The Role Of The Nurse Practitioner In Support Of Families Experiencing Chronic Sorrow

Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief-related feelings associated with ongoing disparity resulting from a loss experience (Eakes, 2004). As a concept, chronic sorrow speaks to the emotional strain in the lived experiences of caregivers of the chronically ill and disabled. The term chronic sorrow was first used by Olshansky (1962) to describe the grief and sadness that parents felt when their child was first diagnosed as being mentally retarded. Research on chronic sorrow has proven its presence not only in parents, but in other family members, caregivers, and those with an illness or disability. Furthermore, chronic sorrow as a phenomenon has also been recorded in caregivers of the physically ill, mentally ill, and those disabled. Healthcare providers across all disciplines are in constant contact with individuals who are dealing with hopeless situations and many of them are experiencing chronic sorrow. It is inconceivable that with modem medicine and technological advancements, the majority of healthcare providers are at a loss in dealing with those caregivers who suffer. Therefore, this author has chosen to look at the progress made since the original usage by Olshansky. To this end, a systematic integrated review of the literature using computer searches of CINAHN, MEDLINE, the Cochrane Library, and electronic media was done in an effort to identify the current level of healthcare knowledge regarding the role of the nurse practitioner in providing support to families experiencing chronic sorrow. These searches produced a limited number of articles regarding support by any healthcare professional and none that referenced nurse practitioners. However, the literature was rich with progressive information and noted enormous gains in understanding of this phenomenon over the past two decades. Of particular importance was information about the instigation of the Nursing Consortium for Chronic Sorrow, the development of the Chronic Sorrow Questionnaire, and the ongoing work to further develop the middle range nursing theory of chronic sorrow. The Uncertainty in Chronic Illness Model developed by Merle Mishel was used as the theoretical foundation for this review. This model is used to describe and to establish an understanding of the uncertainty or unpredictability and lack of consistency that is ever present in chronic illness (Mishel, 1990). Within this review the theoretical and operational definitions of chronic sorrow, nurse practitioner, healthcare provider, and family support were explored. From this review, it is evident that there is a need for further considerations regarding the role o f the nurse practitioner in support of families experiencing chronic sorrow. Further evidenced is the need to fill the void in education of advanced practice nurses as it relates to this phenomenon. Within this review, implications for nursing theory, nursing research, advanced nursing practice, nurse practitioner education, and health policy are provided as they emerge from the concepts explored

A study of the perception of the impact of modeling on the development of commitment to action in Decision Conferencing.

Managers are increasingly faced with making complex decisions in turbulent organisational environments. This has led to greater information processing demands. Increasingly organisations try to deal with this in such a way that many of these decisions are now made in a group environment. The increase in group decision making has generated a corresponding intensification in the interest in options available to support such decision making. One such approach is a Group Decision Support System (GDSS) referred to as Decision Conferencing. However, Decision Conferencing rests on the unsupported key premise that the computer modeling, which forms an intrinsic part of the process, leads to shared understanding and commitment - the stated goals of the process. The application of Decision Conferencing to important organizational issues continues, yet prior to this study its fundamental premise was both empirically unsupported and potentially under-theorised. This theory-building research demonstrates that the interface between these concepts is more complex than the literature suggests and that the concepts themselves are problematic. Shared understanding is essentially a dependent variable, with factors such as comprehension of the modeling process impacting on the degree to which this is developed. In addition, many aspects of commitment fall outside of the domain of the Decision Conference workshop e.g. the individual’s sense of responsibility and degree of commitment to their profession. The idea of commitment appears to fall more into the arena of managerial responsibility and change management and it is partly how the outcomes are managed after the Decision Conference which will be crucial to their implementation.Within this study it appears that the most a Decision Conference can offer is the ‘buy-in’ or constructive involvement of the individual participant; the assurance of an unassailable case to which all participants have contributed, for the adoption of the outcomes; and the confidence in the outcomes that this brings. All of this suggests that a higher order goal which subsumes these factors should be considered when re-conceptualising the Decision Conferencing experience. It is suggested here that Decision Quality is a more appropriate goal for the Decision Conferencing process. In essence this is an expansion of the existing ‘best bet’ concept already endorsed in the Decision Conferencing literature. The thesis presents a number of conditions for assuring decision quality e.g. a democratic environment for decision making; mutual respect and an encouragement of diversity. It is also argued that it falls to the facilitator to encompass all of these factors. Given the above, it is also suggested that it is appropriate to consider an alternative conceptualization of Decision Conferencing which facilitators of public sector groups might adopt. This revised conceptualization is drawn from complexity theory. Incorporating the findings from this study a more strongly theorised facilitation approach, entitled Quality Facilitation Practice (QFP) has been developed. Taking into account all of the above a revised model for Decision Conferencing in the public sector is presented, incorporating both QFP and the higher order goal of Decision Quality

Play and learning in early childhood education: tensions and challenges

International research promotes the value of play for children’s learning and development. However, in early childhood education the development of national policy frameworks highlights a tension, and possible contradiction, between play for its own sake, and educational play. This paper explores these two positions, drawing on contemporary socio-cultural theories. Freely chosen play reflects children’s choices, interests and inquiries, and is understood as complex socio-cultural activity. Educational play focuses on curriculum goals and outcomes, and requires early childhood educators to plan for play in ways that direct children’s learning towards those goals. Recent research on children’s interests and inquiries offers solutions for pedagogical approaches that connect the curriculum as lived experiences, and curriculum as planned experiences, both of which reflect children’s cultural repertoires and peer cultures.Pesquisas internacionais promovem o valor do brincar para a aprendizagem e o desenvolvimento das crianças. No entanto, na educação infantil, o desenvolvimento de quadros de políticas nacionais destaca uma tensão, e uma possível contradição, entre o brincar por si só e o brincar educativo. Este artigo explora essas duas posições, baseando-se em teorias socioculturais contemporâneas. O brincar livremente escolhido reflete as escolhas, os interesses e as indagações das crianças, e é entendido como uma atividade sociocultural complexa. As brincadeiras educativas concentram-se nos objetivos e nos resultados do currículo e exigem que os educadores de infância planeiem as brincadeiras de forma a direcionar a aprendizagem das crianças para esses objetivos. Investigação recente sobre os interesses e questionamentos das crianças oferece soluções para abordagens pedagógicas que ligam o currículo como experiências vividas e o currículo como experiências planeadas, ambos refletindo os reportórios culturais das crianças e as culturas de pares

The Role of Task Manipulations on the Invariant Phasing Characteristics of a Generalized Motor Program (Relative Timing).

Four experiments are reported that investigate the role of relative timing as an invariant characteristic of the generalized motor program. Based upon the concept of a generalized motor program, relative time as an invariant characteristic, should remain constant when variant features of a movement are manipulated. In the present series of experiments, a practice and transfer paradigm was used to investigate the influence of required parameter modifications on the relative timing characteristics during the transfer performance of a practiced three-component movement response. Following 150 training trials (100 trials on Day 1 and 50 trials on Day 2), subjects (n = 12) were randomly assigned to 1 of 10 transfer conditions that manipulated the variant features of the training task. Fifty transfer trials were performed that differed from the training task in terms of the geometric, dimension, direction or muscle selection characteristics. Results based on group analysis of variance and individual linear regression, indicated that for all parameter characteristic manipulations, relative timing patterns during transfer performance deviated significantly from those established during training trials. These results are in contradiction with previous studies which have supported the idea that timing structure remains invariant across changes in muscle selection and event duration. However, since the absolute magnitude of the relative timing proportion changes were so small, typically from .5 to 2%, a modification in the current definition of relative timing invariance is suggested rather than an abandonment of the construct as a generalized motor program feature

Cytokines, antibodies and plasma viremia of cats infected with feline immunodeficiency virus

2013 Spring.Includes bibliographical references.Feline immunodeficiency viruses (FIVs) are naturally occurring lentiviruses (family Retroviridae) of felid species, including domestic and wild cats. Studies on FIVs are beneficial for understanding the host immune response associated with disease progression (e.g., domestic cat FIV) or the viral kinetics and molecular ecology associated with naturally occurring infections in wildlife (e.g., bobcat and mountain lion FIVs). Here we describe the development and validation of the following microsphere immunoassays (MIAs) for evaluating the cytokine and antibody response of domestic cats: i) the quantification of cytokines (interferon gamma (IFNγ), interleukin (IL)-10, and IL-12/IL-23) in cell culture supernatant, and ii) the quantification of these cytokines in plasma; iii) the quantification of total IgG and IgA in plasma, and iv) the detection of IgG and IgA antibodies to feline CD134 (the primary cell receptor for FIV), and FIV capsid (CA) and surface (SU) proteins in plasma. These assays were used to evaluate temporal cytokine and antibody responses of domestic cats experimentally infected with various FIV strains. To analyze viral RNA loads associated with naturally occurring FIV infections in bobcats or mountain lions, we are adapting existing quantitative PCR assays for use with plasma samples. The eight assays described here are/will be beneficial for addressing questions related to lentiviral immune response and viral kinetics

The search for exudates from Eurasian watermilfoil and hydrilla

Secondary metabolites are produced by aquatic plants, and in some instances, exudation of these metabolites into the surrounding water has been detected. To determine whether infestations of Eurasian watermilfoil or hydrilla produce such exudates, plant tissues and water samples were collected from laboratory cultures and pond populations and were analyzed using solid phase extraction, HPLC, and various methods of mass spectrometry including electrospray ionization, GC/MS, electron impact and chemical ionization. Previously reported compounds such as tellimagrandin II (from Eurasian watermilfoil) and a caffeic acid ester (from hvdrilla), along with a newly discovered flavonoid, cyanidin 3 dimalonyl glucoside (from hydrilla), were readily detected in plant tissues used in this research but were not detected in any of the water samples. If compounds are being released, as suggested by researchers using axenic cultures, we hypothesize that they may be rapidly degraded by bacteria and therefore undetectable

Long-term condition management in adults with intellectual disability in primary care: a systematic review

Background: Adults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions. Aim: To synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care. Design & setting: Mixed-methods systematic review. Method: Seven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis. Results: Fifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care. Conclusion: Adults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required

Building a Framework for Change

Change is never easy. Sustained change in education is particularly difficult. To get the desired results, all of the stakeholders must have a shared vision for learning. It is a process not a destination. Brewer Elementary School has been in the process of change in the past several years. Brewer is in the heart of Columbus, Georgia. The school opened in 1991. The building itself is a welcome focal point in a community of apartments, low rent housing, trailer parks and businesses. It is a safe, clean, happy place for children to learn. The school currently has approximately 520 students in pre-kindergarten thru fifth grade. There is a high population of special education students served at the school in the mildly intellectually disabled, severe/profound, learning disabled and behavior disordered programs. Ninety-two percent of the children are African American, four percent Caucasian, two percent Hispanic and two percent are of mixed race. There is an even distribution of male and female students