The apparent desensitization of student nurses during their professional socialization: a cognitive perspective

It is argued that the structures and processes of traditional patterns of pre-registration nurse education in the United Kingdom led to an apparent and relative desensitization of student nurses to human need. The processes underpinning this apparent desensitization were those which promoted both a 'compartmentalization' of concepts for theory and concepts for practice in the cognitions of student nurses and their habituation to examples of poor nursing practice. These processes are described and their nursing pedagogical implications are discussed. It is suggested that unless clinical learning environments are deliberately manipulated to foster the construction and utilization of 'appropriate' action schemata, the considerable opportunities offered by the implementation of Project 2000 to improve both nursing education and nursing practice could be wasted. It is further suggested that this deliberate manipulation should include nurse tutors teaching theory and practice in clinical areas if they are seriously concerned to render nursing care more intelligently responsive to human need.     

An educational initiative in anaesthetic nursing practice

The National Board for Nurses, Midwives and Health Visitors in Northern Ireland (NBNI) has adopted the principles of the UKCC's recommendations for specialist nursing practice and Incorporated these within their continuing education framework. Stage two of this framework decrees the standard required for specialist nursing practice (NBNI, 1995) and, as a result, a specialist anaesthetic nursing course has been instigated. The course extends over 44 weeks and includes 8 weeks of consolidation practice, comprising seven modules at degree and diploma level. The course gives the students an opportunity to deepen their knowledge, skills and attitudes in the field of anaesthetic nursing. Nurses were taught the necessary skills to work in collaboration with other professionals, patients and families in order to coordinate a patient-centred approach to perianaesthetic care. The role of the anaesthetic nurse specialist should be viewed as complementary to that of the anaesthetist. This course facilitates and encourages practitioners to move beyond registered practice on qualifying to a more specialized role where care is delivered in an innovative and creative manner.     

Medical education at Universidad de los Andes, Santiago, Chile

Universidad de los Andes School of Medicine started in 1991 with a new medical curriculum aimed at providing a medical education for its students, that is, it attempts to give, together with technical proficiency in medical matters, formation of character and a strong ethical attitude. The curriculum lasts for seven years: five of basic, pre-clinical and clinical theoretical and practical courses, followed by two years of internships in Internal Medicine, Surgery, Obstetrics and Pediatrics, plus a four month period of an elective internship. The courses have an integrated design, in which each matter is presented from multiple perspectives, e.g. in Internal Medicine together with the clinical aspects of disease, the pathophysiology and the pharmacology of the drugs used are presented. Also the Pathology of each disease is given in coordination in the Pathology course. General educational matters such as Anthropology, Psychology, Origin of Living Beings, Theology and Medical Ethics are interspersed in the curriculum. An important feature is the personal counselling system, in which each student may choose an academic counsellor and discuss with him (her) the subjects of his choosing. Clinical practice is given in a system that includes five hospitals and five private clinics that range from general medical practice to Psychiatry or Ophthalmology.     

Opening minds. Values clarification via electronic meetings

Values clarification for nursing practice is one of the most challenging aspects of nursing education. Use of electronic meeting software has been demonstrated to be effective in overcoming typical barriers to student growth. Inhibitions related to fear of censorship are overcome by anonymity of the system. Monopolizing by dominant members is controlled when the ability to speak in parallel exists. Overall, this application of electronic meeting software in the classroom demonstrated involvement of all students in an innovative approach to understand the effect of personal values on health policy development in a graduate nursing course.     

Applying crisis intervention methodology to the retention of students: a case study

This article presents the application of crisis theory and the adaptation of Aguilera's crisis intervention model for use in the retention of four at-risk students. Knowledge of student learning styles/preferences along with prior knowledge of faculty teaching and testing styles facilitated the selection of appropriate learning strategies to guide these students to successful completion of a course, the subsequent successful completion of the nursing program and entry into professional practice.     

Possible serotonergic mechanisms underlying the antidepressant and anti-obsessive-compulsive disorder responses

Considerable evidence is now available to support the pivotal role of the serotonin (5-HT) system is exerting the antidepressant response in humans. Different type of antidepressant treatments enhance 5-HT neurotransmission via different pre- or postsynaptic mechanisms. The time course for the occurrence of these adaptive changes in the brain of laboratory animals is consistent with the delayed onset of the antidepressant response in humans. The drugs effective in obsessive-compulsive disorder (OCD) also enhance 5-HT neurotransmission in brain regions involved in mediating OCD symptoms but with a more prolonged delay, consistently with the larger time necessary to obtain therapeutic effect in OCD than in depression. The elucidation of these mechanisms of action lead to the development of new pharmacologic strategies to potentiate the therapeutic effect of the drugs currently available and the identification of novel targets to accelerate and further improve treatment response in depression and OCD.     

Comparative effects of K+ channel modulating agents on contractions of rat intestinal smooth muscle

In the bench to bedside development of drugs to treat patients with cancer, the common guide to dose and schedule selection is toxicity to normal organs patterned after the preclinical profile of the drug. An understanding of the cellular pharmacology of the drug and specifically the cellular targets linked to the drug's effect is of substantial value in assisting the clinical investigator in selecting the proper dose and schedule of drug administration. The clinical development of ara-C for the treatment of acute myeloid leukemia (AML) provides a useful paradigm for the study of this process. An understanding of the cellular pharmacology, cytokinetics and pharmacokinetics of ara-C in leukemic mice showed substantial schedule-dependency. Exposure to high doses for a short duration (C x t) resulted in a palliative therapeutic outcome. In marked contrast, exposure to lower doses for a protracted period (c x T) was curative. Clinical use of ara-C in patients with AML patterned after the murine experience, c x T approach, has been of limited benefit in terms of long-term disease-free survival. Studies with human leukemia blasts from patients have shown that for the majority of patients, the initial rate-limiting step is membrane transport, the characteristics of which are substantially affected by extracellular drug concentration (dose). This pharmacologic impediment is eliminated with the blood levels attained during the infusion of gram doses (1-3 gm/m2) of the drug (high-dose ara-C, HiDaC) for shorter periods of time, a C x t approach. Clinical confirmation of these pharmacologic observations is evident in the therapeutic efficacy of HiDaC in patients with relapsed or SDaC-refractory acute leukemia. This is further emphasized by the significantly improved leukemia-free survival of patients with AML treated with HiDaC intensification during remission compared to those patients treated with milligram doses typical of SDaC protocols. Thus, the identification and monitoring of important parameters of drug action in tumors during the course of a clinical trial can be of substantial assistance in optimizing drug dose and schedule so as to attain the best therapeutic index.     

Medical-surgical nursing: a new teaching approach and its evaluation by the student

This issue is about a teaching methodology developed by the Medical-Surgical subject of Nursing on Graduate Course at Universidade Estadual de Londrina. The teachers used the student-centered teaching process based on interpersonal relationship and problem solving method. The aim was to evaluate the last period of nursing students perception about developing of cognitive, affective and psychomotor abilities when compared with others subjects of nursing course since 1985 until 1990. This method of teaching supplied more integration among theory and practice, more ability in developing library search and oral exposition, besides more active student participation on his apprenticeship process.     

Teaching metaphors of student nurses

This research focused on exploring the metaphors nursing students use to express their experience of university teachers' practice. A social constructivist approach to meaning underlies the process of interpreting student language in this study. The following evolved as major research questions: What are the metaphors students use to describe teaching? How do these metaphors operate? The research concluded that: students readily use metaphors to describe their experiences of teaching within the nursing degree programme; there is a pattern to the choice of metaphors; some of these images function as incremental or constructive metaphors, extending understanding of what it means to teach; others support current understandings and reflect taken-for-granted notions of teaching. Specific metaphors used by students to describe teaching were contextually analysed. A number of them may offer teachers of nursing insight, into their craft. Metaphors such as teacher as umpire, teacher as student, teaching with distance and teaching the big picture may be useful images for teachers to think about to guide their practice.     

Succinylcholine-induced hyperkalemia following prolonged pharmacologic neuromuscular blockade

While being treated for the acute respiratory distress syndrome, a 27-year-old woman developed profound hyperkalemia and cardiac arrest following the administration of succinylcholine chloride (SCh). She had none of the risk factors previously described for development of severe hyperkalemia following SCh administrations; however, she had been intermittently treated with nondepolarizing neuromuscular blocking drugs throughout the course of her illness. We suggest that immobilization of critically ill patients with pharmacologic neuromuscular blockade may predispose them to severe hyperkalemia and cardiac arrest following administration of SCh. SCh should be used with great caution in such patients.     

The teaching of pharmacology in Italian medical schools: the point of view of Italian doctors

OBJECTIVE: A survey was carried out to gather the opinions of doctors about the current method of teaching pharmacology in Italy. METHODS: A questionnaire was mailed to 3860 doctors, who were asked a series of questions regarding the teaching of pharmacology to medical students in Italian universities. RESULTS AND CONCLUSIONS: The great majority of those who replied considered the teaching they received to be mainly theoretical. The doctors thought that much more time and attention should be dedicated to those pharmacology subjects that are more closely connected to physiopathology and clinical practice (clinical pharmacology).     

Pharmacotherapies for alcohol abuse. Withdrawal and treatment

Pharmacologic management of alcoholism is only one part of the management of both alcohol dependence and withdrawal, which also includes the provision of a calm, quiet environment; reassurance; ongoing reassessment; attention to fluid and electrolyte disorders; treatment of coexisting addictions and common medical, surgical, and psychiatric comorbidities; and referral for ongoing psychosocial and medical treatment. For further discussion of these topics, the reader is referred to previously published sources. A survey of alcoholism treatment programs revealed that although benzodiazepines were the most commonly used drugs, standardized monitoring of patients' withdrawal severity was not common practice, and a significant minority of clinicians were using a variety of other drugs, some not known to prevent or treat the complications of withdrawal. Treatment should be based on the available evidence (Working Group on Pharmacological Management of Alcohol Withdrawal: American Society of Addiction Medicine Committee on Practice Guidelines: Pharmacological management of alcohol withdrawal: An evidence-based practice guideline. Unpublished draft, 1997). Patients with significant symptoms, patients with complications such as seizures or delirium tremens, and patients at higher risk for complications of alcohol withdrawal should receive benzodiazepines, particularly chlordiazepoxide, diazepam, or lorazepam, because of their safety and documented efficacy in preventing and treating the most serious complications of alcohol withdrawal. These drugs may be dosed on a fixed schedule for a predetermined number of doses on a tapering schedule over several days, or they may be administered by front-loading. An alternative approach for selected patients without seizures or acute comorbidity is symptom-triggered therapy, which individualizes treatment and decreases the duration and dose of medication administration. With either of the regimens, patients should have their withdrawal severity monitored until symptoms are resolving. Once withdrawal from alcohol is safely completed, the focus should turn to helping to prevent relapse. Disulfiram may be useful in highly motivated subsets of patients and when compliance-enhancing strategies are used. Naltrexone is useful in the broader population of patients entering treatment for alcohol dependence. These pharmacologic interventions should be given in the context of ongoing psychosocial support. There is substantial evidence that pharmacologic management of alcohol abuse and dependence is effective. As would be predicted from alcohol's myriad cellular effects, no panacea exists for alcoholism. For alcohol withdrawal, however, although treatment regimens have only recently been refined, evidence for effective treatment of symptoms and prevention of complications with benzodiazepines has been available for decades. Within the last decade, effective treatments, including naltrexone, have been shown to reduce alcohol intake in alcohol-dependent persons. Given the prevalence and cost of alcohol-related problems, all effective therapies (including pharmacologic treatments) should be considered to treat alcohol abuse and dependence.     

Ethical issues and critical thinking: students' stories

Through the stories told by these students it is evident that beginning students do think critically and act ethically during their first clinical nursing course. Ethical dilemmas involving students and staff, patients, faculty, and peers depict beginning students' development of values as they evolve into professionals. The conscientiousness and caring displayed by beginning students is apparent from students' shared perspectives. It is particularly encouraging that they seemed to focus more on values and cognitive aspects of patient care than on primarily technical psychomotor skills such as taking blood pressures and giving injections. Teaching beginning students is a challenge because the educator's role is twofold: Help students build a foundation for developing ongoing critical thinking abilities and help students develop an ethical view of patient care. Further exploration of critical thinking and ethical decision making should emphasize the mutual student-educator roles in facilitating self-awareness, through conscious awareness of their beliefs, values, feelings, and multiple perspectives. Because nursing emphasizes the human element and student nurses deal with human lives, educators play a vital role in facilitating the development of beginning students as critical thinkers and as ethical nurses. The most knowledgeable and most psychologically mature faculty are needed to teach beginning nursing students. Through ongoing reflection and critical thinking, nurse educators can help beginning students to identify and develop multiple perspectives on the ethics of nursing practice.     

Myopic shift after cataract removal in childhood

This article describes the experience of a team of nursing educators who, over the course of 2 years, redesigned the delivery of an undergraduate nursing clinical course to reflect the changing face of mental health care near the turn of this century. Case studies of student learning experiences show the value of nontraditional clinical settings such as homeless shelters to the professional growth and training of nursing students. Recommendations offer practical advice for combining nontraditional community-based clinical experiences with critical thinking exercises as key components of the mental health clinical course delivery.     

Classroom Assessment and Redesign of an Undergraduate Steel Design Course: A Case Study

The objective of this paper is to share experience gained in classroom assessment and subsequent redesign of an undergraduate, practice-oriented steel design course. A term project involving the design of a low-rise structural steel building was used to provide a summative evaluation of student learning. The essence of the project was for students to demonstrate their ability to apply the course material in a realistic activity, similar to structural engineering practice. Critical reflection on student performance, student feedback on course evaluation forms, the author’s observations as course instructor, and the educational literature motivated redesign of the course. Adaptation of an assignment-centered or project-based approach to course planning guided course redesign. Comparison of student performance and course evaluation data suggests that the redesigned course better meets the goal of developing the students’ abilities to apply the subject knowledge and skills to realistic problems or scenarios.     

A perspective on clinical evaluation in nursing education

Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity-subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher-evaluator and formative-summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context-dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher-student relationships.     

Working the system

This article describes the care given to a patients with a chronic leg ulcer during the author's supervised practice as a student district nurse. The Roper, Logan and Tierney (1996) model of nursing was used as a basis to assess, plan, implement and evaluate the nursing care given.     

Cellular and molecular determinants of cisplatin resistance

Cisplatin and carboplatin are among the most active and widely used cytotoxic anticancer drugs. However, the acquisition or presence of resistance significantly undermines the curative potential of these drugs against many malignancies. Multiple potential mechanisms of resistance have been identified at the cellular and molecular levels. Alterations in cellular pharmacology, including decreased drug accumulation, increased cellular thiol levels and increased repair of platinum-DNA damage, have been observed in numerous model systems. More recently, it has become apparent that an enhanced capacity to tolerate cisplatin-induced damage may also contribute to resistance. Alterations in proteins that recognise cisplatin-DNA damage (mismatch repair and high-mobility group (HMG) family proteins) and in pathways that determine sensitivity to apoptosis may contribute to damage tolerance. It remains to be determined whether any of these mechanisms contribute significantly to resistance in the clinical setting. Ongoing biochemical modulation and translational correlative trials should clarify which specific mechanisms are most relevant to clinical cisplatin resistance. Such investigations have the potential to improve the ability to predict likelihood of response and should identify potential targets for pharmacological or molecular intervention.     

Pharmacology and pharmacokinetics of methotrexate in rheumatic disease. Practical issues in treatment and design

Methotrexate (MTX) is among the most effective drugs for treatment of rheumatoid arthritis and has been proven valuable in the treatment of multiple other disorders of immune regulation. MTX has been administered at a wide range of doses and dose intervals, in conjunction with multiple other drugs, and in patients with a broad range of concomitant disorders. To design a safe and effective MTX treatment plan for an individual patient, the provider must have knowledge of the pharmacology and drug interactions of this effective but potentially dangerous medication. The first section of the article reviews MTX structure, pharmacology pharmacokinetics, and mechanisms of action in rheumatic disease. The second section examines factors that can be used to increase MTX efficacy and decrease toxicity.