Traditional Clinical Model Research Articles

Shifting the Clinical Teaching Paradigm in Undergraduate Nursing Education to Address the Nursing Faculty Shortage

To address the faculty shortage problem, schools of nursing are reexamining how they provide clinical education to undergraduate students to find ways to use faculty resources more efficiently and to maintain student enrollment. We describe a unique clinical teaching model implemented at the New York University College of Nursing. The new model currently being evaluated shifts from the traditional clinical education model, in which all clinical education is in a hospital or agency setting, to a model that substitutes high-fidelity human patient simulation for up to half of the clinical education experience. This article describes the clinical teaching model and its effects on nurse faculty capacity.

The Effect of Simulation on Clinical Performance

Patient simulation has been used to augment the traditional clinical model, but its value is unclear. The aim of this study was to evaluate the effects of a theory-driven pediatric simulation curriculum on nursing students' clinical performance. The convenience sample included 116 junior nursing students enrolled in a pediatric course. Using a staggered timing model, students attended simulation instead of clinical for 2 weeks (25%) of an 8-week semester. The students spent the same amount of time in simulation as in clinical (12 hours per week). Student clinical performance was assessed using a Likert-style tool at 2-week intervals by the clinical faculty. Scores of students who attended simulation in the first 2 weeks were compared with students who had not yet attended simulation. Data were analyzed using repeated measure analysis with the mixed model, and covariate effects were considered. A Compound Symmetry covariance model was used to control the correlation between weeks within each subject. Statistical significance was determined at the 5% level. Faculty rated students with patient simulation experience higher than those who had not yet attended simulation (mean ± standard error: 1.74 ± 0.75, P = 0.02). On item-level analysis, therapeutic skills were positively impacted by simulation (P = 0.02). Time in simulation enhanced clinical performance, as simulation students achieved higher scores more quickly than those without simulation and maintained high performance levels. These findings suggest patient simulation is a valuable addition to augment the apprenticeship model.

Using Telepractice in Parent Training in Early Autism

There is a growing body of literature indicating that intense early intervention is current best practice for treating children with autism spectrum disorders (ASD). Several studies demonstrate the effectiveness of parents as agents of intervention in the child's home environment. However, this approach requires intense one-on-one supervision by highly trained professionals. Consequently, there is a significant gap between the intensive service requirements for children with ASD and the available resources to provide these services. In the current pilot study, the use of remote technology, telepractice, is evaluated as a tool for coaching parents of two children found to have ASD. Two clinical models of intervention are compared: a traditional model of twice-weekly speech and language therapy sessions (traditional clinical model) and a model where a once-a-week clinical session is followed by a home-based session administered by the parents and remotely supervised and coached by the clinician (clinic/telepractice model). Results suggest that gains obtained in traditional therapy can be maintained and even exceeded in a treatment model that uses telepractice. Parents reported that they perceived telepractice sessions to be as valuable as those delivered directly by the clinician, felt comfortable using the technology, and were willing to continue intervention with their children at home. These preliminary results suggest that use of telepractice holds promise for reducing the demands on available resources of service for this population. A study with a larger population is currently underway including cost-benefit analyses to examine the implications for such a treatment model to its users and to the healthcare system.

Triple P-Positive Parenting Program as a public health approach to strengthening parenting.

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed.

A Randomized, Controlled Trial of a Neurological and Psychoeducational Group Appointment Model for Pediatric Headaches

This study evaluated the effectiveness of a multidisciplinary group appointment model for pediatric headaches. Eighty-one patients ages 10 to 18 were randomly assigned to a Traditional Clinic Model (TCM) or a Headache Clinic (HCM) Model for the initial neurological appointment. In addition to a neurological evaluation, the HCM included a group educational session describing stressors contributing to pain, pharmaceutical and behavioral treatments, and guided relaxation skills practice. HCM patients demonstrated greater gains in headache knowledge and required slightly less physician face-to-face time than TCM patients. Both groups experienced a sustained decline of about 40% in headache-related disability and high treatment satisfaction.

Building an award-winning women's health ambulatory service and beyond.

Many barriers exist for the provision of high-quality health care to inner-city minority women. The barriers include access to care, compliance problems, financial concerns, system navigation issues, as well as language barriers. This article describes the transition of the Women's Ambulatory Health Services at Hartford Hospital from a traditional clinic model to a culturally sensitive private practice model. The road to transition was paved by valuable input from staff as well as patients. The final product was a much more efficient, inviting model that catered to the needs of the community.

Social Work Practice in Higher Education

This article examines two cases of social work practice in higher education within the context of identifying a model of social practice for use in postsecondary educational settings. The case studies provide insight into a model of social work practice that reflects both the traditional clinical model, which focuses on individual change, and the school-community-pupil relations model, which focuses on system change. The author also discusses implications for social work educators who see college/university counseling centers as an arena for social work practice.

Discussion

Hageman, and Arrindell [Hageman, W.J., & Arrindell, W.A. (in press). Establishing clinically significant change: increment of precision and the distinction between individual and group level of analysis. Behavior Research and Therapy.] suggest adaptations to the traditional clinical significance model originally developed by Jacobson, Follette, and Revenstorf [Jacobson, N.S., Follette, W.C., & Revenstorf, D. (1984). Toward a standard definition of clinically significant change. Behavior Therapy, 17, 308-311.]. They observe that one must distinguish between analysis at the individual and group level and based upon an alternative decision-making strategy have formulated different procedures for assessing clinically significant change that incorporate the unreliability inherent in testing measures. A comparison of the traditional method with Hageman and Arrindell's suggested approach is conducted utilizing data originally presented by Jacobson and Truax [Jacobson, N.S., & Truax, P., a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.] and implications of this comparison for the method developed by Hageman and Arrindell's method are discussed. Although this revised method has much to recommend it, it seems to yield results at the individual level that are quite similar to those derived from the traditional method. Given the complexity of the revised method, the traditional model developed by Jacobson, Follette, and Revenstorf (1984) still seems to be preferable.

Empowering Youth to End Relationship Violence

Violence and abuse in teen dating relationships are now recognized as pervasive and far-reaching problems that cannot be managed by detecting and treating only those who have already begun these patterns. Such problems may need to be addressed outside the confines of traditional clinical and educational models. An alternate model conceptualizes educational and experiential strategies as stand-alone or afterschool curriculum delivered in partnership with community services specializing in violence-related work, such as Child Protective Services, battered women's shelters, male batterer groups, and youth support agencies. We believe that early to middle adolescence is a crucial time for establishing a pattern of healthy, nonviolent relationships with intimate partners that carries forward to future family members. This article describes the Youth Relationship Project (YRP), which has a community-based curriculum designed to enhance youths' social and relationship skills through prosocial action. A section on the YRP is included as an example of an alternate model and is, therefore, intended to be more descriptive than evaluative in nature. Evaluative strategies and preliminary findings are presented.

Self and Shame: A Gestalt Approach

Abstract Shame, both a universal human feeling and also one of the most potentially disorganizing of all affect experiences, has been relatively neglected in clinical writing until recent years and even today remains in unclear focus in much of our dominant clinical tradition and thinking about selfmodels. Both this neglect and this lack of focus are much clarified by a Gestalt model of self-experience and self-process—a perspective which raises paradigmatic questions for our thinking about human nature and relational process. Drawing on the tradition of affect theory and Goodman's radical revision of traditional self-theory, this article examines the terms of the underlying assumptions about self and relationship that have informed our traditional clinical models and offers a new model of shame, support, and their dynamic interplay in self-process and self-integration. Shame then emerges as a key signal affect in a field model of self, much as anxiety stood in this role in an older, individualist model. Implications for clinical practice are then considered, with an examination of five thematic clusters of possible therapeutic interventions, aimed at bringing shame issues to light in the therapeutic relationship itself, and offering the promise of transforming self-inhibition and disorganization into new self-development and growth.

Psychology and decision making: modelling health behavior with multiattribute utility theory

The success of much of dental practice is linked to patient behavior. Understanding the issues that influence patients' decisions when they choose to not follow preventive or therapeutic dental recommendations is instrumental to improving adherence, and ultimately, to improving dental health outcomes. Multiattribute Utility Theory (MAU) provides a methodology for systematically exploring these issues. It is based on a well-established body of knowledge in the psychological literature, and currently represents a state-of-the-art model for predicting behavior and delineating potentially modifiable behavioral determinants. Two examples are presented to illustrate how MAU can be used in clinical settings. In the first example, MAU is used to identify key reasons why nearly 70 percent high-risk patients did not obtain flu shots, a behavioral problem comparable to many confronted in dentistry. MAU correctly predicted the vaccination behavior of 82 percent of patients, and an intervention based on MAU findings nearly doubled vaccination rates. The second example used MAU to identify physician behaviors that influenced patients' satisfaction with an ambulatory care visit. MAU findings from this study identified specific behaviors in a provider's style that if modified may improve patient satisfaction. These MAU applications also emphasize the importance of soliciting the patient's perspective in clinical interactions since some of the most important determinants of patient behavior are not represented in traditional clinical decision models.

Anticonvulsant action of fluzinamide (AHR-8559) on kindled amygdaloid seizures.

The anticonvulsant properties of fluzinamide (AHR-8559) were evaluated in the kindled amygdaloid seizure model in rats. Fluzinamide significantly attenuated afterdischarge durations and the severity of the accompanying convulsive responses in previously kindled rats at doses that did not cause sedation or ataxia. After acute intraperitoneal injections, the maximum anticonvulsant effectiveness against suprathreshold (400 microA) stimulation was seen at 30 min. Fluzinamide (10-80 mg/kg i.p.) was also evaluated in previously kindled rats using threshold (20-microA increments) seizures. Low doses of fluzinamide significantly elevated seizure threshold and reduced both elicited afterdischarge durations and seizure severity. When administered daily during kindling acquisition, fluzinamide (20 and 40 mg/kg i.p.) significantly increased the number of trials necessary to complete kindling. The duration and the severity of the responses induced by stimulations during the acquisition period were reduced. Previous studies have shown that the anticonvulsant profile for fluzinamide, as determined by traditional electrical and clinical models of epilepsies, most closely resembled phenobarbital and valproic acid, and differed from phenytoin and ethosuximide. The current study is consistent with this profile, with fluzinamide--like phenobarbital and valproic acid--significantly modifying both acquisition of kindling and the fully kindled amygdaloid seizure.

Learning Disabilities or Instructional Problems?

The roles and functions of learning disability teachers will not be clearly defined until a more basic issue is resolved: namely, should teacher training conform to the traditional clinical or disease model, or should it be based on a natural science approach? Some of the implications for teacher training for each approach are discussed.