Scientific inquiry in nursing: a model for a new age

Despite the acknowledged need for widespread and rapid scientific advancement in nursing, little systematic attention has been paid to the progenitor of research, the individual investigator. The nature of scientific problem solving as the fundamental process of research practice is explored, and a model of scientific inquiry is proposed. Variables in the model are discussed in relation to their potential effect on the inquiry process, and strategies that facilitate the practice of research are identified.     

Motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation technique: recommendations for the teaching-learning process

It is a bibliographic study about the identification of the motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation (CPR) which aims to obtain subsidies to the planning of the teaching-learning process of this skill. It was found that: the motor capacities involved in the psychomotor skill of the CPR technique are predominantly cognitive and motor, involving 9 perceptive-motor capacities and 8 physical proficiency capacities. The CPR technique is a psychomotor skill classified as open, done in series and categorized as a thin and global skill and the teaching-learning process of the CPR technique has an elevated degree of complexity.     

Unveiling Issues Limiting Participation of Children with Developmental Coordination Disorder: From Early Identification to Insights for Intervention

Developmental coordination disorder (DCD) is a motor skill disorder affecting motor development in children. Part I employed a quantitative approach to validate the DCDQ-C. A total of 123 children in mainstream schools were recruited. Reliabilty analysis, Rasch model analysis, and exploratory factor analysis were conducted. Part II tested the hypothesis that the correlation between movement skills and sensory processing patterns of children with motor coordination problems was different to that for children without motor coordination problems. Fisher’s r-to-z transformation was used to compare the correlation between the two groups. Part III used a case study approach to describe the activity participation of children with DCD. The motor performance, sensory problems, self-efficacy, and participation of the children at home, at school, and in the community were examined thoroughly. The DCDQ-C was confirmed to have favourable internal reliability and construct validity. The factor structured identified in this study was the same as the original scale. Through comparing the significant correlations between the DCD and typically developing groups, significant correlations were evidenced between poor fine motor and handwriting skills and low registration sensory processing pattern in the DCD group. The commonly reported difficulties among children with DCD were low emotional efficacy, low social self-efficacy, and difficulty participating in home- and community-based activities requiring fine motor, communication, or organizational skills. This study is significant as it assists therapists, teachers, and parents to a greater understanding of the underlying issues that may interfere with children’s participation at home, at school, and in the community.     

Learning from experience: differences in how novice vs. expert nurses diagnose why an infant is crying

Diagnosing client health problems is a well-recognized task for nurses. This study examined the effects of nursing education and experience on that problem-solving process by comparing the performance of four groups of nurses. Junior and senior nursing students, nursing students who were parents, and pediatric nurses solved two computer-presented problems. The task involved acquiring information in order to evaluate competing causal hypotheses. One problem concerned why an infant was crying and the other was a control problem. A number of group differences were identified. The experienced groups of pediatric nurses and parents differed from the student nurses by using less information and selecting different information units, such as information about the infant's age, earlier in the problems. Parents were the most accurate; they did not select any incorrect hypotheses. The dual roles of education and experience are discussed and it is proposed that computer-presented simulations can be an important tool for understanding problem-solving processes, as well as for promoting clinical skill development.     

Purposeful activity in motor learning theory: an event approach to motor skill acquisition

This paper presents the event approach to motor skill acquisition as a theoretical treatment of the learning and relearning of motor skills; the emphasis is toward rehabilitation of physical dysfunction. Purposeful activity is viewed as a necessary prerequisite for the formation of coordinative structures, which are the bases for skilled movement. Traditional approaches to motor learning, which focus primarily on the actor, are seen as inadequate to accurately describe motor skill acquisition. The event approach treats the actor and the environment as inseparable in the acquisition of skills. Using this approach, I hope to establish a common ground and collaborative relationships between the disciplines of occupational therapy and motor learning.     

Deliberate clinical inertia: Using meta‐cognition to improve decision‐making

Deliberate clinical inertia is the art of doing nothing as a positive response. To be able to apply this concept, individual clinicians need to specifically focus on their clinical decision‐making. The skill of solving problems and making optimal clinical decisions requires more attention in medical training and should play a more prominent part of the medical curriculum. This paper provides suggestions on how this may be achieved. Strategies to mitigate common biases are outlined, with an emphasis on reversing a ‘more is better’ culture towards more temperate, critical thinking. To incorporate such an approach in medical curricula and in clinical practice, institutional endorsement and support is required.     

Motor learning transiently changes cortical somatotopy

Learning a complex motor skill is associated with changes in motor cortex representations of trained body parts. It has been suggested that representation changes reflect the storage of a skill, i.e., the motor memory trace. If a reflection of the trace, such modifications should persist after training is stopped for as long as the skill is retained. The objective here was to test the persistence of learning-related changes in the representation of the forelimb of the rat after learning a reaching task using repeated epidural stimulation mapping of primary motor cortex. It is shown that the forelimb representations enlarge after 8 days of training (n=8) but contract while performing arm movements without learning (n=7, p=0.006); hindlimb representations remain unchanged. Enlargement correlated with learning success (r=0.82; p=0.012). Subsequently, after 8 days without training, representation size reverted to baseline while the motor skill was retained. Somatotopy remained unaltered by a second training phase in which performance did not improve further (n=5). These findings suggest that successful acquisition but not storage of a motor skill depends on cortical map changes. The motor memory trace in rats may require changes in motor cortex organization other than those detected by stimulation mapping.     

Improving free play skills of severely retarded children

Severely and profoundly retarded children are usually deficient in play skills. Since play facilitates socialization, language, and motor development, it is a vitally improtant skill to acquire. This pilot study examined the effects of a behavioral training program on the autistic, independent, and social types of play of four severely and profoundly retarded children. The training program involved the use of instructions, modeling, physical guidance, and verbal reinforcement. Results indicated that a marked increase in independent and social play occurred with the introduction of the training program with all four children. Occupational therapists can play an increasingly important role in helping educators formulate relevant educational programs for severely retarded children, particularly in the areas of play and motor skill development.     

1991 Muriel Driver lecture. The environment: a focus for occupational therapy

Individuals in Canada with a disability encounter environmental constraints that limit their active participation in the daily life of our communities. Fundamental inequities in participation and integration continue to exist and there is a need for a concerted effort to eliminate these disabling environments. Several factors, including the built environment, societal production of space, classification of individuals based on norms, the perception of disability as deviance, the power of health disciplines and bureaucracy are examined to determine their contribution to the creation of these disabling environments. Recent modifications to occupational therapy theory and practice, while meaningful, have not fully explored ways in which disabling environments limit occupation. Prevailing ideas about occupation and the environment are examined for their contribution to solving these environmental problems. Principles which can assist occupational therapy intervention directed at changing disabling environments are described. The intent is to define methods of changing disabling environments, based on the desires and active participation of people with disabilities     

Integrating motor control and motor learning concepts with neuropsychological perspectives on apraxia and developmental dyspraxia.

This paper reviews selected pertinent literature on the learning and performance of skilled motor acts. Information on normal motor performance is integrated with that on adult apraxia and related to common problems observed in children with developmental dyspraxia. The process of motor skill acquisition is outlined, and aspects of styles of motor organization, modes of control, premovement organization, sensory organization, and analysis of the types of errors are presented. Recommendations for clinicians working with children with developmental dyspraxia are offered.     

The value of intelligent multimedia simulation for teaching clinical decision-making skills

This paper examines the value of using intelligent multimedia simulation for the teaching of nursing clinical decision-making skills. The possibilities of multimedia-based educational resources are examined and the rapid growth and questionable effectiveness of current multimedia computer-based learning applications for nursing students are discussed. The advantages and disadvantages of this technology and the problems developing intelligent agent-based systems are examined. A case study is presented which uses a modular design with an integrated intelligent agent and knowledge base. It is argued that by using this type of approach, the real value of intelligent CBL to provide individual formative advice to students in a simulated experience can be realized.     

Unique Correlates of Problem Solving Effectiveness in Individuals with Generalized Anxiety Disorder

Over the last decade, research on the problem-solving characteristics of individuals high in chronic worry has waned. It is proposed that there remains a lot to be learned about the way in which excessive and uncontrollable worrying affects the way in which people approach problems. The present study examined the relations of negative problem orientation, problem solving styles, intolerance of uncertainty, and worry to in vivo problem-solving performance in people with generalized anxiety disorder (GAD; N?=?43). Problem-solving performance was assessed by rating participants’ ability to develop effective problem solutions. Impulsive/careless problem-solving style was uniquely predictive of lower effectiveness of problem solutions; whereas negative problem orientation, habitual avoidant problem solving style, intolerance of uncertainty and chronic worrying were not. After controlling for state anxiety, none of the variables were unique correlates of problem-solving effectiveness. The study represents an initial examination of the potential impact of negative problem orientation, dysfunctional problem-solving style, intolerance of uncertainty, and worry on problem-solving quality. The findings are discussed in relation to theoretical models and therapeutic approaches for GAD.     

Odd Sensation Induced by Moving-Phantom which Triggers Subconscious Motor Program

Our motor actions are sometimes not properly performed despite our having complete understanding of the environmental situation with a suitable action intention. In most cases, insufficient skill for motor control can explain the improper performance. A notable exception is the action of stepping onto a stopped escalator, which causes clumsy movements accompanied by an odd sensation. Previous studies have examined short-term sensorimotor adaptations to treadmills and moving sleds, but the relationship between the odd sensation and behavioral properties in a real stopped-escalator situation has never been examined. Understanding this unique action-perception linkage would help us to assess the brain function connecting automatic motor controls and the conscious awareness of action.     

Construct validity of the In-Hand Manipulation Test: a discriminant analysis with children without disability and children with spastic diplegia.

OBJECTIVE: This study examined the construct validity of the In-Hand Manipulation Test (IMT) by assessing the test's ability to discriminate between samples of children with and without known fine motor problems. METHOD: The IMT was administered to 55 children without known fine motor problems and 24 children with spastic diplegia who had mild to moderate fine motor problems. Construct validity was estimated by evaluating how accurately the IMT classified the children as having or not having fine motor problems on the basis of total score. RESULTS: A discriminant analysis indicated that IMT total score correctly classified 83.33% of the participants as having or not having fine motor problems. CONCLUSION: The IMT has adequate construct validity to classify the participants of this study and for continued use as a research instrument to assess children's in-hand manipulation skills. Additional validity studies of the IMT are needed with other samples of children before its use for clinical purposes.     

The role of the cerebellum in procedural learning—Are there implications for physiotherapists’ clinical practice?

Motor learning is the means by which we acquire skilled movements and consign them to permanent memory. Multiple brain areas are involved, and patients with neurological damage often experience difficulty when attempting to relearn previously learned skills. For these patients, the location of the lesion may be critical in influencing their motor skill relearning. The cerebellum has been described as an “on-line” comparator and corrector of movement, but recent research suggests that the cerebellum may also have a role in the later stages of motor learning, including the automation of movement patterns, although conflicting research in this area means that there is as yet no consensus. This knowledge may have implications for the way physiotherapists treat patients with cerebellar lesions. Some treatments in regular use by physiotherapists are discussed, and possible implications for practice are considered.     

Brain mechanisms underlying motor skill learning in the rat

Young rats subjected to bilateral brain lesions were subsequently tested for acquisition of eight puzzle-box problems. Lesions to 12 of the 37 brain sites investigated (anterior pretectal area, subthalamus, posterolateral hypothalamus, frontocingulate cortex, anterior thalamus, mediodorsal thalamus, ventromedial thalamus, parafascicular nucleus, mamillary bodies, cerebellum, olfactory bulb, and ventromedial hypothalamus) retarded puzzle-box learning. This study, combined with earlier investigation of 11 additional brain sites, show that 21 of the 48 total brain structures are involved in motor skill learning. These findings suggest that motor skill learning requires the integrity of a nonspecific mechanism and several specific mechanisms, such as vestibular-proprioceptive-kinesthetic discrimination mechanism and probably also response flexibility, visuospatial attentional, visual discrimination and place learning mechanisms.     

The role of the cerebellum in procedural learning--are there implications for physiotherapists' clinical practice?

Motor learning is the means by which we acquire skilled movements and consign them to permanent memory. Multiple brain areas are involved, and patients with neurological damage often experience difficulty when attempting to relearn previously learned skills. For these patients, the location of the lesion may be critical in influencing their motor skill relearning. The cerebellum has been described as an "on-line" comparator and corrector of movement, but recent research suggests that the cerebellum may also have a role in the later stages of motor learning, including the automation of movement patterns, although conflicting research in this area means that there is as yet no consensus. This knowledge may have implications for the way physiotherapists treat patients with cerebellar lesions. Some treatments in regular use by physiotherapists are discussed, and possible implications for practice are considered.