features, experiments, and future plans

Effect of an Advanced Pharmacy Practice Experience on Medication Therapy Management Services in a Centralized Retail Pharmacy Program.

Science.gov (United States)

Vande Griend, Joseph P; Rodgers, Melissa; Nuffer, Wesley

2017-05-01

Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students. The secondary objective was to describe the engagement needed to complete comprehensive medication reviews (CMRs) and targeted interventions. From May 2015 to December 2015, thirty-five APPE students from the University of Colorado Skaggs School of Pharmacy provided MTM services at Albertsons Companies using the OutcomesMTM and Mirixa platforms. Students delivered patient care services by phone at the central office and provided face-to-face visits at pharmacies in the region. With implementation of the MTM APPE in 2015, the team consisted of 2 MTM pharmacists and pharmacy students, as compared with 1 MTM pharmacist in 2014. The number of CMRs and targeted interventions completed and the estimated additional revenue generated during the 2015 time period were compared with those completed from May through December 2014. The patient and provider engagement needed to complete the CMRs and targeted interventions was summarized. 125 CMRs and 1,918 targeted interventions were billed in 2015, compared with 13 CMRs and 767 targeted interventions in 2014. An estimated $16,575-$49,272 of additional revenue was generated in 2015. To complete the interventions in 2015, the team engaged in 1,714 CMR opportunities and 4,686 targeted intervention opportunities. In this MTM rotation, students provided real-life care to patients, resulting in financial and clinical

Media experiences

DEFF Research Database (Denmark)

Buhl, Mie

2010-01-01

The paper discusses mediated experiences from the perspective of the visual modality in combination with the multimodal interaction. ICT-studies has a rapid influx of new words and concepts. Digital technology led to a need to describe the convergence of images, text and sound has taken various w...... to educational practices as still more advanced technology emerge and intertwine the scientific areas in new and cross-disciplinary frameworks....

Experience with Fingolimod in Clinical Practice

Science.gov (United States)

Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

2015-01-01

Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

Technological advances in the treatment of trauma: a review of promising practices.

Science.gov (United States)

Paul, Lisa A; Hassija, Christina M; Clapp, Joshua D

2012-11-01

Given the availability of empirically supported practices for addressing posttraumatic stress disorder and other forms of trauma-related distress, the development and implementation of new technology to deliver these treatments is exciting. Technological innovations in this literature aim to expand availability of empirically based intervention, increase treatment adherence and acceptability, and overcome barriers commonly encountered with conventional trauma-focused treatment. Much of the current research on these technological developments consists of brief reviews and case studies of the separate therapy modalities. Although this work serves to document the appeal and utility of these innovations, it does not provide comprehensive information about the host of options available. To that end, the three general categories of technological advances in trauma therapy (i.e., videoconferencing, e-Health, virtual reality) are reviewed here, including information regarding their empirical support and suggestions for future research and clinical practice.

Nursing home practices following resident death: the experience of Certified Nursing Assistants.

Science.gov (United States)

Barooah, Adrita; Boerner, Kathrin; van Riesenbeck, Isabelle; Burack, Orah R

2015-01-01

This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience. Copyright © 2015 Elsevier Inc. All rights reserved.

Learning Practice-Based Research Methods: Capturing the Experiences of MSW Students

Science.gov (United States)

Natland, Sidsel; Weissinger, Erika; Graaf, Genevieve; Carnochan, Sarah

2016-01-01

The literature on teaching research methods to social work students identifies many challenges, such as dealing with the tensions related to producing research relevant to practice, access to data to teach practice-based research, and limited student interest in learning research methods. This is an exploratory study of the learning experiences of…

Fourth Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE4)

NARCIS (Netherlands)

Katz, Daniel S; Niemeyer, Kyle E; Gesing, Sandra; Hwang, Lorraine; Bangerth, Wolfgang; Hettrick, Simon; Idaszak, Ray; Salac, Jean; Chue Hong, Neil; Núñez-Corrales, Santiago; Allen, Alice; Geiger, R Stuart; Miller, Jonah; Chen, Emily; Dubey, Anshu; Lago, Patricia

2018-01-01

This article summarizes motivations, organization, and activities of the Fourth Workshop on Sustainable Software for Science: Practice and Experiences (WSSSPE4). The WSSSPE series promotes sustainable research software by positively impacting principles and best practices, careers, learning, and

Diagnostics for advanced laser acceleration experiments

Energy Technology Data Exchange (ETDEWEB)

Misuri, Alessio [Univ. of Pisa (Italy)

2002-01-01

The first proposal for plasma based accelerators was suggested by 1979 by Tajima and Dawson. Since then there has been a tremendous progress both theoretically and experimentally. The theoretical progress is particularly due to the growing interest in the subject and to the development of more accurate numerical codes for the plasma simulations (especially particle-in-cell codes). The experimental progress follows from the development of multi-terawatt laser systems based on the chirped-pulse amplification technique. These efforts have produced results in several experiments world-wide, with the detection of accelerated electrons of tens of MeV. The peculiarity of these advanced accelerators is their ability to sustain extremely large acceleration gradients. In the conventional radio frequency linear accelerators (RF linacs) the acceleration gradients are limited roughly to 100 MV/m; this is partially due to breakdown which occurs on the walls of the structure. The electrical breakdown is originated by the emission of the electrons from the walls of the cavity. The electrons cause an avalanche breakdown when they reach other metal parts of the RF linacs structure.

Diagnostics for advanced laser acceleration experiments

International Nuclear Information System (INIS)

Misuri, Alessio

2002-01-01

The first proposal for plasma based accelerators was suggested by 1979 by Tajima and Dawson. Since then there has been a tremendous progress both theoretically and experimentally. The theoretical progress is particularly due to the growing interest in the subject and to the development of more accurate numerical codes for the plasma simulations (especially particle-in-cell codes). The experimental progress follows from the development of multi-terawatt laser systems based on the chirped-pulse amplification technique. These efforts have produced results in several experiments world-wide, with the detection of accelerated electrons of tens of MeV. The peculiarity of these advanced accelerators is their ability to sustain extremely large acceleration gradients. In the conventional radio frequency linear accelerators (RF linacs) the acceleration gradients are limited roughly to 100 MV/m; this is partially due to breakdown which occurs on the walls of the structure. The electrical breakdown is originated by the emission of the electrons from the walls of the cavity. The electrons cause an avalanche breakdown when they reach other metal parts of the RF linacs structure

The gamification and the enrichment of innovation practices in the firm: an analysis of experiences

Directory of Open Access Journals (Sweden)

Cristina Gallego Gomez

2013-09-01

Full Text Available Purpose: Description of gamification practices in the company and the analysis of its influence on firm’s results by comparing experiences. Design/methodology: Analysis of experiences from different firm’s experiences. Findings: To show through real examples that the gamification leads to the achievement of better results in the organizations. Research limitations/implications: Access to the information of the few cases that we can find in our context. It is a quite new a yet unusual practice for most organizations. Practical implications: Reformulation of business communication strategies from best practices, where the gaming industry is an interesting precedent, which proofs that these practices improve business results. Social implications: Socialization of the innovation process at firms Originality/value: Provide an overview of the gamification as a practice that helps to pursue the strategy of collaboration with the client to improve results.

Simulation Experiments in Practice : Statistical Design and Regression Analysis

NARCIS (Netherlands)

Kleijnen, J.P.C.

2007-01-01

In practice, simulation analysts often change only one factor at a time, and use graphical analysis of the resulting Input/Output (I/O) data. Statistical theory proves that more information is obtained when applying Design Of Experiments (DOE) and linear regression analysis. Unfortunately, classic

Experience of developments and implementation of advanced fuel cycles of WWER-440 reactors

International Nuclear Information System (INIS)

Gagarinski, A.A.; Lizorkin, M.P.; Novikov, A.N.; Proselkov, V.N.; Saprykin, V.V.

2000-01-01

The paper presents the experience of development and implementation of advanced four- and five-year fuel cycles in the WWER-440 reactors, the results of experimental operation of the new fuel design and the main neutronic characteristics of the core. (Authors)

Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

Science.gov (United States)

Vogel, Wendy H

2016-01-01

Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.

Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study.

Science.gov (United States)

Smeulers, Marian; Onderwater, Astrid T; van Zwieten, Myra C B; Vermeulen, Hester

2014-04-01

To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative interview study of 20 nurses in an academic medical centre was conducted between March and December of 2011. Three themes emerged from this study: (1) nurses' roles and responsibilities in medication safety: aside from safe preparation and administration, the clinical reasoning of nurses is essential for medication safety; (2) nurses' ability to work safely: knowledge of risks and nurses' work circumstances influence their ability to work safely; and (3) nurses' acceptance of safety practices: advantages, feasibility and appropriateness are important incentives for acceptance of a safety practice. Nurses' experiences coincide with the assumption that they are in a pre-eminent position to enable safe medication management; however, their ability to adequately perform this role depends on sufficient knowledge to assess the risks of medication administration and on the circumstances in which they work. Safe medication management requires a learning climate and professional practice environment that enables further development of professional nursing skills and knowledge. © 2014 John Wiley & Sons Ltd.

Primary healthcare nurses' experiences with motivational interviewing in health promotion practice.

Science.gov (United States)

Brobeck, Elisabeth; Bergh, Håkan; Odencrants, Sigrid; Hildingh, Cathrine

2011-12-01

The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. This study has a descriptive design and uses a qualitative method. Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices

Seamless learning: Technology-enhanced learning from practical experiences across contexts

NARCIS (Netherlands)

Rusman, Ellen

2018-01-01

Rusman, E. (2018, 8th of June). Seamless learning: Technology-enhanced learning from practical experiences across contexts. Keynote presentation at the Seamless learning conference, Maastricht, The Netherlands. http://www.ou.nl/slc

Findings: Sector-Leading and Innovative Practice in Advancing Equality and Diversity. Report to HEFCE by the Equality Challenge Unit

Science.gov (United States)

Higher Education Funding Council for England, 2017

2017-01-01

Following our "Call for evidence of sector-leading and innovative practice in advancing equality and diversity" (HEFCE Circular letter 16/2016), HEFCE commissioned the Equality Challenge Unit (ECU) to report back on the range of equality and diversity practice undertaken across the higher education sector. Of 120 submissions received,…

Achieving Full Scope of Practice Readiness Using Evidence for Psychotherapy Teaching in Web and Hybrid Approaches in Psychiatric Mental Health Advanced Practice Nursing Education.

Science.gov (United States)

McCoy, Kathleen T

2018-01-01

Radical changes in role, education, and practice have affected how education of advance practice nurses and practice deliverables occur. This article examines the effects of distance education upon the teaching/learning of psychotherapy in integrating Web-based technology and platforms. With the advent and proliferation of online programs of study, the question begs: How do distance-linked programs successfully introduce, practice, and supervise one-to-one and group psychotherapy training? By employing evidence-based education strategies, technology, and strong interpersonal skills and evidence-based therapies, a charter Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice program paved an innovative and successful path. In that program, they prepared their students for full scope of practice, upon graduation, inclusive of psychotherapy as well as the other highly demanding and compressed requirements of the 3-year program. This article explores that journey and its recommendations for application derived from this 2010 cohort. © 2017 Wiley Periodicals, Inc.

Advancing Research and Practice: The Revised APA Division 30 Definition of Hypnosis.

Science.gov (United States)

Elkins, Gary R; Barabasz, Arreed F; Council, James R; Spiegel, David

2015-04-01

This article describes the history, rationale, and guidelines for developing a new definition of hypnosis by the Society of Psychological Hypnosis, Division 30 of the American Psychological Association. The definition was developed with the aim of being concise, being heuristic, and allowing for alternative theories of the mechanisms (to be determined in empirical scientific study). The definition of hypnosis is presented as well as definitions of the following related terms: hypnotic induction, hypnotizability, and hypnotherapy. The implications for advancing research and practice are discussed. The definitions are presented within the article.

Assessing experience in the deliberate practice of running using a fuzzy decision-support system

Science.gov (United States)

Roveri, Maria Isabel; Manoel, Edison de Jesus; Onodera, Andrea Naomi; Ortega, Neli R. S.; Tessutti, Vitor Daniel; Vilela, Emerson; Evêncio, Nelson

2017-01-01

The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches’ knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p0.86, p<0.001). From the expert’s knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency) and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings. PMID:28817655

Assessing experience in the deliberate practice of running using a fuzzy decision-support system.

Directory of Open Access Journals (Sweden)

Maria Isabel Roveri

Full Text Available The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches' knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p0.86, p<0.001. From the expert's knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings.

Teacher's experiences in PBL: implications for practice

Science.gov (United States)

Alves, Anabela C.; Sousa, Rui M.; Fernandes, Sandra; Cardoso, Elisabete; Carvalho, Maria Alice; Figueiredo, Jorge; Pereira, Rui M. S.

2016-03-01

Project-Based Learning (PBL) has been implemented in the first year of the Industrial Engineering and Management programme at the University of Minho, Portugal, since 2004/2005. The purpose of this paper is to analyse and discuss teachers' experiences in PBL in this programme and to explore its implications for student learning and for teaching practices in higher education. For data collection, the research method used was written narratives to these teachers, at the end of the PBL semester. Findings suggest that teachers express a positive view of PBL as a learning approach. They identify student motivation and engagement, along with a better understanding of the application of concepts in real-life situations, as important outcomes of the project for students. Besides this, teachers also highlight the importance of the development of transversal skills by students throughout the project. Recommendations for future work and implications for practice will also be discussed.

Thermal-Hydraulic Experiments and Modelling for Advanced Nuclear Reactor Systems

International Nuclear Information System (INIS)

Song, C. H.; Chung, M. K.; Park, C. K. and others

2005-04-01

The objectives of the project are to study thermal hydraulic characteristics of reactor primary system for the verification of the reactor safety and to evaluate new safety concepts of new safety design features. To meet the research goal, several thermal hydraulic experiments were performed and related thermal hydraulic models were developed with the experimental data which were produced through the thermal hydraulic experiments. Followings are main research topics; - Multi-dimensional Phenomena in a Reactor Vessel Downcomer - Condensation Load and Thermal Mixing in the IRWST - Development of Thermal-Hydraulic Models for Two-Phase Flow - Development of Measurement Techniques for Two-Phase Flow - Supercritical Reactor T/H Characteristics Analysis From the above experimental and analytical studies, new safety design features of the advanced power reactors were verified and lots of the safety issues were also resolved

Advances in shock timing experiments on the National Ignition Facility

International Nuclear Information System (INIS)

Robey, H F; Celliers, P M; Moody, J D; Sater, J; Parham, T; Kozioziemski, B; Dylla- Spears, R; Ross, J S; LePape, S; Ralph, J E; Hohenberger, M; Dewald, E L; Berzak Hopkins, L; Kroll, J J; Yoxall, B E; Hamza, A V; Landen, O L; Edwards, M J; Boehly, T R; Nikroo, A

2016-01-01

Recent advances in shock timing experiments and analysis techniques now enable shock measurements to be performed in cryogenic deuterium-tritium (DT) ice layered capsule implosions on the National Ignition Facility (NIF). Previous measurements of shock timing in inertial confinement fusion (ICF) implosions were performed in surrogate targets, where the solid DT ice shell and central DT gas were replaced with a continuous liquid deuterium (D2) fill. These previous experiments pose two surrogacy issues: a material surrogacy due to the difference of species (D2 vs. DT) and densities of the materials used and a geometric surrogacy due to presence of an additional interface (ice/gas) previously absent in the liquid-filled targets. This report presents experimental data and a new analysis method for validating the assumptions underlying this surrogate technique. (paper)

Advances in shock timing experiments on the National Ignition Facility

Science.gov (United States)

Robey, H. F.; Celliers, P. M.; Moody, J. D.; Sater, J.; Parham, T.; Kozioziemski, B.; Dylla-Spears, R.; Ross, J. S.; LePape, S.; Ralph, J. E.; Hohenberger, M.; Dewald, E. L.; Berzak Hopkins, L.; Kroll, J. J.; Yoxall, B. E.; Hamza, A. V.; Boehly, T. R.; Nikroo, A.; Landen, O. L.; Edwards, M. J.

2016-03-01

Recent advances in shock timing experiments and analysis techniques now enable shock measurements to be performed in cryogenic deuterium-tritium (DT) ice layered capsule implosions on the National Ignition Facility (NIF). Previous measurements of shock timing in inertial confinement fusion (ICF) implosions were performed in surrogate targets, where the solid DT ice shell and central DT gas were replaced with a continuous liquid deuterium (D2) fill. These previous experiments pose two surrogacy issues: a material surrogacy due to the difference of species (D2 vs. DT) and densities of the materials used and a geometric surrogacy due to presence of an additional interface (ice/gas) previously absent in the liquid-filled targets. This report presents experimental data and a new analysis method for validating the assumptions underlying this surrogate technique.

Thermal-Hydraulic Experiments and Modelling for Advanced Nuclear Reactor Systems

Energy Technology Data Exchange (ETDEWEB)

Song, C. H.; Chung, M. K.; Park, C. K. and others

2005-04-15

The objectives of the project are to study thermal hydraulic characteristics of reactor primary system for the verification of the reactor safety and to evaluate new safety concepts of new safety design features. To meet the research goal, several thermal hydraulic experiments were performed and related thermal hydraulic models were developed with the experimental data which were produced through the thermal hydraulic experiments. Followings are main research topics; - Multi-dimensional Phenomena in a Reactor Vessel Downcomer - Condensation Load and Thermal Mixing in the IRWST - Development of Thermal-Hydraulic Models for Two-Phase Flow - Development of Measurement Techniques for Two-Phase Flow - Supercritical Reactor T/H Characteristics Analysis From the above experimental and analytical studies, new safety design features of the advanced power reactors were verified and lots of the safety issues were also resolved.

Patient acceptability and practical implications of pharmacokinetic studies in patients with advanced cancer.

Science.gov (United States)

Dobbs, N A; Twelves, C J; Ramirez, A J; Towlson, K E; Gregory, W M; Richards, M A

1993-01-01

We have studied the practical implications and acceptability to patients of pharmacokinetic studies in 34 women receiving anthracyclines for advanced breast cancer. The following parameters were recorded: age, ECOG performance status, psychological state (Rotterdam Symptom Checklist), cytotoxic drug and dose, number of venepunctures for treatment and sampling, and time when the sampling cannula was removed. Immediately after finishing pharmacokinetic sampling, patients completed a questionnaire which revealed that (i) all patients understood sampling was for research, (ii) 35% of patients experienced problems with sampling, (iii) benefits from participation were perceived by 56% of patients. Of 20 patients later questioned after completion of their treatment course, 40% recalled difficulties with blood sampling. Factors identifying in advance those patients who tolerate pharmacokinetic studies poorly were not identified but the number of venepunctures should be minimised. Patients may also perceive benefits from 'non-therapeutic' research.

Goethe's Conception of "Experiment as Mediator" and Implications for Practical Work in School Science

Science.gov (United States)

Park, Wonyong; Song, Jinwoong

2018-03-01

There has been growing criticism over the aims, methods, and contents of practical work in school science, particularly concerning their tendency to oversimplify the scientific practice with focus on the hypothesis-testing function of experiments. In this article, we offer a reading of Johann Wolfgang von Goethe's scientific writings—particularly his works on color as an exquisite articulation of his ideas about experimentation—through the lens of practical school science. While avoiding the hasty conclusions made from isolated experiments and observations, Goethe sought in his experiments the interconnection among diverse natural phenomena and rejected the dualistic epistemology about the relation of humans and nature. Based on a close examination of his color theory and its underlying epistemology, we suggest three potential contributions that Goethe's conception of scientific experimentation can make to practical work in school science.

Laser Light Scattering, from an Advanced Technology Development Program to Experiments in a Reduced Gravity Environment

Science.gov (United States)

Meyer, William V.; Tscharnuter, Walther W.; Macgregor, Andrew D.; Dautet, Henri; Deschamps, Pierre; Boucher, Francois; Zuh, Jixiang; Tin, Padetha; Rogers, Richard B.; Ansari, Rafat R.

1994-01-01

Recent advancements in laser light scattering hardware are described. These include intelligent single card correlators; active quench/active reset avalanche photodiodes; laser diodes; and fiber optics which were used by or developed for a NASA advanced technology development program. A space shuttle experiment which will employ aspects of these hardware developments is previewed.

Modes of relating to contingency: An exploration of experiences in advanced cancer patients.

Science.gov (United States)

Kruizinga, Renske; Hartog, Iris D; Scherer-Rath, Michael; Schilderman, Hans; Van Laarhoven, Hanneke

2017-08-01

Throughout their lives, people are confronted with unexpected life events, which can be difficult to incorporate into their life narratives. Such a confrontation can result in an experience of contingency. Different ways of relating to contingency have been described by Wuchterl: denying, acknowledging, and "encounter with the Other." In the present article, we aim to trace these theoretical distinctions in real-life experiences of patients. We analyzed 45 interviews using the constant comparative method with a directed content analysis approach in the Atlas.ti coding program. The interviews originated from a randomized controlled trial evaluating an assisted reflection on life events and ultimate life goals. Seven spiritual counselors from six hospitals in the Netherlands conducted the interviews from July of 2014 to March of 2016. All 45 patients had advanced cancer. We found four different modes into which relating to contingency can be classified: denying, acknowledging, accepting, and receiving. With denying, patients did not mention any impact of the life event on their lives. In acknowledging, the impact was recognized and a start was made to incorporate the event into their life. In accepting, patients went through a process of reinterpretation of the event. In receiving, patients talked about receiving insights from their illness and living a more conscious life. Our study is the first to investigate the different ways of relating to contingency in clinical practice. The defined modes will improve our understanding of the various ways in which cancer patients relate to their disease, allowing caregivers to better target and shape individual care.

Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study

NARCIS (Netherlands)

Smeulers, Marian; Onderwater, Astrid T.; van Zwieten, Myra C. B.; Vermeulen, Hester

2014-01-01

To explore nurses' experiences with and perspectives on preventing medication administration errors. Insight into nurses' experiences with and perspectives on preventing medication administration errors is important and can be utilised to tailor and implement safety practices. A qualitative

Advance care planning with individuals experiencing homelessness: Literature review and recommendations for public health practice.

Science.gov (United States)

Hubbell, Sarah A

2017-09-01

Vulnerable populations in the United States experience disparities in access to advance care planning and may have significant unmet health care needs at the end of life, including unrelieved suffering. People who are homeless have increased morbidity and mortality risks, yet lack opportunities to communicate end-of-life preferences. This paper includes a narrative literature review of advance care planning interventions and qualitative investigations into end-of-life concerns among people experiencing homelessness. Trials of clinician-guided interventions with homeless individuals demonstrated effectiveness in achieving advance directive completion and surrogate decision-maker designation. End-of-life concerns among homeless persons included fears of dying alone, dying unnoticed, or remaining unidentified after death. Research participants also reported concerns regarding burial and notification of family members. Public health practitioners should facilitate advance care planning for people who are homeless by providing opportunities for education and discussion on care options and advance directives. © 2017 Wiley Periodicals, Inc.

Geographic Medical History: Advances in Geospatial Technology Present New Potentials in Medical Practice

Science.gov (United States)

Faruque, F. S.; Finley, R. W.

2016-06-01

Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes) and lifestyle of the patient (behaviour), but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, "Airs, Waters, Places", yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient's medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient's "Geographic Medical History". In order to accomplish this we need information on: a) relevant spatiotemporal environmental variables, and b) location of the individual in that person's dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual's location can be tracked in real time if

GEOGRAPHIC MEDICAL HISTORY: ADVANCES IN GEOSPATIAL TECHNOLOGY PRESENT NEW POTENTIALS IN MEDICAL PRACTICE

Directory of Open Access Journals (Sweden)

F. S. Faruque

2016-06-01

Full Text Available Genes, behaviour, and the environment are known to be the major risk factors for common diseases. When the patient visits a physician, typical questions include family history (genes and lifestyle of the patient (behaviour, but questions concerning environmental risk factors often remain unasked. It is ironic that 25 centuries ago Hippocrates, known as the father of medicine, noted the importance of environmental exposure in medical investigation as documented in his classic work, “Airs, Waters, Places”, yet the practice of routinely incorporating environmental risk factors is still not in place. Modern epigenetic studies have found that unhealthy lifestyle and environmental factors can cause changes to our genes that can increase disease risk factors. Therefore, attempting to solve the puzzle of diseases using heredity and lifestyle alone will be incomplete without accounting for the environmental exposures. The primary reason why environmental exposure has not yet been a routine part of the patient’s medical history is mostly due to our inability to provide clinicians useful measures of environmental exposures suitable for their clinical practices. This presentation will discuss advances in geospatial technology that show the potential to catalyse a paradigm shift in medical practice and health research by allowing environmental risk factors to be documented as the patient’s “Geographic Medical History”. In order to accomplish this we need information on: a relevant spatiotemporal environmental variables, and b location of the individual in that person’s dynamic environment. Common environmental agents that are known to interact with genetic make-up include air pollutants, mold spores, pesticides, etc. Until recently, the other component, location of an individual was limited to a static representation such as residential or workplace location. Now, with the development of mobile technology, changes in an individual’s location

The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students.

Science.gov (United States)

Heller, Katharina; Bullerjahn, Claudia; von Georgi, Richard

2015-01-01

Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck's Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. 'Flow-experience,' 'self-congruence' and 'fear of losing control over concentration,' assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories ('self,' 'group,' 'audience,' 'teacher'). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style ('classical' or 'popular'). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one's instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers. In conclusion, this offers a starting

Cash Advance Accounting: Accounting Regulations and Practices

OpenAIRE

Aristita Rotila

2012-01-01

It is known the fact that often the entities offer to staff or third parties certain amounts of money, in order to make payments for the entities, such sums being registered differently in the accounting as cash advances. In the case in which the advances are offered in a foreign currency, there is the problem of the exchange rate used when justifying the advance, for the conversion in lei of payments that were carried out. In this article we wanted to signal the effect that the exchange rate...

The experiences of student nurses on placements with practice nurses : a pilot study

OpenAIRE

Gale, Julia; Ooms, Ann; Sharples, Kath; Marks-Maran, Di

2016-01-01

To prepare the registered nurse of tomorrow in the United Kingdom (UK) to care for patients in general practice (GP)-led services, today's student nurses need to have the opportunity to experience placements with practice nurses to enable them to make positive career choices to become practice nurses in the future. The role of the practice nurse is described in the article. As a pilot project, seventeen students undertook placements with practice nurses in one of seven GP practices selected b...

Exploring body-anchored and experience-based learning in a community of practice

DEFF Research Database (Denmark)

Stelter, Reinhard

2008-01-01

which, in a second step, is presented as part of the social realm and as one of the prerequisites of learning in a community of practice. This integration is established and becomes visible through the following two concepts: 1. Reification as the outflow of co-ordinated action, and 2. narratives......The article aims to integrate body-anchored and experience-based learning in the theoretical concept of learning in a community of practice. Present moment, epoché, intentional orientation and meaning making are introduced as the four basic premises for body-anchored and experience-based learning...

Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance.

Science.gov (United States)

Carter, Christine E; Grahn, Jessica A

2016-01-01

Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the "contextual interference effect." While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

Optimizing Music Learning: Exploring How Blocked and Interleaved Practice Schedules Affect Advanced Performance

Science.gov (United States)

Carter, Christine E.; Grahn, Jessica A.

2016-01-01

Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the “contextual interference effect.” While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (12 min per piece) and a second concerto exposition and technical excerpt to practice in an interleaved schedule (3 min per piece, alternating until a total of 12 min of practice were completed on each piece). Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated better than those in the blocked schedule

Optimizing music learning: Exploring how blocked and interleaved practice schedules affect advanced performance

Directory of Open Access Journals (Sweden)

Christine E Carter

2016-08-01

Full Text Available Repetition is the most commonly used practice strategy by musicians. Although blocks of repetition continue to be suggested in the pedagogical literature, work in the field of cognitive psychology suggests that repeated events receive less processing, thereby reducing the potential for long-term learning. Motor skill learning and sport psychology research offer an alternative. Instead of using a blocked practice schedule, with practice completed on one task before moving on to the next task, an interleaved schedule can be used, in which practice is frequently alternated between tasks. This frequent alternation involves more effortful processing, resulting in increased long-term learning. The finding that practicing in an interleaved schedule leads to better retention than practicing in a blocked schedule has been labeled the contextual interference effect. While the effect has been observed across a wide variety of fields, few studies have researched this phenomenon in a music-learning context, despite the broad potential for application to music practice. This study compared the effects of blocked and interleaved practice schedules on advanced clarinet performance in an ecologically valid context. Ten clarinetists were given one concerto exposition and one technical excerpt to practice in a blocked schedule (twelve minutes per piece and a second concerto exposition and technical excerpt to practice in an interleaved schedule (three minutes per piece, alternating until a total of twelve minutes of practice were completed on each piece. Participants sight-read the four pieces prior to practice and performed them at the end of practice and again one day later. The sight-reading and two performance run-throughs of each piece were recorded and given to three professional clarinetists to rate using a percentage scale. Overall, whenever there was a ratings difference between the conditions, pieces practiced in the interleaved schedule were rated

A Survey of Optometry Graduates to Determine Practice Patterns: Part II: Licensure and Practice Establishment Experiences.

Science.gov (United States)

Bleimann, Robert L.; Smith, Lee W.

1985-01-01

A summary of Part II of a two-volume study of optometry graduates conducted by the Association of Schools and Colleges of Optometry is presented. Part II includes the analysis of the graduates' licensure and practice establishment experiences. (MLW)

Advanced control and instrumentation systems in nuclear power plants. Design, verification and validation

International Nuclear Information System (INIS)

Haapanen, P.

1995-01-01

The Technical Committee Meeting on design, verification and validation of advanced control and instrumentation systems in nuclear power plants was held in Espoo, Finland on 20 - 23 June 1994. The meeting was organized by the International Atomic Energy Agency's (IAEA) International Working Group's (IWG) on Nuclear Power Plant Control and Instrumentation (NPPCI) and on Advanced Technologies for Water Cooled Reactors (ATWR). VTT Automation together with Imatran Voima Oy and Teollisuuden Voima Oy responded about the practical arrangements of the meeting. In total 96 participants from 21 countries and the Agency took part in the meeting and 34 full papers and 8 posters were presented. Following topics were covered in the papers: (1) experience with advanced and digital systems, (2) safety and reliability analysis, (3) advanced digital systems under development and implementation, (4) verification and validation methods and practices, (5) future development trends. (orig.)

Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice.

Science.gov (United States)

Blacker, Susan; Head, Barbara A; Jones, Barbara L; Remke, Stacy S; Supiano, Katherine

2016-01-01

The importance of interprofessional collaboration in achieving high quality outcomes, improving patient quality of life, and decreasing costs has been growing significantly in health care. Palliative care has been viewed as an exemplary model of interprofessional care delivery, yet best practices in both interprofessional education (IPE) and interprofessional practice (IPP) in the field are still developing. So, too, is the leadership of hospice and palliative care social workers within IPE and IPP. Generating evidence regarding best practices that can prepare social work professionals for collaborative practice is essential. Lessons learned from practice experiences of social workers working in hospice and palliative care can inform educational efforts of all professionals. The emergence of interprofessional education and competencies is a development that is relevant to social work practice in this field. Opportunities for hospice and palliative social workers to demonstrate leadership in IPE and IPP are presented in this article.

Reform and practice for photoelectric specialty experimental teaching based on virtual simulation experiment platform

Science.gov (United States)

Ye, Yan; Lv, Qingsong; Wu, Maocheng; Xu, Yishen; Gu, Jihua

2017-08-01

In view of some problems about the traditional photoelectric specialty experimental teaching process, such as separation of theoretical teaching and practical teaching, immobilization of experimental teaching contents, low quality of experiments and no obvious effect, we explored and practiced a new experimental teaching model of "theoretical teaching, virtual simulation and physical experiment", which combined the characteristics of photoelectric information science and engineering major and the essential requirements of engineering innovation talents cultivation. The virtual simulation experiment platform has many advantages, such as high performance-to-price ratio, easy operation and open experimental process, which makes virtual simulation combine physical experiment, complete each other with virtual for practical. After the users log into the virtual simulation experimental platform, they will first study the contents of the experiment, clarify the purpose and requirements of the experiment, master the method of using the instrument and the relevant notes, and then use the experimental instruments provided by the platform to build the corresponding experimental system. Once the experimenter's optical path is set incorrectly or the instrument parameters are set incorrectly, the error or warning message will be automatically triggered, and the reference information will be given instructing the student to complete the correct experimental operation. The results of our practice in recent years show that the teaching reform of the photoelectric specialty experiments has not only brought great convenience to the experimental teaching management, broadened the students' thinking and vision, enhanced the students' experimental skills and comprehensive qualities, but also made the students participate in the experiment with their enthusiasm. During the construction of experiment programs, the students' engineering practical ability and independent innovation awareness

Experiments with radioactive samples at the Advanced Photon Source

International Nuclear Information System (INIS)

Veluri, V. R.; Justus, A.; Glagola, B.; Rauchas, A.; Vacca, J.

2000-01-01

The Advanced Photon Source (APS) at Argonne National Laboratory is a national synchrotron-radiation light source research facility. The 7 GeV electron Storage Ring is currently delivering intense high brilliance x-ray beams to a total of 34 beamlines with over 120 experiment stations to members of the international scientific community to carry out forefront basic and applied research in several scientific disciplines. Researchers come to the APS either as members of Collaborative Access Teams (CATs) or as Independent Investigators (IIs). Collaborative Access Teams comprise large number of investigators from universities, industry, and research laboratories with common research objectives. These teams are responsible for the design, construction, finding, and operation of beamlines. They are the owners of their experimental enclosures (''hutches'') designed and built to meet their specific research needs. Fig. 1 gives a plan view of the location of the Collaborative Access Teams by Sector and Discipline. In the past two years, over 2000 individual experiments were conducted at the APS facility. Of these, about 60 experiments involved the use of radioactive samples, which is less than 3% of the total. However, there is an increase in demand for experiment stations to accommodate the use of radioactive samples in different physical forms embedded in various matrices with activity levels ranging from trace amounts of naturally occurring radionuclides to MBq (mCi) quantities including transuranics. This paper discusses in some detail the steps in the safety review process for experiments involving radioactive samples and how ALARA philosophy is invoked at each step and implemented

How is brand experience designed in practice? : Results of a multiple-case study

NARCIS (Netherlands)

Bakker-Wu, S.; Calabretta, G.; Hultink, H.J.; Bohemia, E.; de Bont, C.; Svengren Holm, L.

2017-01-01

Brand experience is an important concept in marketing because it can affect brand loyalty, brand recall, and brand attitude. Brand experience design is therefore an important practice for companies to create favourable and meaningful experiences, through the design of various touchpoints that are in

Simulated learning environment experience in nursing students for paediatric practice.

Science.gov (United States)

Mendoza-Maldonado, Yessy; Barría-Pailaquilén, René Mauricio

The training of health professionals requires the acquisition of clinical skills in a safe and efficient manner, which is facilitated by a simulated learning environment (SLE). It is also an efficient alternative when there are limitations for clinical practice in certain areas. This paper shows the work undertaken in a Chilean university in implementing paediatric practice using SLE. Over eight days, the care experience of a hospitalized infant was studied applying the nursing process. The participation of a paediatrician, resident physician, nursing technician, and simulated user was included in addition to the use of a simulation mannequin and equipment. Simulation of care was integral and covered interaction with the child and family and was developed in groups of six students by a teacher. The different phases of the simulation methodology were developed from a pedagogical point of view. The possibility of implementing paediatric clinical practice in an efficient and safe way was confirmed. The experience in SLE was highly valued by the students, allowing them to develop different skills and abilities required for paediatric nursing through simulation. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Palliative radiation therapy practice for advanced esophageal carcinoma in Africa.

Science.gov (United States)

Sharma, V; Gaye, P M; Wahab, S A; Ndlovu, N; Ngoma, T; Vanderpuye, V; Sowuhami, A; Dawotola, D A; Kigula-Mugambe, J; Jeremic, B

2010-04-01

While numerous surveys of pattern of practices of palliative radiotherapy (RT) in advanced esophageal cancers have been published in developed countries, there is no such survey in African countries. During and after a regional training course by the International Atomic Energy Agency (IAEA) in palliative cancer care, a questionnaire was distributed to African RT centers to gather information about infrastructure and human resources available, and the pattern of practice of palliative RT for esophageal cancers. Twenty-four of the 35 centers (60%) completed the questionnaire. Twenty out of 23 (87%) centers treat patients with esophageal cancer presenting with dysphagia using external beam RT (16 centers external beam RT alone and 4 centers also use brachytherapy as a boost). Twelve (60%) centers prescribe RT doses of 30 Gy in 10 fractions and 2 centers 20 Gy in 5 fractions. Eighteen centers (78%) have low dose rate (LDR) brachytherapy, and 9 (39%) centers have high dose rate (HDR) brachytherapy. One center only used HDR brachytherapy alone to a dose of 16 Gy in 2 fractions over 8 days. RT remains a major component of treatment of patients with esophageal cancers in African countries. Still, there is a great variety among centers in both indications for RT and its characteristics for a treatment indication.

Impact of Advanced Practice Registered Nurses on Quality Measures: The Missouri Quality Initiative Experience.

Science.gov (United States)

Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Murray, Cathy; Crecelius, Charles; Ge, Bin; Petroski, Gregory

2018-06-01

The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services Innovations Center. While the goals of the MOQI for long-stay nursing home residents did not specifically include improvement of the QM scores, it was anticipated that improvement most likely would occur. Primary goals of the MOQI were to reduce the frequency of avoidable hospital admissions and readmissions; improve resident health outcomes; improve the process of transitioning between inpatient hospitals and nursing facilities; and reduce overall healthcare spending without restricting access to care or choice of providers. A 2-group comparison analysis was conducted using statewide QMs; a matched comparison group was selected from facilities in the same counties as the intervention homes, similar baseline QM scores, similar size and ownership. MOQI nursing homes each had an APRN embedded full-time to improve care and help the facility achieve MOQI goals. Part of their clinical work with residents and staff was to focus on quality improvement strategies with potential to influence healthcare outcomes. Trajectories of QM scores for the MOQI intervention nursing homes and matched comparison group homes were tested with nonparametric tests to examine for change in the desired direction between the 2 groups from baseline to 36 months. A composite QM score for each facility was constructed, and baseline to 36-month average change scores were examined using nonparametric tests. Then, adjusting for baseline, a repeated measures analysis using analysis of covariance as conducted. Composite QM scores of the APRN intervention group were significantly better (P = .025) than the comparison group

Optimal utilization of a breast care advanced practice clinician.

Science.gov (United States)

Russell, Katie W; Mone, Mary C; Serpico, Victoria J; Ward, Cori; Lynch, Joanna; Neumayer, Leigh A; Nelson, Edward W

2014-12-01

Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team. An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction. During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development. Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

Care Coordination for Children with Complex Special Health Care Needs: The Value of the Advanced Practice Nurse’s Enhanced Scope of Knowledge and Practice

Science.gov (United States)

Looman, Wendy S.; Presler, Elizabeth; Erickson, Mary M.; Garwick, Ann E.; Cady, Rhonda G.; Kelly, Anne M.; Finkelstein, Stanley M.

2012-01-01

Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. There is limited existing literature that addresses the relevance of the APN role as a fit for coordination of care for children with SHCN. The objective of this paper is to describe the value of the advanced practice nurse’s (APN’s) enhanced scope of knowledge and practice for relationship-based care coordination in healthcare homes that serve children with complex special health care needs (SHCN). The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a healthcare home for children with SHCN. PMID:22560803

The Relationship Between Personality Traits, Flow-Experience, and Different Aspects of Practice Behavior of Amateur Vocal Students

Science.gov (United States)

Heller, Katharina; Bullerjahn, Claudia; von Georgi, Richard

2015-01-01

Most of the existing studies on musical practice are concerned with instrumentalists only. Since singers are seldom considered in research, the present study is based on an online-sample of amateur vocal students (N = 120; 92 female, 28 male). The study investigated the correlations between personality traits, flow-experience and several aspects of practice characteristics. Personality was represented by the three personality dimensions extraversion, neuroticism and psychoticism, assessed by Eysenck’s Personality Profiler as well as the trait form of the Positive and Negative Affect Schedule. ‘Flow-experience,’ ‘self-congruence’ and ‘fear of losing control over concentration,’ assessed by the Practice Flow Inventory, served as variables for flow-experience. The practice motivation was measured by the Practice Motivation Questionnaire in four categories (‘self,’ ‘group,’ ‘audience,’ ‘teacher’). In addition, the Practice Behavior Questionnaire was used to provide an insight into the practice situation and behavior of singing students. The results show significant correlations: participants with high extraversion-scores experience significantly more flow than less extraverted persons, whereas lesser flow-experience seems to be related to high neuroticism-scores. Nevertheless, there is no influence in flow-experience concerning singing style (‘classical’ or ‘popular’). The longer the practicing time, the more likely students are to achieve flow-experience. However, older singers tend to have less flow-experience. Consequently, singers seem to differ in their personality and practice behavior compared to other musicians. Most of the findings show that having control over one’s instrument is decisive for achieving a performance of high quality, especially for singers. On the other hand, certainty in handling an instrument is essential to arouse a flow-feeling. However, flow-experience seems to be common mainly with amateur singers

Interim Service ISDN Satellite (ISIS) hardware experiment development for advanced ISDN satellite designs and experiments

Science.gov (United States)

Pepin, Gerard R.

1992-01-01

The Interim Service Integrated Service Digital Network (ISDN) Satellite (ISIS) Hardware Experiment Development for Advanced Satellite Designs describes the development of the ISDN Satellite Terminal Adapter (ISTA) capable of translating ISDN protocol traffic into Time Division Multiple Access (TDMA) signals for use by a communications satellite. The ISTA connects the Type 1 Network Termination (NT1) via the U-interface on the line termination side of the CPE to the RS-499 interface for satellite uplink. The same ISTA converts in the opposite direction the RS-499 to U-interface data with a simple switch setting.

Interim Service ISDN Satellite (ISIS) hardware experiment design for advanced ISDN satellite design and experiments

Science.gov (United States)

Pepin, Gerard R.

1992-01-01

The Interim Service Integrated Services Digital Network (ISDN) Satellite (ISIS) Hardware Experiment Design for Advanced Satellite Designs describes the design of the ISDN Satellite Terminal Adapter (ISTA) capable of translating ISDN protocol traffic into time division multiple access (TDMA) signals for use by a communications satellite. The ISTA connects the Type 1 Network Termination (NT1) via the U-interface on the line termination side of the CPE to the V.35 interface for satellite uplink. The same ISTA converts in the opposite direction the V.35 to U-interface data with a simple switch setting.

The role of the nurse executive in fostering and empowering the advanced practice registered nurse.

Science.gov (United States)

Talbert, Tukea L

2012-06-01

The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders. Copyright © 2012 Elsevier Inc. All rights reserved.

School Counselors' Professional Experience and Practices Working with Students Who Self-Harm: A Qualitative Study

Science.gov (United States)

Roberts, Ellen Adams

2013-01-01

The professional experiences and practices of school counselors and the interventions they employ while working with adolescent students who self-harm is an underrepresented area within current research. This generic qualitative study provides a rich description and a deeper understanding of the professional experiences and practices of school…

Advanced Electron Microscopy and Micro analytical technique development and application for Irradiated TRISO Coated Particles from the AGR-1 Experiment

Energy Technology Data Exchange (ETDEWEB)

Van Rooyen, Isabella Johanna [Idaho National Lab. (INL), Idaho Falls, ID (United States); Lillo, Thomas Martin [Idaho National Lab. (INL), Idaho Falls, ID (United States); Wen, Haiming [Idaho National Lab. (INL), Idaho Falls, ID (United States); Wright, Karen Elizabeth [Idaho National Lab. (INL), Idaho Falls, ID (United States); Madden, James Wayne [Idaho National Lab. (INL), Idaho Falls, ID (United States); Aguiar, Jeffery Andrew [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2017-01-01

A series of up to seven irradiation experiments are planned for the Advanced Gas Reactor (AGR) Fuel Development and Quantification Program, with irradiation completed at the Advanced Test Reactor (ATR) at Idaho National Laboratory (INL) for the first experiment (i.e., AGR-1) in November 2009 for an effective 620 full power days. The objective of the AGR-1 experiment was primarily to provide lessons learned on the multi-capsule test train design and to provide early data on fuel performance for use in fuel fabrication process development and post-irradiation safety testing data at high temperatures. This report describes the advanced microscopy and micro-analysis results on selected AGR-1 coated particles.

Some Misconceptions in Meiosis Shown by Students Responding to an Advanced Level Practical Examination Question in Biology.

Science.gov (United States)

Brown, C. R.

1990-01-01

Discussed are problems revealed in student responses to a practical task which formed part of an advanced level examination. The frequencies with which some misconceptions about cell reproduction and genetics occurred are presented. The nature of these misconceptions is analyzed and their implications discussed. (CW)

Principles of modern radar advanced techniques

CERN Document Server

Melvin, William

2012-01-01

Principles of Modern Radar: Advanced Techniques is a professional reference for practicing engineers that provides a stepping stone to advanced practice with in-depth discussions of the most commonly used advanced techniques for radar design. It will also serve advanced radar academic and training courses with a complete set of problems for students as well as solutions for instructors.

Advanced Colloids Experiment (ACE) Science Overview

Science.gov (United States)

Meyer, William V.; Sicker, Ronald J.; Chiaramonte, Francis P.; Luna, Unique J.; Chaiken, Paul M.; Hollingsworth, Andrew; Secanna, Stefano; Weitz, David; Lu, Peter; Yodh, Arjun;

Undergraduates' perceptions of the value of practical inhalation sedation experience in a UK dental school.

Science.gov (United States)

Walley, S; Albadri, S

2015-10-01

This was to establish the level and reported value of paediatric IHS experience from the perspective of final year undergraduates and to evaluate whether those students with more experience expressed feeling better-prepared for future practice and more likely to undertake further postgraduate education in IHS. All final year students were invited to complete an anonymous questionnaire designed to elicit undergraduate perceptions of IHS using visual analogue scales and free-text questions. A response rate of 77 % was achieved. Results revealed that only 21 % of participants reported acting as operator sedationist in ten or more IHS cases. Thus, the majority of undergraduates' did not meet the recommended quantity of practical IHS experiences, as outlined by the British Dental Sedation Teachers Group. In general, students felt on the value of IHS in the management of anxious children and expressed a desire to undertake further postgraduate education in conscious sedation. However, those students with more experience of practical IHS expressed feeling better able to describe the IHS experience with patients and parents, and were more satisfied with the quality of teaching. Furthermore free-text comments revealed that, regardless of experience, students wished to gain more experience of the practical administration of IHS. There is a need to increase the provision of IHS training within an undergraduate curriculum, in addition to improving the accessibility of postgraduate sedation courses.

Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?

Directory of Open Access Journals (Sweden)

de Wit Niek J

2009-12-01

Full Text Available Abstract Background Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs with and without professional experience in a developing country in performance both clinical and organisational. Methods A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level. 517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management to compare having experience in a developing country or not. Results Almost 8% of the GPs had experience in a developing country of at least two years. These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower. Conclusions We found interesting

Laguna Verde nuclear power plant: an experience to consider in advanced BWR design

International Nuclear Information System (INIS)

Fuentes Marquez, L.

2001-01-01

Laguna Verde is a BWR 5 containment Mark II. Designed by GE, two external re-circulation loops, each of them having two speed re-circulation pump and a flow control valve to define the drive flow and consequently the total core flow an power control by total core flow. Laguna Verde Design and operational experience has shown some insights to be considering in design for advanced BRW reactors in order to improve the potential of nuclear power plants. NSSS and Balance of plant design, codes used to perform nuclear core design, margins derived from engineering judgment, at the time Laguna Verde designed and constructed had conducted to have a plant with an operational license, generating with a very good performance and availability. Nevertheless, some design characteristics and operational experience have shown that potential improvements or areas of opportunity shall be focused in the advanced BWR design. Computer codes used to design the nuclear core have been evolved relatively fast. The computers are faster and powerful than those used during the design process, also instrumentation and control are becoming part of this amazing technical evolution in the industry. The Laguna Verde experience is the subject to share in this paper. (author)

Educational experiment for students using natural radioactivity. 2. Practical example of radiochemical experiment conducted at Tottori University

International Nuclear Information System (INIS)

Nakamura, Mariko; Esaka, Takao; Kamata, Masahiro

1999-01-01

This paper presents a practical example of educational experiment conducted at Tottori University, whose theme is to separate 214 Bi(+ 214 Pb) from superphosphate of lime or the soil sampled at Ningyo-Touge mountain pass. The results of this experiment are quantitative enough for educational purpose, although the amount of radioactivity is so small that it is free from any regulation in Japan. (author)

Embodied practice: claiming the body's experience, agency, and knowledge for social work.

Science.gov (United States)

Tangenberg, Kathleen M; Kemp, Susan

2002-01-01

Although social work practice typically is concerned with physical conditions and experiences such as poverty, addiction, and violence, relatively little attention has been given to the body in professional literature. Emphasizing both physical and sociocultural dimensions of the body, this article argues for an invigorated, more complex understanding of the body in social work theory, practice, and research. Drawing from scholarship in the humanities, social sciences, and social work, a framework involving three dimensions of the body is proposed for integration with accepted ecological practice models. The nature and implications of three primary dimensions of the body for multiple domains of social work practice are explored, citing examples from narratives of mothers living with HIV disease: (1) the experiencing body, focused on the physicality of daily life; (2) the body of power, focused on the physicality of oppression and marginality, typically based on race or ethnicity, socioeconomic status, gender, sexual orientation, age, disability, physical appearance, and illness; and (3) the client body, reflecting the bodily experiences of those identified as clients who participate in relationships with social workers.

A pilot study of the experience of participating in a Therapeutic Touch practice group.

Science.gov (United States)

Moore, Theresa; Ting, Brigid; Rossiter-Thornton, Maria

2008-09-01

This pilot study explored the experience of participating in a Therapeutic Touch practice group. A qualitative descriptive-exploratory method was used, involving 12 members of practice groups in Ontario and British Columbia, Canada. Analysis of the data using an extraction-synthesis process yielded four themes: (a) learning with others through sharing and hands-on experience is valued; (b) connecting with a network of supportive relationships that sustain self and Therapeutic Touch practice; (c) comfort-discomfort arising with self, others, or ideas; and (d) meaningful changes emerge while experiencing group energy and Therapeutic Touch. The findings expand current knowledge about the positive aspects of participating in practice groups and provide a beginning understanding of member discomfort, which had not been previously reported. This knowledge will be useful to Therapeutic Touch organizations, practice group leaders, and group members. It will also guide health care agencies and practitioners of other healing modalities who may be considering establishing practice groups.

q=1 advanced tokamak experiments in JET and comparison with ASDEX Upgrade

International Nuclear Information System (INIS)

Joffrin, E.; Wolf, R.; Alper, B.

2002-01-01

The ASDEX Upgrade advanced tokamak scenario with central q close to 1 has been reproduced on JET. For almost identical q profiles, the comparative analysis does show similar features like the fishbone activity and the current profile evolution. In JET, transport analyses indicates that an internal transport barrier (ITB) has been produced. Gradient length criterions based on the ion temperature gradient turbulence stabilization are used to characterize the ITBs in both devices. The trigger of ITBs is associated with rational surfaces in both devices although the underlying physics for this triggering seems different. This experiment has the prospect to get closer to identity experiments between the two tokamaks. (author)

Interim Service ISDN Satellite (ISIS) simulator development for advanced satellite designs and experiments

Science.gov (United States)

Pepin, Gerard R.

1992-01-01

The simulation development associated with the network models of both the Interim Service Integrated Services Digital Network (ISDN) Satellite (ISIS) and the Full Service ISDN Satellite (FSIS) architectures is documented. The ISIS Network Model design represents satellite systems like the Advanced Communications Technology Satellite (ACTS) orbiting switch. The FSIS architecture, the ultimate aim of this element of the Satellite Communications Applications Research (SCAR) Program, moves all control and switching functions on-board the next generation ISDN communications satellite. The technical and operational parameters for the advanced ISDN communications satellite design will be obtained from the simulation of ISIS and FSIS engineering software models for their major subsystems. Discrete event simulation experiments will be performed with these models using various traffic scenarios, design parameters, and operational procedures. The data from these simulations will be used to determine the engineering parameters for the advanced ISDN communications satellite.

Advances in endodontics: Potential applications in clinical practice

Science.gov (United States)

Kishen, Anil; Peters, Ove A.; Zehnder, Matthias; Diogenes, Anibal R.; Nair, Madhu K.

2016-01-01

Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment. PMID:27217630

Student agreement regarding adequacy of didactic content and practical experiences of vaccination clinic business operations.

Science.gov (United States)

George, David L; Johnson, Eric J; O'Neal, Katherine S; Smith, Michael J

2018-04-01

To report student perceived adequacy regarding didactic content and practical experiences of vaccination clinic business operations. Didactic content, a case study, and practical experiences regarding vaccination clinic business operations were implemented in related lectures of a Pharmacy Business and Entrepreneurship (PBE) elective and the college of pharmacy sponsored vaccination clinics. An online survey was used to evaluate student perceived adequacy of didactic content and practical experiences of vaccination clinic business operations. Mean scaled agreement was compared between students in the PBE elective versus those not in the elective. Student confidence in performing business operations was also assessed. Students in the PBE had higher mean confidence than non-elective students regarding staff management (3.23 vs. 2.73, p = 0.04). Success of the interventions may be attributed to students in the PBE elective that reported a higher mean perceived adequacy of content and practical experiences and confidence in performing nearly all business operations. Still, further evaluation of interventions is being considered to assess effectiveness of learning. Published by Elsevier Inc.

Practical experiences with granular activated carbon (GAC) at the ...

African Journals Online (AJOL)

Practical experiences with granular activated carbon (GAC) at the Rietvlei Water Treatment Plant. ... The porosity was found to be 0.69 for the 12 x 40 size carbon and 0.66 for the 8 x 30 size carbon. By using a ... The third part of the study measured the physical changes of the GAC found at different points in the GAC cycle.

ETA-II experiments for determining advanced radiographic capabilities of induction linacs

International Nuclear Information System (INIS)

Weir, J.T.; Caporaso, G.J.; Clark, J.C.; Kirbie, H.C.; Chen, Y.J.; Lund, S.M.; Westenskow, G.A.; Paul, A.C.

1997-05-01

LLNL has proposed a multi-pulsed, multi-line of sight radiographic machine based on induction linac technology to be the core of the advanced hydrotest facility (AHF) being considered by the Department of Energy. In order to test the new technologies being developed for AHF we have recommissioned the Experimental Test Accelerator (ETA II). We will conduct our initial experiments using kickers and large angle bending optics at the ETA II facility. Our current status and our proposed experimental schedule will be presented

Family practice residents' maternity leave experiences and benefits.

Science.gov (United States)

Gjerdingen, D K; Chaloner, K M; Vanderscoff, J A

1995-09-01

A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

Advanced Test Reactor (ATR) Facility 10CFR830 Safety Basis Related to Facility Experiments

International Nuclear Information System (INIS)

Tomberlin, T.A.

2002-01-01

The Idaho National Engineering and Environmental Laboratory (INEEL) Advanced Test Reactor (ATR), a DOE Category A reactor, was designed to provide an irradiation test environment for conducting a variety of experiments. The ATR Safety Analysis Report, determined by DOE to meet the requirements of 10 CFR 830, Subpart B, provides versatility in types of experiments that may be conducted. This paper addresses two general types of experiments in the ATR facility and how safety analyses for experiments are related to the ATR safety basis. One type of experiment is more routine and generally represents greater risks; therefore this type of experiment is addressed with more detail in the safety basis. This allows individual safety analyses for these experiments to be more routine and repetitive. The second type of experiment is less defined and is permitted under more general controls. Therefore, individual safety analyses for the second type of experiment tend to be more unique from experiment to experiment. Experiments are also discussed relative to ''major modifications'' and DOE-STD-1027-92. Application of the USQ process to ATR experiments is also discussed

Advanced and extended scope practice of radiographers: The Scottish perspective

International Nuclear Information System (INIS)

Henderson, I.; Mathers, S.A.; McConnell, J.; Minnoch, D.

2016-01-01

Purpose: The impact of changing roles, skill mix and a shortage of consultant radiologists on the profession of diagnostic radiography is not clearly understood in Scotland although the anecdotal perspective suggests the situation in many areas does not equate to that of England. Method: A questionnaire survey was administered to ‘lead diagnostic radiographers’ across all Health Boards in Scotland and this was supplemented with telephone interviews. Results: The implementation of skill mix initiatives and particularly advanced/extended scope practice was found to be geographically variable with limited evidence of change in some areas. Lack of effective funding and backfill for training was found to be a major barrier to change, although it was also acknowledged that opposition from some professional groups could be a major factor. Conclusion: Although there is some optimism and evidence of accelerating change, development of the radiographic workforce in Scotland does not in general compare favourably to the findings of Price et al., in 2007. The reasons are multi-factorial including fiscal, professional and geographical elements. - Highlights: • Implementation of extended scope practice is geographically inconsistent. • AfC banding of radiographers in extended scope roles is inconsistent. • Funding and backfill for training is a recognised difficulty for many managers. • Professional opposition, primarily from radiologists is a barrier to implementation. • Extended scope roles make a notable contribution to enhanced outcomes.

Assessing the Spread and Uptake of a Framework for Introducing and Evaluating Advanced Practice Nursing Roles.

Science.gov (United States)

Boyko, Jennifer A; Carter, Nancy; Bryant-Lukosius, Denise

2016-08-01

Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods. The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts. We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively. Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these. This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been

Advanced Biasing Experiments on the C-2 Field-Reversed Configuration Device

Science.gov (United States)

Thompson, Matthew; Korepanov, Sergey; Garate, Eusebio; Yang, Xiaokang; Gota, Hiroshi; Douglass, Jon; Allfrey, Ian; Valentine, Travis; Uchizono, Nolan; TAE Team

2014-10-01

The C-2 experiment seeks to study the evolution, heating and sustainment effects of neutral beam injection on field-reversed configuration (FRC) plasmas. Recently, substantial improvements in plasma performance were achieved through the application of edge biasing with coaxial plasma guns located in the divertors. Edge biasing provides rotation control that reduces instabilities and E × B shear that improves confinement. Typically, the plasma gun arcs are run at ~ 10 MW for the entire shot duration (~ 5 ms), which will become unsustainable as the plasma duration increases. We have conducted several advanced biasing experiments with reduced-average-power plasma gun operating modes and alternative biasing cathodes in an effort to develop an effective biasing scenario applicable to steady state FRC plasmas. Early results show that several techniques can potentially provide effective, long-duration edge biasing.

Perceptions, views and opinions of university students about physics learning during practical work at school

International Nuclear Information System (INIS)

Sneddon, P H; Reid, N; Slaughter, K A

2009-01-01

The teaching of physics through practical experiments has long been an established practice. It forms a key component of teaching of that subject at both school and university levels. As such, students have strong views of this method of teaching. This paper reports on the view of undergraduate physics students in relation to their experiences of practical physics at school. 500 students across three Higher Education Institutions in the UK were surveyed to determine their perceptions, views and opinions in this area. This paper initially presents the overall views of the students, and then looks in more detail at the effect the different levels to which students took the subject at school affected those views. Specifically, students who took Advanced Higher versus Higher are compared, as well as those who took Advanced Higher versus A-level. Comparison was also made between the responses of female and male students. The general picture is very encouraging, with students broadly appreciating the practical side of physics.

Perceptions, views and opinions of university students about physics learning during practical work at school

Science.gov (United States)

Sneddon, P. H.; Slaughter, K. A.; Reid, N.

2009-09-01

The teaching of physics through practical experiments has long been an established practice. It forms a key component of teaching of that subject at both school and university levels. As such, students have strong views of this method of teaching. This paper reports on the view of undergraduate physics students in relation to their experiences of practical physics at school. 500 students across three Higher Education Institutions in the UK were surveyed to determine their perceptions, views and opinions in this area. This paper initially presents the overall views of the students, and then looks in more detail at the effect the different levels to which students took the subject at school affected those views. Specifically, students who took Advanced Higher versus Higher are compared, as well as those who took Advanced Higher versus A-level. Comparison was also made between the responses of female and male students. The general picture is very encouraging, with students broadly appreciating the practical side of physics.

HIV testing and counseling: test providers' experiences of best practices.

Science.gov (United States)

Myers, Ted; Worthington, Catherine; Haubrich, Dennis J; Ryder, Karen; Calzavara, Liviana

2003-08-01

Although education is central to HIV testing and counseling, little is known about the educational processes within the testing experience. This study investigated test providers' understandings of testing and counseling best practices. Interviews with a purposive sample of 24 test providers were thematically analyzed. Analysis revealed five best practices specific to HIV education and public health--ensuring information and education for HIV risk reduction, individualization of risk assessment, ensuring test results are given in person, providing information and referrals, and facilitating partner notification--and six practices not specific to HIV counseling relationship building. The latter were building trust and rapport; maintaining professional boundaries; ensuring a comfortable, safe environment; ensuring confidentiality; imparting nonjudgmntal attitude; and self-determination. The identified best practices demonstrated remarkable consistency across respondent subgroups. Although counseling was seen as largely educational and with a preventive focus, it included individualized messages based on assessments of risk, knowledge, and social and cultural characteristics.

Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure.

LENUS (Irish Health Repository)

Ryan, Marie

2012-02-01

BACKGROUND: Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person\\'s point of view as its central focus. AIM: The aim of this study was to describe patients\\' experiences of living with advanced heart failure. METHODS: The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. RESULTS: Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. CONCLUSIONS: The findings suggest that there may be an illogical but enduring ethos of \\'cure\\' pervading health care worker\\'s attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

Practical Applications and Experiences in K-20 Blended Learning Environments

Science.gov (United States)

Kyei-Blankson, Lydia, Ed.; Ntuli, Esther, Ed.

2014-01-01

Learning environments continue to change considerably and is no longer confined to the face-to-face classroom setting. As learning options have evolved, educators must adopt a variety of pedagogical strategies and innovative technologies to enable learning. "Practical Applications and Experiences in K-20 Blended Learning Environments"…

Wind and Solar Energy Curtailment: Experience and Practices in the United States

Energy Technology Data Exchange (ETDEWEB)

Bird, Lori [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cochran, Jaquelin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wang, Xi [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2014-03-01

This report examines U.S. curtailment practices, with a particular emphasis on utilities in the Western states. The information presented here is based on a series of interviews conducted with utilities, system operators, wind energy developers, and non-governmental organizations. The report provides case studies of curtailment experience and examines the reasons for curtailment, curtailment procedures, compensation, and practices that can minimize curtailment.

The Next Generation Nuclear Plant/Advanced Gas Reactor Fuel Irradiation Experiments in the Advanced Test Reactor

International Nuclear Information System (INIS)

Grover, S. Blaine

2009-01-01

The United States Department of Energy's Next Generation Nuclear Plant (NGNP) Program will be irradiating eight separate low enriched uranium (LEU) tri-isotopic (TRISO) particle fuel (in compact form) experiments in the Advanced Test Reactor (ATR) located at the Idaho National Laboratory (INL). The ATR has a long history of irradiation testing in support of reactor development and the INL has been designated as the new United States Department of Energy's lead laboratory for nuclear energy development. The ATR is one of the world's premiere test reactors for performing long term, high flux, and/or large volume irradiation test programs. These irradiations and fuel development are being accomplished to support development of the next generation reactors in the United States, and will be irradiated over the next ten years to demonstrate and qualify new particle fuel for use in high temperature gas reactors. The goals of the irradiation experiments are to provide irradiation performance data to support fuel process development, to qualify fuel for normal operating conditions, to support development and validation of fuel performance and fission product transport models and codes, and to provide irradiated fuel and materials for post irradiation examination (PIE) and safety testing. The experiments, which will each consist of at least six separate capsules, will be irradiated in an inert sweep gas atmosphere with individual on-line temperature monitoring and control of each capsule. The sweep gas will also have on-line fission product monitoring on its effluent to track performance of the fuel in each individual capsule during irradiation. The first experiment (designated AGR-1) started irradiation in December 2006, and the second experiment (AGR-2) is currently in the design phase. The design of test trains, as well as the support systems and fission product monitoring system that will monitor and control the experiment during irradiation will be discussed. In

Parental Attitudes Toward Advanced Behavior Guidance Techniques Used in Pediatric Dentistry.

Science.gov (United States)

Patel, Monica; McTigue, Dennis J; Thikkurissy, Sarat; Fields, Henry W

2016-01-01

To re-examine parental attitudes toward advanced behavior management techniques in pediatric dentistry and determine whether cost, urgency, and amount of treatment influence parental preferences. Parents viewed previously validated videotaped clinical vignettes of four advanced behavior guidance techniques: (1) passive immobilization; (2) active immobilization; (3) general anesthesia; and (4) oral sedation. The study was conducted in a children's hospital dental clinic and a suburban private pediatric dentistry office. Parents rated overall acceptance of the techniques, and acceptance under specified conditions using an anchored visual analogue scale. One hundred five parents completed the survey; 55 from the children's hospital and 50 from private practice. Oral sedation was rated as the most acceptable technique, followed by general anesthesia, active immobilization, and passive immobilization. As urgency, convenience, and previous experience increased, parental acceptance of the technique increased. As cost of treatment increased, parental acceptance decreased. Ratings between the children's hospital group and private practice group differed, as did the demographic variables of insurance, income, and race. The hierarchy of parental acceptance of advanced behavior guidance techniques is changing with increasing approval of pharmacological management and decreasing approval of physical management. The health care delivery system, urgency, convenience, previous experience, and cost all influence parental acceptance.

Family caregiving challenges in advanced colorectal cancer: patient and caregiver perspectives.

Science.gov (United States)

Mosher, Catherine E; Adams, Rebecca N; Helft, Paul R; O'Neil, Bert H; Shahda, Safi; Rattray, Nicholas A; Champion, Victoria L

2016-05-01

Family caregivers of advanced colorectal cancer patients may be at increased risk for psychological distress. Yet their key challenges in coping with the patient's illness are not well understood. Soliciting both patient and caregiver perspectives on these challenges would broaden our understanding of the caregiving experience. Thus, the purpose of this research was to identify caregivers' key challenges in coping with their family member's advanced colorectal cancer from the perspective of patients and caregivers. Individual, semi-structured qualitative interviews were conducted with 23 advanced colorectal cancer patients and 23 primary family caregivers. Interview data were analyzed via thematic analysis. In nearly all cases, patient and caregiver reports of the caregiver's key challenge were discrepant. Across patient and caregiver reports, caregivers' key challenges included processing emotions surrounding the patient's initial diagnosis or recurrence and addressing the patient's practical and emotional needs. Other challenges included coping with continual uncertainty regarding the patient's potential functional decline and prognosis and observing the patient suffer from various physical symptoms. Findings suggest that eliciting the perspectives of both patients and caregivers regarding caregivers' challenges provides a more comprehensive understanding of their experience. Results also point to the need to assist caregivers with the emotional and practical aspects of caregiving.

ADX: a high field, high power density, Advanced Divertor test eXperiment

Science.gov (United States)

Vieira, R.; Labombard, B.; Marmar, E.; Irby, J.; Shiraiwa, S.; Terry, J.; Wallace, G.; Whyte, D. G.; Wolfe, S.; Wukitch, S.; ADX Team

2014-10-01

The MIT PSFC and collaborators are proposing an advanced divertor experiment (ADX) - a tokamak specifically designed to address critical gaps in the world fusion research program on the pathway to FNSF/DEMO. This high field (6.5 tesla, 1.5 MA), high power density (P/S ~ 1.5 MW/m2) facility would utilize Alcator magnet technology to test innovative divertor concepts for next-step DT fusion devices (FNSF, DEMO) at reactor-level boundary plasma pressures and parallel heat flux densities while producing high performance core plasma conditions. The experimental platform would also test advanced lower hybrid current drive (LHCD) and ion-cyclotron range of frequency (ICRF) actuators and wave physics at the plasma densities and magnetic field strengths of a DEMO, with the unique ability to deploy launcher structures both on the low-magnetic-field side and the high-field side - a location where energetic plasma-material interactions can be controlled and wave physics is most favorable for efficient current drive, heating and flow drive. This innovative experiment would perform plasma science and technology R&D necessary to inform the conceptual development and accelerate the readiness-for-deployment of FNSF/DEMO - in a timely manner, on a cost-effective research platform. Supported by DE-FC02-99ER54512.

Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices.

Science.gov (United States)

Palakshappa, Deepak; Doupnik, Stephanie; Vasan, Aditi; Khan, Saba; Seifu, Leah; Feudtner, Chris; Fiks, Alexander G

2017-07-01

Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. We conducted 23 semistructured interviews with parents of children practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources. Copyright © 2017 by the American Academy of Pediatrics.

Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.

Science.gov (United States)

Conover, Chris; Richards, Robert

2015-01-01

With looming provider shortages and increased demand for health care, many states are looking for low-cost ways to alleviate the shortages. The purpose of this study was to assess the economic impact of less restrictive regulations for advanced practice registered nurses (APRNs) in North Carolina. We use economic impact analysis to demonstrate the economic impacts of making state scope-of-practice regulations on APRNs less restrictive in North Carolina. Outcomes include economic output, value-added, payroll compensation, employment, and tax revenue for North Carolina and for various subregions. If North Carolina adopted the same approach to APRN regulation as the least restrictive states, its economy will benefit from substantial increases in economic output and employment. The state will also see increases in tax revenue. In addition to substantially shrinking the size of projected physician shortages, allowing full scope-of-practice for APRNs will bring significant economic benefits to the state of North Carolina. Our analysis should be helpful to policy makers considering ways to deal with provider shortages. Copyright © 2015 Elsevier Inc. All rights reserved.

Career Advancement Experiences of Hispanic Secondary Principals in Suburban School Districts: A Phenomenological Study

Science.gov (United States)

Fernandez, Rick

2013-01-01

Purpose: The purpose of this study was to examine the perceptions and experiences of Hispanic secondary school principals who work in suburban school districts regarding their career advancement. Moreover, the objective of this research was to understand these Hispanic principals' motivational drivers and barriers regarding their career choices,…

Experience of Military Nurse Practitioners During their First Year of Practice

Science.gov (United States)

2000-05-01

Manen , 1990). Lived body refers to the phenomenological fact that we are always bodily in the world. Van Manen writes, in our physical or bodily...experience as it is lived. Phenomenology focuses on gaining a deeper understanding of the meaning of our everyday experiences ( Van Manen , 1990). The...preceptor stories, patients and practice, and looking toward the future. The data was related to Van Manen s four existential themes. This study is

Beliefs, practices, and experiences of Korean women in relation to childbirth.

Science.gov (United States)

Park, K J; Peterson, L M

1991-01-01

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Advancing community stakeholder engagement in biomedical HIV prevention trials: principles, practices and evidence.

Science.gov (United States)

Newman, Peter A; Rubincam, Clara

2014-12-01

Community stakeholder engagement is foundational to fair and ethically conducted biomedical HIV prevention trials. Concerns regarding the ethical engagement of community stakeholders in HIV vaccine trials and early terminations of several international pre-exposure prophylaxis trials have fueled the development of international guidelines, such as UNAIDS' good participatory practice (GPP). GPP aims to ensure that stakeholders are effectively involved in all phases of biomedical HIV prevention trials. We provide an overview of the six guiding principles in the GPP and critically examine them in relation to existing social and behavioral science research. In particular, we highlight the challenges involved in operationalizing these principles on the ground in various global contexts, with a focus on low-income country settings. Increasing integration of social science in biomedical HIV prevention trials will provide evidence to advance a science of community stakeholder engagement to support ethical and effective practices informed by local realities and sociocultural differences.

Research for the advancement of green chemistry practice: Studies in atmospheric and educational chemistry

Science.gov (United States)

Cullipher, Steven Gene

Green chemistry is a philosophy of chemistry that emphasizes a decreasing dependence on limited non-renewable resources and an increasing focus on preventing pollution byproducts of the chemical industry. In short, it is the discipline of chemistry practiced through the lens of environmental stewardship. In an effort to advance the practice of green chemistry, three studies will be described that have ramifications for the practice. The first study examines the atmospheric oxidation of a hydrofluorinated ether, a third-generation CFC replacement compound with primarily unknown atmospheric degradation products. Determination of these products has the potential to impact decisions on refrigerant usage in the future. The second study examines chemistry students' development of understanding benefits-costs-risks analysis when presented with two real-world scenarios: refrigerant choice and fuel choice. By studying how benefits-costs-risks thinking develops, curricular materials and instructional approaches can be designed to better foster the development of an ability that is both necessary for green chemists and important in daily decision-making for non-chemists. The final study uses eye tracking technology to examine students' abilities to interpret molecular properties from structural information in the context of global warming. Such abilities are fundamental if chemists are to appropriately assess risks and hazards of chemistry practice.

Focused development of advanced practice nurse roles for specific patient groups in a Swiss university hospital

Science.gov (United States)

Spichiger, Elisabeth; Zumstein-Shaha, Maya; Schubert, Maria; Herrmann, Luzia

2018-02-01

Background: To cover future health care needs of the population, new care models are necessary. The development of advanced nursing practice (ANP) offers the opportunity to meet these challenges with novel services. At the Inselspital, Bern University Hospital, ANP services and corresponding advanced practice nurse (APN) roles have been developed since 2011. Purpose: The aim is to develop innovative and evidence based ANP services to supplement health care for specific patient groups and their family members with the goal to improve safety and achieve better outcomes. Methods: Project-based ANP services are developed in close collaboration of clinical departments and the Nursing Development Unit (NDU) of the Directorate of Nursing. Structure, process and outcome data are collected for evaluation. Findings: Currently, five ANP services are established and running, eight more are in the developmental phase. Most services address the long term care of patients with chronic illnesses and their family members. Ten APNs work between 10 % and 80 %, three are leading an ANP-team. APNs work over 50 % in direct clinical practice, primarily in counselling. An ANP network connects APNs and NDU, promoting synergy and exchange. Conclusions: The available resources often constitute a challenge for the development of ANP services. Vital for the long-term success are an adequate extent of the position, the support by department directorate, the conceptual framework that is implemented across the whole hospital, and the development within project structures.

Fuel plate stability experiments and analysis for the Advanced Neutron Source

International Nuclear Information System (INIS)

Swinson, W.F.; Battiste, R.L.; Luttrell, C.R.; Yahr, G.T.

1992-01-01

The planned Advanced Neutron Source (ANS) and several existing reactors use closely spaced arrays of involute shaped fuel-plates which are cooled by water flowing through the channels between the plates. There is concern that at certain coolant flow velocities adjacent plates may deflect and touch, with resulting failure of the plates. Experiments have been conducted at the Oak Ridge National Laboratory to examine this potential phenomenon. Results of the experiments and comparison with analytical predictions are reported in this paper. The tests were conducted using full scale epoxy plate models of the aluminum/uranium silicide ANS involute shaped fuel plates. Use of epoxy plates and model theory allowed lower flow velocities and pressures to explore the potential failure mechanism. Plate deflections and channel pressures as function of the flow velocity are examined. Comparisons with mathematical models are noted. 12 refs

Fuel plate stability experiments and analysis for the Advanced Neutron Source

International Nuclear Information System (INIS)

Swinson, W.F.; Battiste, R.L.; Luttrell, C.R.; Yahr, G.T.

1993-05-01

The planned reactor for the Advanced Neutron Source (ANS) will use closely spaced arrays of involute-shaped fuel plates that will be cooled by water flowing through the channels between the plates. There is concern that at certain coolant flow velocities, adjacent plates may deflect and touch, with resulting failure of the plates. Experiments have been conducted at the Oak Ridge National Laboratory to examine this potential phenomenon. Results of the experiments and comparison with analytical predictions are reported. The tests were conducted using full-scale epoxy plate models of the aluminum/uranium silicide ANS involute-shaped fuel plates. Use of epoxy plates and model theory allowed lower flow velocities and pressures to explore the potential failure mechanism. Plate deflections and channel pressures as functions of the flow velocity are examined. Comparisons with mathematical models are noted

Practical experience in spent fuel management for German nuclear power plants

International Nuclear Information System (INIS)

Althaus, D.; Luehrmann, A.; Seepolt, R.; Springer, K.

1999-01-01

The paper describes the practical experience in spent fuel management gained in the past by using the traditional route of reprocessing and, since the amendment to the Atomic Law in 1994, by using also direct disposal via interim storage. (author)

The Experience of Evidence-Based Practice in an Australian Public Library: An Ethnography

Science.gov (United States)

Gillespie, Ann; Partridge, Helen; Bruce, Christine; Howlett, Alisa

2016-01-01

Introduction: This paper presents the findings from a project that investigated the lived experiences of library and information professionals in relation to evidence-based practice within an Australian public library. Method: The project employed ethnography, which allows holistic description of people's experiences within a particular community…

Advanced Concepts, Technologies and Flight Experiments for NASA's Earth Science Enterprise

Science.gov (United States)

Meredith, Barry D.

2000-01-01

Over the last 25 years, NASA Langley Research Center (LaRC) has established a tradition of excellence in scientific research and leading-edge system developments, which have contributed to improved scientific understanding of our Earth system. Specifically, LaRC advances knowledge of atmospheric processes to enable proactive climate prediction and, in that role, develops first-of-a-kind atmospheric sensing capabilities that permit a variety of new measurements to be made within a constrained enterprise budget. These advances are enabled by the timely development and infusion of new, state-of-the-art (SOA), active and passive instrument and sensor technologies. In addition, LaRC's center-of-excellence in structures and materials is being applied to the technological challenges of reducing measurement system size, mass, and cost through the development and use of space-durable materials; lightweight, multi-functional structures; and large deployable/inflatable structures. NASA Langley is engaged in advancing these technologies across the full range of readiness levels from concept, to components, to prototypes, to flight experiments, and on to actual science mission infusion. The purpose of this paper is to describe current activities and capabilities, recent achievements, and future plans of the integrated science, engineering, and technology team at Langley Research Center who are working to enable the future of NASA's Earth Science Enterprise.

Returns to nursing education: rural and nonrural practice.

Science.gov (United States)

Pan, S; Straub, L

1997-01-01

This study uses data from a national sample of registered nurses to compare earnings of nurses in rural and nonrural practice. The comparisons, conditioned by the nurses' education level, are analogous to the concept of "returns to human capital investment" used in labor economics. A general linear model is applied within a framework of labor economics analysis. Results show that nurses with more education receive less for their investment if they practice in rural areas. Work experience and employment setting are also related to lower annualized earnings for rural practice. One exception to the otherwise consistent findings is that returns to advanced practice nursing are higher in rural areas. Results and policy implications are discussed.

Does Experience Rating Improve Obstetric Practices?

DEFF Research Database (Denmark)

Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

2015-01-01

is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7–11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream......Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

Trispyrazolylborate Complexes: An Advanced Synthesis Experiment Using Paramagnetic NMR, Variable-Temperature NMR, and EPR Spectroscopies

Science.gov (United States)

Abell, Timothy N.; McCarrick, Robert M.; Bretz, Stacey Lowery; Tierney, David L.

2017-01-01

A structured inquiry experiment for inorganic synthesis has been developed to introduce undergraduate students to advanced spectroscopic techniques including paramagnetic nuclear magnetic resonance and electron paramagnetic resonance. Students synthesize multiple complexes with unknown first row transition metals and identify the unknown metals by…

Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

Science.gov (United States)

Hoff, Timothy; DePuccio, Matthew

2018-07-01

The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

[Differences in practice among physicians staffing an emergency department in relation to years of experience].

Science.gov (United States)

Busca, Pablo; Inchaurza, Estibaliz; Illarramendi, Aiora; Urbina, Ohiana; González, Laura; Miró, Òscar

2015-06-01

To determine differences in certain variables reflecting clinical practice in a group of emergency physicians with varying levels of experience and to explore whether differences are associated with experience. Retrospective observational study of differences in variables reflecting emergency physicians' practice between 2005 and 2012. We studied work variables (months worked, patients treated, caseload distribution according to triage levels), patient management variables (consultation with other specialists, admissions, ambulance requests), diagnostic procedures ordered (simple radiographs, laboratory tests, ultrasound or computed tomography imaging), and time patients discharged home spent in the department (arrival to discharge). We explored relationships between these variables and the emergency physician's experience using linear regression analysis, followed by the construction of multivariable models to adjust for physician characteristics. Data for 50 emergency medicine physicians, in 291 years of work, were analyzed. The specialists' experience ranged from 1 to 22 years (mean [SD], 9.5 [5.8] years). They attended between 47 and 158 patients monthly (mean, 86 [19] patients). The physicians' experience was inversely and independently related to the mean number of patients attended monthly and the percentage of patients assigned a triage level of 1 or 2. Experience was directly and independently related to discharged patients' time spent in the emergency department and number of simple radiographs ordered. All associations were small (R2<0.010), however. Those variables continued to show statistically significant associations after increasingly complex modeling to adjust for the following physician variables: physician, age, sex, specialty, residency training in the same hospital). The practice of emergency physicians with more accumulated experience shows slight but significant differences from the practice of less experienced physicians.

From hope to hope: the experience of older Chinese people with advanced cancer.

Science.gov (United States)

Chen, Hong; Komaromy, Carol; Valentine, Christine

2015-03-01

In our study that explored the current end-of-life care provision for Chinese older people with advanced/terminal cancer, hope emerged as a significant aspect of coping with their condition. Drawing on data from in-depth interviews with a group of older people, their family carers and health professionals, this article explores participants' constructions of hope in terms of what they were hoping for, how their hopes helped them cope with their illness and what sociocultural resources they drew on to build and sustain these hopes. While acknowledging similarities to Western studies of hope in terminal illness, this article identifies significant divergences in terms of the impact of different sociocultural values and their implications for clinical practice in light of an unfavourable health care environment for patients with advanced cancer and a social support system sustained mainly by Chinese families. It argues that hope represents an important resource for coping with terminal illness among these patients. © The Author(s) 2014.

Advancing Knowledge and Practice to Systems Thinking to ...

International Development Research Centre (IDRC) Digital Library (Canada)

Extrants. Articles de revue. Advancing the application of systems thinking in health: advice seeking behavior among primary health care physicians in Pakistan. Articles de revue. Advancing the application of systems thinking in health : a realist evaluation of a capacity building programme for district managers in Tumkur, ...

A qualitative study of the impact of the implementation of advanced access in primary healthcare on the working lives of general practice staff

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Offredy Maxine

2005-09-01

Full Text Available Abstract Background The North American model of 'advanced access' has been emulated by the National Primary Care Collaborative in the UK as a way of improving patients' access in primary care. The aim of this study was to explore the impact of the implementation of advanced access on the working lives of general practice staff. Methods A qualitative study design, using semi-structured interviews, was conducted with 18 general practice staff: 6 GPs, 6 practice managers and 6 receptionists. Two neighbouring boroughs in southeast England were used as the study sites. NUD*IST computer software assisted in data management to identify concepts, categories and themes of the data. A framework approach was used to analyse the data. Results Whilst practice managers and receptionists saw advanced access as having a positive effect on their working lives, the responses of general practitioners (GPs were more ambivalent. Receptionists reported improvements in their working lives with a change in their role from gatekeepers for appointments to providing access to appointments, fewer confrontations with patients, and greater job satisfaction. Practice managers perceived reductions in work stress from fewer patient complaints, better use of time, and greater flexibility for contingency planning. GPs recognised benefits in terms of improved consultations, but had concerns about the impact on workload and continuity of care. Conclusion AA has improved working conditions for receptionists, converting their perceived role from gatekeeper to access facilitator, and for practice managers as patients were more satisfied. GP responses were more ambivalent, as they experienced both positive and negative effects.

The experience of being a member of the Student International Community of Practice: a collaborative reflection

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Brighide M. Lynch

2015-05-01

Full Text Available Background: In 2010 a community of practice was set up for and by doctoral students engaged in person-centred and practitioner research. After three years, this community became part of a larger international community of practice. Aims and objectives: Captured under the stanzas of a poem and supported by the literature, this paper uses member narratives and creative expressions in a critical reflection on the experience of being a member of the Student International Community of Practice. Conclusions: Membership in the community of practice was experienced as beneficial, providing both support and challenge to enrich the doctoral students’ development as person-centred researchers. Retaining connectivity across an international landscape and finding effective ways to integrate new members into the community presented the greatest challenges. Implications for practice development: • The theoretical foundation and experiential knowledge could assist others considering support structures for the development of person-centred practices • Shared learning and co-creation of knowledge add value to the experience of being a doctoral researcher • Membership fluctuations present challenges to continuity of learning and the maintenance of a safe space with communities of practice. Such fluctuations, however, create chances for community members to experience diverse roles within the group and encourage explicit attention to person-centredness

Technologies for adaptation. Perspectives and practical experiences; Climate change

Energy Technology Data Exchange (ETDEWEB)

Christiansen, Lars; Olhoff, A; Traerup, S

2011-11-15

The present report is the second volume of the UNEP Risoe Centre Technology Transfer Perspectives Series. The report is related to the global Technology Needs Assessment (TNA) project, financed by the Global Environment Facility (GEF) and implemented by UNEP Risoe Centre. The nine articles in this volume discuss issues like: a) the concepts and context of technologies for adaptation; b) assessments of adaptation technology needs; c) practical experiences from working with technologies for adaptation. (LN)

Applying thematic analysis theory to practice: a researcher's experience.

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Tuckett, Anthony G

2005-01-01

This article describes an experience of thematic analysis. In order to answer the question 'What does analysis look like in practice?' it describes in brief how the methodology of grounded theory, the epistemology of social constructionism, and the theoretical stance of symbolic interactionism inform analysis. Additionally, analysis is examined by evidencing the systematic processes--here termed organising, coding, writing, theorising, and reading--that led the researcher to develop a final thematic schema.

Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

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Craig Vincent-Lambert

2016-10-01

Objectives: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment. Method: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment. Results: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

Assertiveness levels of nursing students who experience verbal violence during practical training.

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Unal, Sati; Hisar, Filiz; Görgülü, Ulkü

2012-08-01

The aim of the study was to investigate students' verbal violence experiences, the effect of assertiveness on being subjected to violence, the behaviour of students after the violence and the experience of psychological distress during practical training. The study sample consisted of 274 students attending a school of nursing. A questionnaire form and the Rathus Assertiveness Schedule (RAS) were used for data collection. Percentages, means and the independent samples t-test were used for the evaluation of data. During practical training, the students suffered verbal violence from teachers, department nurses and doctors. The students had higher mean scores of RAS for most types of violence committed by the teachers and being reprimanded by the nurses and 69.3% had not responded to the violence. Students with a high level of assertiveness are subjected to violence more frequently. Being subjected to verbal violence and feeling psychological distress during practical training are a major problem among nursing students. Students should be supported in terms of assertiveness and dealing with violence effectively.

Listening Instruction and Practice for Advanced ESL Students.

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Godfrey, Dennis

This paper attempts to enact Rivers' (1971 and 1972) urgings to base ESL listening instruction on both psychological and linguistic findings and contends that advanced ESL students' listening needs call for improvement in processing spoken English discourse. Psychological data on memory span is cited to demonstrate that advanced ESL students…

Servant leadership: a phenomenological study of practices, Experiences, organizational effectiveness and barriers

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Amy R. Savage-Austin, PhD

2013-07-01

Full Text Available The subject of leadership is complex, and one of the main issues facing organizational leaders today is how to motivate employees to actively participate in the efforts that lead to accomplishing organizational goals. This study gathered lived experiences of 15 organizational leaders who practice the servant leadership philosophy, and explored how business leaders link their servant leadership practices to their organization’s effectiveness. The qualitative responses obtained during this study indicated that the perceived organizational barriers that prevent the servant leadership practices are the organization’s culture, the fear of change, and the lack of knowledge regarding the servant leadership philosophy. This study also gained insight into the impact that these organizational barriers have on one’s ability to practice servant leadership

Nigerian Hospital Practice

African Journals Online (AJOL)

Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. Journal Homepage Image. The aim of the Nigerian Hospital Practice Journal is to aid in enhancing the advancement of medicine globally by acting as a medium for disseminating information on current clinical and drug practices in ...

Milestone experiments for single pass UV/X-ray FELs

Science.gov (United States)

Ben-Zvi, Ilan

1995-04-01

In the past decade, significant advances have been made in the theory and technology of high brightness electron beams and single pass FELs. These developments facilitate the construction of practical UV and X-ray FELs and has prompted proposals to the DOE for the construction of such facilities. There are several important experiments to be performed before committing to the construction of dedicated user facilities. Two experiments are under construction in the IR, the UCLA self-amplified spontaneous emission experiment and the BNL laser seeded harmonic generation experiment. A multi-institution collaboration is being organized about a 210 MeV electron linac available at BNL and the 10 m long NISUS wiggler. This experiment will be done in the UV and will test various experimental aspects of electron beam dynamics, FEL exponential regime with gain guiding, start-up from noise, seeding and harmonic generation. These experiments will advance the state of FEL research and lead towards future dedicated users' facilities.

Milestone experiments for single pass UV/X-ray FELs

International Nuclear Information System (INIS)

Ben-Zvi, I.

1994-01-01

In the past decade, significant advances have been made in the theory and technology of high brightness electron beams and single pass FELS. These developments facilitate the construction of practical UV and X-ray FELs and has prompted proposals to the DOE for the construction of such facilities. There are several important experiments to be performed before committing to the construction of dedicated user facilities. Two experiments are under construction in the IR, the UCLA Self Amplified Spontaneous Emission experiment and the BNL laser seeded Harmonic Generation experiment. A multi-institution collaboration is being organized about a 210 MeV electron linac available at BNL and the 10 meter tong NISUS wiggler. This experiment will be done in the UV and will test various experimental aspects of electron beam dynamics, FEL exponential regime with gain guiding, start up from noise, seeding and harmonic generation. These experiments will advance the state of FEL research and lead towards future dedicated users' facilities

Relating to the Experience of Contingency in Patients With Advanced Cancer: An Interview Study in U.S. Patients.

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Kruizinga, Renske; Jafari, Najmeh; Scherer-Rath, Michael; Schilderman, Hans; Bires, Jennifer; Puchalski, Christina; van Laarhoven, Hanneke

2018-03-01

Being diagnosed with incurable cancer can be a life-changing experience, evoking different spiritual questions and needs. Confronting a serious life-threatening event occurs not only often unexpected but also can disrupt a person's self-image and ideals of their personhood. This confrontation makes it difficult for people to integrate it into their personal life story-otherwise referred to as an experience of contingency. Different modes of relating to the contingent life event of having cancer have been studied in a Dutch patient population. Here we present an interview study in an U.S. population with advanced cancer patients. We included eight American patients with advanced cancer from the George Washington University Cancer Center. All patients were interviewed twice discussing their life events and life goals using a semistructured interview model. All interviews were transcribed and analyzed focusing on how patients described the way they related to the experience of having advanced cancer. The constant comparative method with a directed content analysis approach was used to code the themes in the interviews. The analyses show that the four modes of relating to contingency that we found in the Dutch study population can also be found in an American advanced cancer patient population. Differences were found in the extended way American patients described the fourth mode of "receiving." This study ensures a broader and deeper understanding of relating to the experience of contingency in having incurable cancer, which is crucial in developing accurate spiritual care in the palliative phase of patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Culture care theory: a major contribution to advance transcultural nursing knowledge and practices.

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Leininger, Madeleine

2002-07-01

This article is focused on the major features of the Culture Care Diversity and Universality theory as a central contributing theory to advance transcultural nursing knowledge and to use the findings in teaching, research, practice, and consultation. It remains one of the oldest, most holistic, and most comprehensive theories to generate knowledge of diverse and similar cultures worldwide. The theory has been a powerful means to discover largely unknown knowledge in nursing and the health fields. It provides a new mode to assure culturally competent, safe, and congruent transcultural nursing care. The purpose, goal, assumptive premises, ethnonursing research method, criteria, and some findings are highlighted.

Five important advances in hematopathology.

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Shi, Min; Xiao, Ruobing; Woda, Bruce A; Yu, Hongbo

2014-03-01

Hematopathology is a dynamic field that has always been on the frontier of clinical research within the scope of pathology. Several recent developments in hematopathology will likely affect its practice clinically. To review 5 important recent advances in hematopathology: (1) detection and prognostic implication of MYC in diffuse large B-cell lymphomas, (2) determining origin and prognosis through immunoglobulin gene usage in mature B-cell neoplasms, (3)detecting minimal residual disease in multiple myeloma, (4) using genome-wide analysis in myelodysplastic syndromes, and (5) employing whole-genome sequencing in acute myeloid leukemias. Literature review and the authors' experiences in an academic center. These advances will bring hematopathology into a new molecular era and help us to better understand the molecular, pathologic mechanisms of lymphomas, leukemias, myelomas, and myelodysplastic syndromes. They will help us to identify diagnostic and prognostic markers and eventually provide new therapeutic targets and treatments for these diseases.

Patient experience of source isolation: lessons for clinical practice.

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Barratt, Ruth Linda; Shaban, Ramon; Moyle, Wendy

2011-10-01

Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.

Beyond image interpretation: Capturing the impact of radiographer advanced practice through activity diaries

International Nuclear Information System (INIS)

Snaith, B.; Milner, R.C.; Harris, M.A.

2016-01-01

Background: There is limited evidence of the impact of radiographers working in advanced roles beyond task substitution. This study reviews the contribution of advanced (and consultant) practitioner radiographers to service delivery whilst reporting radiographs and demonstrates the impact this has on patients and staff, both internal and external to the imaging department. Method: The study was a prospective exploratory study using activity diaries to allow interval sampling when individuals were rostered to report. Data was coded using a compiled list of activities and recorded in 15-min intervals over the period of one week. Thirteen radiographers who independently report radiographs participated across 6 locations in a busy multisite English National Health Service (NHS) Trust. Results: Radiographers reported the majority of the examinations during the study period (n = 4512/5671; 79.6%). The total number of coded activities recorded over the study period was 1527, equating to 380.5 relative hours. The majority of available time was spent reporting, including dictating and verifying the reports of colleagues or trainees, although 69.5% of reporting time was interrupted. Based upon the hours of reporting there was an average of 19.3 reports (patient episodes) produced per hour. Direct patient care tasks and support for staff in decision making were regularly documented. Supplementary tasks included administrative activity, amendments to rotas, preparing presentations and documenting incidents identified during reporting. Conclusion: This study has demonstrated the breadth and complexity of the activities performed by advanced practice radiographers. The findings confirm their role in supporting service delivery beyond image interpretation. - Highlights: • Radiographers can make a significant contribution to reporting workloads. • The range of activities undertaken when reporting is complex and varied. • Reporting radiographers impact on staff, patients

Role of laser myringotomy in a pediatric otolaryngology practice: initial experience

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Shah, Udayan K.

2001-05-01

A new technology (OtoLAM) to fenestrate the tympanic membrane with the carbon dioxide laser (CO2), in the office or the operating room, has been introduced over the last three years. While not new conceptually, this product offers the ability to easily create a precise window into the middle ear using a portable system. Controversy regarding the indications and benefits of this technique, amplified by the costs of the system and the marketing of the technology prior to extensive clinical testing, has plagued the clinical application of this technology. We report our experience over the past year with this system in a busy pediatric otolaryngology practice. Laser fenestration of the tympanic membrane has been useful for the insertion of tympanostomy tubes, and for the minimally invasive evaluation of the middle ear. Our small experience to date reveals that there is a limited role for laser tympanic membrane fenestration in a busy pediatric otolaryngology practice.

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

Energy Technology Data Exchange (ETDEWEB)

Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

2006-09-01

The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

Student Teachers' Experiences of Relation Building in Teaching Practice