Unique Body Of Knowledge Research Articles

Hospice and Palliative Medicine: New Subspecialty, New Opportunities

Palliative care is the physical, psychological, social, and spiritual care provided to patients from diagnosis to death or resolution of a life-threatening illness. Hospice care is a comprehensive program of care that is appropriate when patients with chronic, progressive, and eventually fatal illness are determined to have a prognosis of 6 months or fewer. Hospice and palliative medicine has now been recognized by the American Board of Medical Subspecialties as a field with a unique body of knowledge and practice. With 9 other specialty boards, the American Board of Emergency Medicine has cosponsored hospice and palliative medicine as an official subspecialty. As a result, board-certified emergency physicians may now pursue certification in hospice and palliative medicine through either fellowship training or, for a limited time, completing practice track requirements, followed by a written examination in the subspecialty. As the practice of palliative medicine grows in hospitals, emergency physicians can develop a core of generalist palliative medicine skills for use with adults and children. These would include assessing and communicating prognoses, managing the relief of pain and other distressing symptoms, helping articulate goals of patient care, understanding ethical and legal requirements; and ensuring the provision of culturally appropriate spiritual care in the last hours of living. Front-line emergency physicians possessing these basic palliative medicine skills will be able to work collaboratively with subspecialty physicians who are dually certified in emergency medicine and hospice and palliative medicine. Together, generalist and specialist emergency physicians can advance research, education, and policy in this new field to reach the common goals of high-quality, efficient, evidence-based palliative care in the emergency department.

Integrative medicine: the golden opportunity for family medicine

The discipline of Family Medicine is now recognised as an essential component in the health care system with a unique body of knowledge, skills and attitudes embodied in defined post graduate curricula in various academic institutions worldwide. Integrative Medicine should be incorporated into the paradigm of Family Medicine to combine the best insights of both conventional and alternative/complementary medicine, while providing a unifying perspective to guide physicians in intelligently combining these heterogeneous systems of thought.

Epistemological and methodological issues for the conceptualization, development, and assessment of ICT–TPCK: Advances in technological pedagogical content knowledge (TPCK)

In this paper, several issues regarding the epistemology of technological pedagogical content knowledge (TPCK) are first raised for the purpose of clarifying the construct. Specifically, the transformative and integrative views are juxtaposed for exploring the epistemology of TPCK, and, at the end, the transformative view is adopted concluding that TPCK is a unique body of knowledge that is constructed from the interaction of its individual contributing knowledge bases. Then, ICT–TPCK is introduced as a strand of TPCK, and is described as the ways knowledge about tools and their affordances, pedagogy, content, learners, and context are synthesized into an understanding of how particular topics that are difficult to be understood by learners or difficult to be represented by teachers can be transformed and taught more effectively with technology in ways that signify its added value. One model for the development and another for the assessment of ICT–TPCK are then discussed. Technology Mapping is proposed as a situative methodology for the development of ICT–TPCK, and three forms of assessment, namely, expert assessment, peer assessment, and self-assessment are proposed for assessing teachers’ competencies to teach with technology. The paper also reports on the empirical findings of a study that was undertaken to investigate the impact of the proposed models on student learning within the context of two design tasks in a pre-service primary teacher education course. Repeated measures within-subject effects were tested and the results indicated that ICT–TPCK competency significantly improved over the course of a semester. The results of this study clearly show that the theoretical models proposed herein can positively impact the development of ICT–TPCK. Lastly, these results can be used as baseline data in future studies that may be conducted to further validate or improve the proposed models in different contexts.

The Confidence to Practice Midwifery: Preceptor Influence on Student Self-Efficacy

The imperative for midwifery educators is to transmit to their students midwifery's unique body of knowledge and hallmarks of care that guide midwifery practice. Concerns have been raised about the ability to maintain the unique aspects of midwifery practice in a culture where routine use of intervention prevails. A theory-practice gap may lead to fewer student midwives exposed to the perspective and practices of midwifery during their clinical education. Preceptor role modeling is important to developing student confidence, conceptualized as self-efficacy, to persist in the practice of midwifery hallmark behaviors, particularly under conditions that undermine these practices. This study examined student perceptions of preceptor behaviors of two midwifery hallmarks of practice: therapeutic presence and non-intervention in the absence of complication and student self-efficacy for performing these behaviors. Recent graduates of education programs accredited by the American College of Nurse-Midwives Division of Accreditation completed researcher-developed tools regarding perceptions of preceptor behaviors of therapeutic presence and non-intervention and their outcome expectancy and self-efficacy for the same behaviors. The results indicate that preceptor behaviors influence student confidence to perform hallmark behaviors. Student belief in the value of the hallmark to benefit women is the biggest predictor of self-efficacy for hallmark behaviors. Clinical and educational implications and directions for future research are discussed.

The emergent ‘coaching industry’: a wake-up call for HRD professionals

Recent years have seen the rapid growth of an emergent ‘coaching industry’ in many countries with some scholars calling for the development of a ‘coaching profession’ replete with its own clear identity, clear boundaries and unique body of knowledge. Yet, at the same time, coaching has also been conceived as a necessary area of expertise and skill set among contemporary HRD professionals. Therefore, this article reports the results of a comparative study of the different conceptualizations and definitions of ‘coaching’ and contemporary HRD as reported in the literature. Results suggest that the intended purposes and processes associated with both fields of practice are virtually the same. The challenge and dilemma posed by these results are described from both a coaching and HRD perspective, and are discussed in terms of seeing the findings of this comparative study as a wake-up call for HRD professionals.

Te Hoe Nuku Roa: A journey towards Maori centered research

Maori people have a unique body of knowledge that, while based on ancestral  traditions, has adapted  to meet con-temporary  challenges. While Maori  knowledge  is widely applied in Maori communities it is now increasingly being used in mainstream domains.This  paper will  focus  on  a  project  known  as  Best Out-comes For Māori: Te Hoe Nuku Roa Maori Profiles, a longitudinal Maori household project with a focus on Maori development in cultural, social and economic terms. This project  is  based  on  a  cultural  framework  that  has  been formulated from ‘traditional’ principles. It provides a model for  the  interaction  between Maori  knowledge  and main-stream  social  science  practices  and  demonstrates  how Maori knowledge and the Western scientific tradition can be used together to resolve critical failings in previous re-search and advance the aspirations of Maori people. It is just one example of how traditional principles are demon-strating their continuing value in contemporary Maori de-velopment.  “The challenge  today  is  to survive as Māori, to  retain a Maori  identity, while still being able  to partici-pate fully in society and in the communities of the world.”   (Durie 1997)

A New Era

A New Era

The professionalization of Western herbalists: Response to new product regulations in Canada

New Canadian Natural Health Products regulations (NHP regulations) came into law January 1st, 2004 and will be implemented over 6 years. These regulations have the potential to impact a variety of stakeholders, in particular complementary and alternative medicine (CAM) practitioners. In this article, we document Canadian Western herbalist leaders' responses to the new regulations, so as to provide insight into how new healthcare policy serves as a stimulus for the organization of an emerging healthcare profession. The data are derived from key informant interviews with Western herbalist leaders in Canada (n=9). The NHP regulations include "good manufacturing practices" and Western herbalist leaders are concerned that many small companies, often owned and run by Western herbalists, will find the regulations too costly to implement, causing them to reduce the number and diversity of products they manufacture, or go out of business all together. Furthermore, lack of availability of whole plant products could severely restrict the practice of Canadian Western herbalists. In response to this challenge, herbalists are attempting to (i) organize as a more cohesive group, (ii) define their unique body of knowledge and (iii) increase the perceived legitimacy of their practices in the eyes of the public, conventional healthcare practitioners, and regulators, in an attempt to protect their unique practices. An examination of the findings reveals the extent to which external factors (i.e., the new NHP regulations) both provoke and shape the professionalization of this group of healthcare practitioners.

Pain and Aging: A Call to Those with the Power of Inquiry, the Skills to Teach, and the Desire to Heal

Unlike other medical specialties, geriatric medicine arose not from a unique body of knowledge, but because of the need for one. This “development out of necessity” principle also applies to the field of pain and aging, which is still in its infancy. Geriatrics practitioners have long realized the challenges of treating pain in older adults imposed by their tremendous physical and cognitive heterogeneity. In response to this realization, some have established successful multidisciplinary pain management clinics for older patients [1,2]. Others have highlighted the age-related pain management disparities that exist in multiple settings of care (e.g., emergency rooms, hospitals, outpatient clinics, and long-term care facilities) across multiple disciplines (e.g., physicians and nurses), and for multiple pain disorders (e.g., acute and chronic pain, malignant and nonmalignant pain), so as to spur practitioners into action [3–11]. The American Geriatrics Society has published comprehensive pain management guidelines to help practitioners navigate the sometimes murky waters of pain management for older adults [12]. Practitioners have established the need to advance …

Nursing Education Moves Into the University: The Story of the Hadassah School of Nursing in Jerusalem, 1918–1984

The acceptance of nursing as a profession taught in universities reflects basic changes in the essence of nursing as a vocation. The characteristics of university-level education include a specific and unique body of knowledge, entrance requirements, training requirements for practice, and a maximum of autonomy. These factors are shaping the status of nursing in the academic community, health services, and society at large. In 1918, the members of the American Zionist Medical Unit (AZMU) from New York (which later became the Hadassah Medical Organization [HMO] in Jerusalem), headed by Henrietta Szold, founded the Hadassah School of Nursing in Jerusalem and brought about a revolution in nursing in the country. The school awarded 1,400 Registered Nurse diplomas from 1921 to 1975, the year the university school of nursing opened.1 The idea of offering a university nursing education arose as early as the 1920s. In 1975, Hadassah, a pioneer and role model in health services in Israel, focused on introducing the first basic university curriculum for nurses. This article describes the transformation of nursing into an academically grounded profession, and the social and ideological context in which the transformation occurred, first under the British Mandate for Palestine (1918-1948) and then in die State of Israel (hereafter Israel) up to 1984. It augments the work of Lea Zwanger and Rivka Adams-Stockier.2 It is based on interviews with eighteen personalities significant in the transformation of nursing education, die memoirs of one of die coauthors (Judith Steiner-Freud), archival documents, and the professional literature.3 Europe has only a few university-level nursing programs. European university nursing education was only inaugurated in Britain in the 1930s, Germany in the 1960s, Austria and the Netherlands in the 1980s, and Switzerland in the 1990s.4 The movement of nursing education into universities in early twentieth century United States is therefore especially relevant to contemporary developments in pre-Israel Palestine and Israel.5 In the early decades of the twentieth century, American institutions of higher education were modifying their goals and adapting themselves to the needs of society by encouraging applied knowledge, new fields of study, and students from a wide range of social classes.6 As a women's profession, however, nursing had more difficulty than other fields due to colleges' reluctance to admit women; opposition by doctors' organizations, which were worried about possible harm to the status of physicians; and the question of whether nursing was a field worthy of study in an academic setting.7 This is the context of the struggle of leading nurses such as Isabel A. Hampton-Robb, Lavinia L. Dock, Lillian Wald, Adelaide Nutting, and Isabel Stewart. The American literature describes three trends in collegiate nursing education in this period:8 (1) an independent nursing school in a university, as at Yale; (2) studies in a college setting combined with a diploma track in a school of nursing, as at the Universities of Michigan and California and Northwestern University; (3) continuing university education programs in nursing for nurses who had completed the basic requirements for a diploma or baccalaureate degree, as at Teachers College, Columbia University. All three models were recognized and eventually partly adopted in Israel. In American society, the economics of hospital based nurses' training and the need for nurses' labor were among the main obstacles to making nursing education an academic pursuit at the university level.9 This argument has also been very important in Israel, a financially strained society that concentrates its resources on building itself-a society in need of working hands. In fact, according to Judith T. Shuval and Ofra Anson, efforts in Israel to convert nursing into a profession that requires a university degree may be described in terms of political struggle. …

A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes

Documentation of clinical services within health care systems has become increasingly significant because greater amounts of information are now required by accrediting agencies, third-party payers, researchers, and others in their evaluation of patient care and because of the increasing emphasis on patient outcomes. Given the multiple users who depend on health care information in the patient record, it is imperative that clinical nutrition practitioners implement a standardized nutrition care process and language to document comprehensively and communicate meaningful information concerning their role in improving patient outcomes. A body of work has led to the development and adoption of a standardized nutrition care process for the dietetics profession. A standardized nutrition care process consistent with the scientific method and a standardized language are two essential components required to articulate a conceptual model for clinical nutrition practice and documentation and distinguish clinical dietetics’ unique body of knowledge. The conceptual model serves as an organizing framework to standardize and guide nutrition practitioners’ clinical judgments or critical thinking processes and document information linking nutrition care to patient outcomes.

Scholarship: It's Not An Option, It's a Necessity

Members of evolving professions, such as physical therapists, often appear to spend endless hours discussing how to best fulfill the definition of “profession.” The discussion often seems irrelevant, esoteric, and elitist. There appears to be little connection to the daily lives of practitioners, the very people who define what we are and who make us a cohesive group. This disconnect costs us dearly and has resulted in a failure to consider issues that can be critical to those who see patients every day. The disconnect also is unnecessary. We often hear that one of the things that makes a profession is a unique body of knowledge, but we spend little time discussing what this means. We act as if a body of knowledge will fall, fully formed, from the sky. For physical therapists, “body of knowledge” primarily means that we have generated information on how we uniquely manage patients. To some extent, it also means that we have generated information that supports the theory underlying what we do or that allows the development of new ideas. Above all, however, our body of knowledge should deal with the core of our being and focus on our patients and what we do with them. Although practitioners can contribute, in mature professions, new knowledge is produced primarily by academics. Not only is this part of the job of academics, it often is the only means by which they can be evaluated, and it serves as a mechanism through which they can evolve and renew their expertise. By generating new knowledge, faculties not only contribute to the profession but also repay the hardworking clinicians who …

Critical Care Nursing Expertise during Air Transport

The purpose of this study was to describe the practical knowledge possessed by registered nurses that are part of the Air Force's Critical Care Air Transport Team (CCATT) and distinguish salient features of CCATT knowledge to critical care nursing in the hospital. This research study used descriptive, exploratory methods. Twelve CCATT nurses, identified as experts, were included in the study. Data were collected using written narratives by each participant; group interviews in which nurses discussed the written narratives; and individual interviews. Data were analyzed using interpretive phenomenology. Four major themes developed from the data. The knowledge embedded in CCATT nursing included: preflight preparation, in-flight assessment and environment, characteristics of CCATT nurse, and hospital vs. in-flight nursing practice. CCATT nurses improvise and provide nursing care based on past experiences using a broad critical care knowledge base. This has led to the development of a unique body of knowledge for nursing care. The areas of assessment and preparation described by the CCATT nurses can serve as a template for the Air Force's CCATT training program and CCATT orientation checklists. This study also identified several topics for future research.

Children's nursing: can it justify a separate existence in the UK?

There is currently debate about how the professional register for nurses is organized in the UK. Children's nurses, like the other minority registrants of mental health and learning disabilities nurses felt threatened with the potential loss of a separate register. Children's nurses should be able to articulate their own unique body of knowledge. Using Fawcett's framework for the hierarchy of contemporary nursing knowledge, the development of children's nursing knowledge is examined to determine if, indeed, children's nursing is a separate discipline, by having its own metaparadigm of children's nursing, philosophy, conceptual model of nursing, nursing theories and, finally, empirical indicators. Although some levels of knowledge appear to have been developed, it is considered that children's nursing is still lacking in some levels of knowledge, thus suggesting that the continuing development of children's nursing knowledge is necessary.

A discipline-specific determination of high quality nursing care.

The purpose of this study is to establish a framework for defining quality of care based in nursing's unique body of knowledge through identification of nursing actions associated with high quality care. Nurses are legally liable and morally responsible for the quality of the care they provide to patients. Yet the meaning of 'high quality nursing care' remains ambiguous mainly because models used to define it are borrowed from other disciplines. Two frameworks, quality and nursing knowledge, guided the selection and review of this literature review. The third framework of learning domains, an educational theory, assisted in organizing the data gathered from the literature. Attributes of high quality nursing care as perceived by both patients and nurses are described. Despite a professed philosophy of holism and humanism, nursing relies heavily on the industrially derived structure-process-outcome model with current emphasis on outcomes. Patient outcomes are the product of the service nurses deliver and are appropriate as defining criteria only when care is being evaluated from the patient's perspective. Defining quality from the nursing profession's frame of reference focuses on evaluating the services provided; that is, nursing actions and behaviours, linked to the use of nursing knowledge. High quality nursing equates with competence in the cognitive, affective, and psychomotor domains.

Who knows best: the patient or the provider? A nursing perspective.

Who knows best: the patient or the provider? My opinion, based on a review of the literature and practical experience, is that the patient, the provider and the system each offer a unique perspective that we can draw upon in ensuring quality care across the continuum. Nurses have a unique body of knowledge and skill that they bring to each interaction with the patient. They must have an awareness of the patient's and the system's expectations and interact and negotiate realistic expectations for each. The maintenance of balanced expectations and the measurement of effectiveness will continue to be a challenge. However, patients should be involved in and direct aspects of their care and feel satisfied with the process. Ultimately, nurses and the hospitals in which they work are responsible for providing effective and satisfying care. I would like to end by reinforcing the importance of the patient's voice in the provision of compassionate care. It is disheartening to read about patients' experiences of "discompassionate healthcare" (Holloway 1999). Yet I am reassured when I read or experience examples of compassionate and effective care such as that outlined by Valerie McDonald. (Hospital Quarterly Winter 1999/2000) Ms. McDonald, a former social worker and adult educator, is the mother of three daughters, one who had Burkitt's lymphoma diagnosed in 1994 and a second who had acute lymphostatic leukemia diagnosed in 1997 and who died recently in 1999. McDonald provided a wonderful perspective about her hospital experiences--the good and the bad. There would be no denying from this report that patients know the key qualities necessary for effective and compassionate care and that this mother recognized the energy and time it took to provide this care. "I hope," she states, "as the dust settles from restructuring and cutbacks that hospital staff will still have the time, energy and flexibility to practice the art of healing as they did with my children" (p. 24). I too reinforce that we must ensure nurses (and others) have the resources, the flexibility within their roles and the knowledge and skill to practise both the art and science of nursing.

An Ally as well as a Partner in Practice

Through her own personal story and experience the author describes herself as the ultimate client. She recounts some of the stages in her own rehabilitation process, and the ways in which the health professions helped or hindered her. Her involvement with the grass roots organizations for disabled people strengthened her convictions about the value of peers and role models for those with a disability. She urges occupational therapists, because of their unique body of knowledge and skills, to become partners, and even more importantly, allies with their clients. She encourages the profession to become truly inclusive and representative, and to take steps to bridge the power gap between the profession and its clients, with whom it seeks partnerships.

Human movement study as source of order for a scientific theme, a profession, and a component of the school curriculum

A legitimidade de uma disciplina acadêmica é verificada através de três critérios: (1) foco ou objeto particular de estudo, (2) método especializado, e (3) corpo único de conhecimento. Analisando-se a Educação Física à luz desses critérios, conclui-se que ela é melhor caracterizada como um tema científico do que como uma disciplina acadêmica. Essa característica tem propiciado um grande intercâmbio com diversas áreas de investigação científica, dando origem à formação de um corpo de conhecimento sobre a motricidade humana. Uma parcela significativa desse conhecimento é considerada como o conteúdo mais apropriado dos cursos de preparação profissional em Educação Física, além de complementar a formação acadêmica de outros profissionais cujo conhecimento sobre a motricidade humana assume um papel relevante. Como considerações finais, são feitas seis proposições para dissipar a desordem instalada na área de estudo, na profissão e no componente do currículo escolar, apresentadas inicialmente nesse trabalho

Integration of Emergency Medical Services and Special Weapons and Tactics (SWAT) Teams: The Emergence of the Tactically Trained Medic

The emphasis of training for paramedics that function in the civilian sector in the United States has focused on the management of blunt trauma. The personal risks they face generally are the result of accidents or public health threats. The management of penetrating trauma under the threat of intentional personal harm is a different matter.Law enforcement agencies have responded to the threat of apprehending heavily armed felons by forming special units highly trained in military-style, small-unit tactics. To provide care in this special environment, and support a special weapons and tactics (SWAT) team in fulfilling its mission, there is a requirment for a unique body of knowledge and special skills. (Prehospital care providers with at least emergency medical technician [EMT] skills and SWAT training will be referred to as tactical medics.).

The current status and future significance of nursing as a discipline.

The nature of nursing and the need for knowledge distinct from medicine was first spoken of by Florence Nightingale in 1859. Her notions may be regarded as the earliest formations of nursing as a discipline. Since that time there has been substantial effort committed to the development of a distinct theory base for nursing. Increased interest in nursing's unique body of knowledge has been particularly evident in the last decade, as seen by the growth in research undertaken from a nursing perspective, and by the numbers of publications which focus on the nature of knowledge and theory in nursing. These efforts have served not only to advance the discipline of nursing but also to challenge all nurses to articulate for themselves the theoretical foundations of their own practice. The main thesis of this paper is that nursing is an evolving discipline. Aspects of its evolution will be discussed using the four characteristics of a discipline; domain, syntax, history, and output of knowledge.