The measurement of clinical skills performance continues to pose a challenge for nurse educators. This paper will report on the use of the objective structured clinical examination (OSCE) to measure the psychomotor learning outcomes of a programme designed to assist students to learn to conduct a nursing neurological examination. The OSCE has a tradition in medicine, having been developed by Ronald Harden in Scotland and first reported in the British Medical Journal in 1975. The University of Ottawa has the longest North American experience with this type of evaluation procedure and there is an increasingly rich medical literature referring to the OSCE. Although the OSCE appears to be a promising method for evaluating competence in the performance of clinical skills, there are no studies in the nursing literature examining the use of the OSCE as a method for evaluating the performance of clinical skills by nurses. Our experience suggests that the OSCE may be a powerful tool in the evaluation of clinical competence in nursing and that it may also be an effective facilitator for learning to perform clinical skills in nursing.
The importance of nursing theories and models for the growth and development of the profession of nursing is widely acknowledged. The variety of nursing phenomena and situations demands some flexibility in the choice of specific conceptualizations to be used. This paper demonstrates the goodness of fit of the Betty Neuman Systems Model to the care of clients with multiple sclerosis. An adapted assessment tool, based on Neuman's tool, but more useful in the acute care medical setting, is used to gather data related to a woman with recently diagnosed multiple sclerosis. A nursing care plan illustrating the use of Neuman's model is generated, implemented and evaluated. The Neuman Model is demonstrated to be useful and effective in the implementation of the nursing process in this case.
This article describes the introduction of a community nutrition specialist nurse role in Buckinghamshire. The need for this role arose from issues experienced by the large but busy district nursing team (caseload of >300 patients per day) in home enteral feeding management and troubleshooting. The post holder was appointed to support community, hospital, dietitians and industry home care nurses with nutritional screening in the community and home enteral feeding, with a greater focus on the former. The post holder was involved in the development of a community version of MUST along with a care pathway and the design of a training programme to improve district nurses' knowledge and confidence in managing malnutrition in the community. The post holder is also involved providing patients personalised advice for managing malnutrition and in referrals to the community dietetics team. Such innovations in staffing are vital if the negative impact of malnutrition on patients and the health service is to be curtailed.
Abstracts -13th World Congress on Disaster and Emergency Medicinedistributed to the workers to assess their hazard exposures and their local experiences related to work and industrial hazards, chemical exposures, and their consequent health effects. Interviews and focus group discussions also were conducted. Results: There was 100% use of chemicals in the industries used as raw material or solvents for processing including toluene, alcohols, lead, and trichloro-and perchloroethylene. The industries generated dust and vapours, as well as acids and caustics. The blood lead levels of the 285 subjects sampled indicated that 40.7% had blood lead levels within the 21-30 ug/dL, which is considered by the Department of Health as inimical to the health of workers. When hazards and illness were correlated with the alpha set at 0.05, radiation exposure was associated with bone pain, and dust exposure with eye strain and viral exposure. Based on the results, a proposed exposure rating instrument for chemical exposure was developed. This tool provides an easy assessment of chemical risks using factors such as contact with the body surface, generation of vapor within the breathing zone, threshold limit values (TLV), and exposure time. For example, exposure rating estimate of "0" means "no" exposure either through dermal contact or within the breathing zone of the worker. "Moderate" exposure is given an estimate of "2", which means an exposure time of less than 50% of the total 8-hour workday. "Very high" exposure is excessive exposure above the TLV that varies by the chemical, and when the exposure time is beyond the 8-hour work duration. The interviews revealed that the terms of employment included lack of social benefits, practice of unfair labor terms like apprenticeship where workers are given only 75% of the minimum wage, forced overtime, piece-rate wage rather than daily minimum wage, and the restriction from organizing labor.
Recommendations:It is suggested that a broad front of strategies coupled by a policy framework for industrial hazard exposures be developed. To fight for social inclusion at work means more involvement of the stakeholders in the development of actions to improve their control of their work, enhanced entitlements to economic and social benefits through policy frameworks of national governments and a thorough democratic alliance of various sectors including the now, so called third sector, so that social objectives are not subjugated to pure economic considerations. Disasters from industrial hazards can be reduced or controlled through the review of labour standards and the engagement of workers themselves through active labour organization to attain levels of safety and health in the workplace.
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