Quality assessment instruments in nursing: towards validation

The aim of this study was to explore the validity of the nursing quality assessment instruments, Monitor, Senior Monitor and Qualpacs. This follows recommendations in the literature for the need for more comprehensive validation of instruments than has been the case hitherto. A multiple triangulation research design was used which included observation of and interviews with nurses and patients as well as administration of the instruments with the same patients and a questionnaire completed by the nurses in charge on ward organisation and their approach to nursing care. Results reported here focus on our experiences of using the instruments, their inter-rater reliability and comparisons of instrument scores within medical, surgical and elderly care wards. Difficulties were encountered in using the instruments but most of these can be overcome given sufficient time for preliminary discussions. Inter-rater reliability of all three instruments taken as a whole reached acceptable levels, although some of the section score correlation coefficients were low, especially for Qualpacs. Convergent validity was achieved for the Senior Monitor-Qualpacs comparisons in four elderly care wards. The results were less clear for the Monitor-Qualpacs comparisons in seven medical and surgical wards. Explanations for the equivocal results are suggested and subsequent hypotheses were tested which supported these explanations.     

Accurate empathy: Confusion of a construct.

Presents empirical and logical evidence to refute the C. Truax (see PA, Vol. 48: Issue 5) rejoinder to an earlier critique by the authors. It is argued that the construct accurate empathy is markedly confused. The accurate empathy scale is shown to lack discriminant validity, and its relationship to therapeutic outcome is considered. The meaning of ratings of empathy in the absence of client responses is questioned. Finally, the use of repeated measurement of the same therapist is shown to be faulty on both statistical and design grounds and to yield spuriously inflated reliability coefficients. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical disability and mental health: An epidemiology of psychiatric and substance disorders.

Objective: To estimate the lifetime and 1-year prevalence of psychiatric and substance disorders as they vary by the presence of physical disability and across gender, race- ethnicity, and age. Study Design: Community screening provided a sampling frame from which stratified random samples were drawn. Participants: Half were men, half were screened as having activity limitation, and African Americans, non-Hispanic Whites, persons of Cuban heritage, and other Hispanics each composed 25% of the sample. Interviews were completed with 1,986 individuals using the Composite International Diagnostic Interview. Outcome Measures: The authors provide the lifetime and past-year occurrence of both psychiatric and substance disorders. Results: A compelling relationship is observed between physical disability and risk for the lifetime occurrence of both psychiatric and substance disorders and for the past-year occurrence of psychiatric disorders. Elevations in risk are greater for men than for women, for the young than for the old, and for persons of Hispanic heritage compared with African Americans and non- Hispanic Whites. Conclusions: Physical disability appears to represent a dimension of stress that increases risk for the occurrence of psychiatric or substance disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premorbid social competence construct generalizability across ethnic groups: Path analyses with two premorbid social competence components.

Studied the stability across ethnic groups of interrelations among 5 variables (education, age at 1st psychiatric hospitalization, current age, alcoholism symptom severity, and behavioral adjustment while hospitalized) using path analysis. 24 male Mexican Americans, mean age 39.8 yrs, and 24 male Anglo Americans, mean age 47.1 yrs, were studied. Behavioral adjustment was determined with the MACC Behavioral Adjustment Scale. Certain findings involving 4 variables were consistent with theoretical expectations for the Anglo-American group but were reversed in the Mexican-American group. Methodological and theoretical implications are presented. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocal affect recognition and psychopathy: Converging findings across traditional and cluster analytic approaches to assessing the construct.

Deficits in emotion processing have been widely reported to be central to psychopathy. However, few prior studies have examined vocal affect recognition in psychopaths, and these studies suffer from significant methodological limitations. Moreover, prior studies have yielded conflicting findings regarding the specificity of psychopaths’ affect recognition deficits. This study examined vocal affect recognition in 107 male inmates under conditions requiring isolated prosodic vs. semantic analysis of affective cues and compared subgroups of offenders identified via cluster analysis on vocal affect recognition. Psychopaths demonstrated deficits in vocal affect recognition under conditions requiring use of semantic cues and conditions requiring use of prosodic cues. Moreover, both primary and secondary psychopaths exhibited relatively similar emotional deficits in the semantic analysis condition compared to nonpsychopathic control participants. This study demonstrates that psychopaths’ vocal affect recognition deficits are not due to methodological limitations of previous studies and provides preliminary evidence that primary and secondary psychopaths exhibit generally similar deficits in vocal affect recognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socialization and personal change: a personal construct psychology approach

As we enter the world of work we are socialized into the role we are to perform, and also into the ethos of the organization where we are to work. This socialization is argued to be both a normative and individualistic process. Studies on socialization which concentrate on the social elements tend to identify the commonalities or normative aspects of this change. Studies which have analysed the cognitive elements tend to identify the idiosyncratic aspects of the change. This paper presents Kelly's theory of Personal Construct Psychology (PCP) as a technique for analysing this change which can identify both the normative and ideographic changes if these are present. This paper gives a brief account of the theory prior to concentrating on the specific treatment of self and change in self (the experience cycle). It is argued that use of PCP theory can assist in understanding not only the changes that occur during socialization, but also other changes, and training needs, that individuals may experience within their working life.     

Root canal instruments for manual use: a review

Root canal instruments can be subdivided into instruments made of different alloys (stainless steel, nickel-titanium and nickel-aluminium) and instruments with different geometric forms (e.g., instruments with short cutting segments). Several types of stainless steel and titanium-based instruments are presented and assessed by a review of the current literature. In summary, flexible stainless steel instruments with noncutting tips seem to be a decisive improvement in the development of an ideal root canal instrument. They are superior to titanium-based instruments in both cutting efficiency and instrumentation of curved root canals.     

Xenotransplantation: steps towards a clinical reality

It was clear that significant research progress has been made in the two years since the last congress, although, as the chairman J.P. Soulillou (Nantes) concluded, there were no singular advances announced during the week; rather, it was a congress for assimilation of information. It was also apparent that there is now an attitude of realism in the xenotransplantation community. The prevailing mood is one of cautious optimism, to contrast with the unguarded optimism of the previous meeting. The future for clinical xenotransplantation now appears more secure than it has been previously.     

Neurolaw: towards a new medical jurisprudence

Traumatic brain injuries and spinal cord injuries occur in a variety of accidents which may become the subject of civil litigation. A new field of medical jurisprudence, called neurolaw, is emerging to join health-care professionals and attorneys in a common quest to employ legal remedies to enhance the quality of life for individuals with neurological injury and their families. Presented here is a review of the underpinnings of this developing area of inquiry.     

The placebo: Conceptual analysis of a construct in transition.

Suggests that the placebo in psychotherapy has retained the negative connotation of an inert "nuisance variable," a label that it originally incurred in the field of medicine. In addition, the transition toward more cognitive models of psychotherapy, particularly A. Bandura's (see record 1977-25933-001) theory of self-efficacy, has led to problems in defining the placebo within psychology. This transition has resulted in an awkward interface between certain preferred cognitive metaphors and the negative connotations of a presumably cognitive placebo construct. Suggestions have been made to dismiss the placebo construct from psychology and to do away with the use of true placebo controls in outcome research. The present analysis maintains that (a) the placebo can be adequately defined within psychology, (b) the negative connotation of the placebo label is largely undeserved, (c) the placebo retains a continuing conceptual and empirical utility for evaluating psychotherapy, and (d) the therapeutic efficacy of current therapies is well established even though they have not generally been shown to be more effective than nonspecific treatment. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Refining the construct of psychopathy: Towards a hierarchical model.

Psychopathy is characterized by diverse indicators. Clinical accounts have emphasized 3 distinct facets: interpersonal, affective, and behavioral. Research using the Psychopathy Checklist–Revised (PCL–R), however, has emphasized a 2-factor model. A review of the literature on the PCL–R and related measures of psychopathy, together with confirmatory factor analysis of PCL–R data from North American participants, indicates that the 2-factor model cannot be sustained. A 3-factor hierarchical model was developed in which a coherent superordinate factor, Psychopathy, is underpinned by 3 factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience, and Impulsive and Irresponsible Behavioral Style. The model was cross-validated on North American and Scottish PCL–R data, Psychopathy Screening Version data, and data derived from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) antisocial personality disorder field trial. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social psychology and personality: Toward a convergence.

Argues that social and personality psychology are becoming increasingly characterized by greater receptiveness to the other's theoretical assumptions, concern with similar problems and the development of similar solutions to those problems, and the tendency of members of one specialty to adopt the methodologies typically identified with the other. Three recent developments are reviewed to substantiate this claim. Several cases are presented that demonstrate the increasing willingness of social psychologists to treat situational and personality perspectives as equally valid approaches to understanding social behavior. Several social-psychological constructs are described, each of which had been first operationalized via experimental manipulations and then later reconceptualized as an individual-difference variable. Interactionism is seen as a logical bridge between the differing orientations of personality and social psychology, and the current enthusiasm over this approach is one that is shared by many in both disciplines. A 3rd area of convergence becomes evident from an examination of the close parallels in the recent histories of attitudes and traits—dispositional concepts that play a central role in social and personality psychology, respectively. Especially notable is the fact that some of the recent strategies for improving trait–behavior consistencies are techniques that have been shown to strengthen attitude–behavior links as well. (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An RGD-oligolysine peptide: a prototype construct for integrin-mediated gene delivery

We have synthesized a linear, bifunctional peptide that comprises an integrin-targeting domain containing an arginine-glycine-aspartic acid tripeptide motif and a DNA-binding moiety consisting of a short stretch of 16 lysine residues. This peptide can form distinctive, condensed complexes with DNA and is capable of mediating its delivery and expression in a variety of mammalian cells in culture. Internalization is mediated by cell surface integrin receptors via a mechanism that is known to be phagocytic. We have analyzed the relationship between DNA and peptide and have investigated the conditions suitable for optimal gene delivery. The formation of condensed peptide DNA complexes leads to resistance to nuclease degradation. The level of reporter gene expression obtained is dependent on the peptide-to-DNA ratio and is enhanced in the presence of the endosomal buffer chloroquine, polyethyleneimine, and deactivated adenovirus during gene delivery. Under optimal conditions the levels of reporter gene expression obtained approach or even exceed those obtained with DNA delivered with the commercial liposome Lipofectamine. The ability to produce an efficient gene delivery system using small, easily modified, and well-defined constructs that have no constraint of particle size demonstrates the advantages of integrin-targeting peptides for gene transfer.     

Otitis media with effusion: a disability or not?

Otitis media with effusion (OME) is a disease most commonly affecting the paediatric population. However, it is a condition that is also seen in adults and does lead to significant morbidity. We studied the effect of surgical treatment of OME in an adult population and found that the subjective relief of symptoms exceeded the objective audiometric gain. In children where subjective symptoms are perhaps more difficult to assess the clinician needs to beware of underestimating the effect of a hearing loss.     

Specific learning disabilities: Clarifying, not eliminating, a construct.

Comments on the original article "After the demise of the discrepancy: Proposed learning disabilities diagnostic criteria," by S. C. Dombrowski, R. W. Kamphaus, and C. R. Reynolds (see record 2004-16907-006). Over the past decades, both researchers and practitioners in the field of specific learning disabilities (LD) have grappled over an appropriate definition as well as the subsequent operational diagnostic criteria. In their article, Dombrowski et al proposed a new set of suggested diagnostic criteria that challenges many of the traditional beliefs about these disorders. This article provides a critique of their proposed criteria as well as an alternative approach for LD identification that is more aligned with current understanding of the etiology and characteristics of these disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Doctors, diagnosis, and disability: a disastrous diversion

Patients and third party payers expect physicians to identify damage or disease as the cause of pain and disability, but often there is no damage or disease that can be identified. The process of disability determination requires physicians to make determinations that cannot be based on medical science and for which they have no specialized training. The combination of pseudodiagnosis and pseudodisability is likely to bankrupt countries that do not recognize this folly and design more productive health and disability systems. Physicians need much more education about human behavior and the highly variable relationships among disease, distress, and disability.