Comparison of multicultural literature in three health professions: physical therapy, nursing & social work

All health professions' education programs are mandated by their accrediting agencies to include diversity and multicultural content within their curricula. This article reviews literature from the three professions of nursing, social work, and physical therapy that indicates that they accomplish this at different places on the continuum of curricular integration and transformation as identified by Banks. An examination of the complexity of each profession's standards, and a comparison of the depth of cultural competency within each profession is included. Even with the more 'experienced' professions of social work and nursing, there appear to continue to be inconsistencies in the structuring and teaching of multicultural content.     

Hispanic acculturation: a concept analysis.

Although acculturation has been widely used as a health research variable among Hispanics, several inconsistencies exist in the definitions of this concept. The work of Walker and Avant is used as a guide to analyze and to clarify the definitions of acculturation in the Hispanic population. Multidisciplinary research studies involving Hispanic populations and the concept of acculturation are reviewed. Defining attributes include interaction between two cultures, change, learning, adaptation, and sociocultural context. Antecedents, consequences, case studies, and empirical referents are discussed. Implications for future practice and research are also identified.     

Shock at the millennium. I. Walter B. Cannon and Alfred Blalock

Present management of shock derives, in part, from the classic investigations of Walter B. Cannon and Alfred Blalock. The intersections of their professional lives as recorded in the professional literature and in personal correspondence suggest that Blalock's pivotal studies of experimental shock were fueled, at least in part, by Cannon's inability to resolve the inconsistencies of the then-popular toxic theory of shock. Cannon appears to have substantially shaped Blalock's thought and work, initially as authority and competitor and later as colleague and friend. Blalock's experimental proof that injury precipitated obligatory locoregional fluid losses, the effects of which could be ameliorated by vigorous restoration of plasma volume, became a cornerstone of shock theory and therapy.     

Tests of thyroid function: update in the diagnosis and management of thyroid disease

Current thyroid function tests give the clinician powerful tools for the accurate assessment of thyroid status in the majority of patients encountered. There are, however, a small number of clinical situations in which there appear to be inconsistencies in the interrelationship of the thyroid function tests and/or in which they are apparently inappropriate to the clinical status of the patient. In most instances, there is a rational explanation for these observed alterations. The application of this information should allow clinicians to further refine their diagnostic accuracy and thereby enable them to proceed with an appropriate therapeutic or management program.     

Role of brain death and the dead-donor rule in the ethics of organ transplantation

The "dead-donor rule" requires patients to be declared dead before the removal of life-sustaining organs for transplantation. The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. Brain death is essential to current practices of organ retrieval because it legitimates organ removal from bodies that continue to have circulation and respiration, thereby avoiding ischemic injury to the organs. The concept of brain death has long been recognized, however, to be plagued with serious inconsistencies and contradictions. Indeed, the concept fails to correspond to any coherent biological or philosophical understanding of death. We review the evidence and arguments that expose these problems and present an alternative ethical framework to guide the procurement of transplantable organs. This alternative is based not on brain death and the dead-donor rule, but on the ethical principles of nonmaleficence (the duty not to harm, or primum non nocere) and respect for persons. We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead. Advantages of this approach are that (unlike the dead-donor rule) it focuses on the most salient ethical issues at stake, and (unlike the concept of brain death) it avoids conceptual confusion and inconsistencies. Finally, we point out parallel developments, both domestically and abroad, that reflect both implicit and explicit support for our proposal.     

Using a computer simulation program to assess the decision-making process in child health care.

The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.     

Use of X-linked short tandem repeat loci in routine parentage casework

BACKGROUND: Dealing with genetic inconsistencies in parentage testing, especially in motherless cases, remains a continual difficulty. STUDY DESIGN AND METHODS: Four difficult cases, comprising two trios and two duos, were selected from routine parentage testing casework. In these, relatively low combined paternity indices were observed as a result of few discrepant loci that were treated as being due to paternal mutations. An additional eight short tandem repeat (STR) loci along the X chromosome were studied in the alleged father and female child to try and help resolve these cases. RESULTS: In all four cases, the X chromosome haplotypes in the alleged father were different from those in the child, showing decisively that the alleged father could be excluded from being the biologic father of the child. CONCLUSION: In recent times the study of X chromosome haplotypes has been shown to be useful in parentage testing where the alleged father is absent and where only his close relatives are available for testing. This work demonstrates that such studies can also prove valuable in the testing of standard trios and duos in cases where there only a few genetic inconsistencies amongst the loci tested, making it difficult to distinguish between paternal mutations and a close relative of the alleged father being the biologic father.     

Ethical arguments for providing palliative care to non-cancer patients

Palliative care professionals have begun to address the issues surrounding the provision of palliative care to non-cancer patients. Yet the situation remains inconsistent and morally unjustifiable. The duty to provide care, non-maleficence, beneficence, protecting the patient's best interests and respecting patient autonomy are key responsibilities which palliative care professionals have for all their patients, regardless of their diagnosis. On the grounds of justice as fairness, equality and equity, the current inconsistencies in the provision of palliative care to non-cancer patients are unfair unequal and inequitable. Professionals can no longer ignore their moral responsibility to address these issues and change their practice to include the provision of care for dying patients regardless of their diagnoses.     

Developing clinical guidelines in eye care for intensive care units

It is common for children in paediatric intensive care units (PICUs) to have impaired ocular defence mechanisms. The authors discovered inconsistencies in eye care practice in their PICU and found that there were no clinical guidelines available to promote evidence-based practice and prevent corneal complications. This article describes the issues involved and the development of a guideline that is now in use.     

Using Deweyan philosophy to rename and reframe adaptation-to-environment.

John Dewey's philosophy has been suggested as having been formative in the philosophy of occupational therapy, but the occupational therapy literature offers few analyses of Dewey's work and its implications for the discipline. I offer an abbreviated analysis of Deweyan philosophy and then assess how adequately that philosophical corpus has been interpreted in the occupational therapy literature. My conclusion is that significant inconsistencies exist between a Deweyan perspective and selected concepts in occupational therapy. I take particular issue with the concept of adaptation-to-environment and specifically with aspects of that conceptualization that I term "environment as container," "subjective-internalized focus," and "mechanization of processes." I offer an alternative concept, "place integration," that is more consistent with Dewey's philosophy. The advantages of the conceptual renaming and reframing are discussed.     

Transtibial energy-storage-and-return prosthetic devices: a review of energy concepts and a proposed nomenclature

Prosthetic devices that can store and return energy during gait enhance the mobility and functionality of lower-limb amputees. The process of selecting and fitting such devices is complicated, partly because of confusing literature on the topic. Gait analysis methods for measuring energy characteristics are often incomplete, leading to inconsistencies in the energy classifications of different products. These inconsistencies are part of the reason for the lack of universally accurate terminology in the field. Inaccurate terminology perpetuates misunderstanding. In this paper, important prosthetic energy concepts and methods for measuring energy characteristics are reviewed. Then a technically accurate nomenclature and a method of functional classification are proposed. This review and proposed classification scheme should help to alleviate confusion and should facilitate enhancement of the design, selection, and fitting of prosthetic limbs for amputee patients.     

Nursing Leadership,Missing Questions,and the Elephant(s) in the Room: Problematizing the Discourse on Nursing Leadership

To expose inconsistencies and contradictions in the nurse leadership literature (“text”), this article adopts a deconstructive approach and draws upon the work of Derrida in examining the text or discourse. What is almost entirely missing in the literature are articles that ask difficult, searching questions that challenge some of the taken-for-granted truths or maxims about nursing leadership. The current examination of the literature, described in this article, shows: (a) a lack of convergence of the literature and health care/nursing organizations concerning leadership, (b) a conflation of nursing leadership with managerial or administrative positions, and (c) a possible lack of understanding about the complexity of nursing leadership coupled with an unwillingness to raise these issues.     

A competency-based approach for nursing care instruction. Analysis of teaching practices

The aims of this qualitative research is in understanding how the teaching methods of nursing instructors favor the student's development in competency. Eight nursing instructors were interviewed in a non-directive approach. A thematic as well as a structural analysis of the data indicates that in the majority of cases, their methods are based primarily on an impression and conditioning model, and in an isolated approach on an interactive and constructive model. The analysis of the nursing instructors' accounts in regards to their role as educators illustrates: an inadequacy between teaching goals and the choices of pedagogical methods; an ambivalent and unclear understanding of their role as instructor leading to the privileging of strategies for their success rate over teaching quality. inconsistencies in conveying the training and qualification evaluations as well as between the theoretical and clinical evaluations. In conclusion, various individual strategies, institutional and national, are offered with the view of favoring a competence-based approach for nursing training.     

A literature review of nursing turnover costs

Aim To report the findings of a literature review of studies examining nursing staff turnover costs published between 1990 and 2010. Background Nurse turnover is a global concern that is both costly for health-care organizations and, in the context of the work environment, affects quality and safety. Evaluation We reviewed past literature and describe the conceptualization of nurse turnover, evaluate the methodologies and calculation of costs, identify the reported range of turnover costs and provide suggestions for future study. Key issues We report inconsistencies in past studies in terms of the conceptualization and measurement of nurse turnover and turnover rates, the methodologies for gathering data and the data sources used, the approaches for calculating turnover costs and the resulting nursing staff turnover costs estimated. Conclusion Past studies reached different conclusions about nurse turnover. We still need to explore the actual costs and benefits of nurse turnover and retention. Implications for nursing management This study should be helpful for nurse executives as they build a business case to address nurse turnover in their organizations, and for policy-makers as they develop policies about turnover.     

Consistency of the Moreau CLL score

Background

The Moreau score is essential for the diagnosis of B‐cell lymphoproliferative disorders (B‐LPD).

Methods

We assessed the consistency of the Moreau score in a series of 138 patients with at least two samples involved by a B‐LPD (316 samples) other than germinal center‐derived malignancies, hairy cell leukemia, and mantle cell lymphomas. Patients with evidence of two distinct B‐LPDs were also excluded.

Results

We found 53 inconsistencies in 44 of 138 (32%) patients. FMC7 was the most inconsistent (18 cases) and CD5 the least (5 cases). CD200 was inconsistent in 6 of 67 (9%) cases. The most important predictive factor for the finding of antigenic inconsistencies was sampling of a different anatomic site. Other factors, including number of samples, time between samples, or cytogenetic group, were not predictive. For the most part, these inconsistencies did not appear to be clinically relevant.

Conclusion

Inconsistencies in the Moreau score are common, supporting the importance of integrated laboratory diagnosis. However, the practical implications of these antigenic inconsistencies are probably limited.

     

Development of Definitions for Taxonomy II

In the process of placing diagnoses into Taxonomy I. certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained. what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised. and describe the steps establishing the validity of the process of formation of the nine human response patterns.     

Development of definitions for taxonomy II.

In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.     

Guidelines in respect of advance directives: the position in England

The fundamental aim of the advance directive is to provide a means for the patient to continue to exercise autonomy and shape the end of his/her life. The principle is not new. Patients who are aware of approaching death have for many years discussed with their health-care team how they wish to be treated. The advance directive registers these views in a more formal way. However, inconsistencies persist in the understanding of the legal issues around advance directives in the UK, and suggest that national guidelines would encourage National Health Service trusts to develop local policies to improve understanding and compliance with the law. This article draws on English law to address misunderstandings and proposes which information advance directives should include.