The purpose of this study is to describe the perceptions of medical educators regarding the care perspective and to examine implications for medical ethics education. After many years of being omitted from the theory of medical ethics, the care perspective is beginning to emerge in theoretical discussion. Work to date does not tell us whether or how physician-educators view or use the care perspective in medical practice and/or in medical ethics education. Yet it is physician-educators who influence the content and focus of medical ethics education. In this exploratory, qualitative study, in-depth focused interviews were conducted with ten physician-educators who teach medical ethics at one academic medical center. A systematic multiple level analysis of participants' responses led to the identification of themes, patterns and interrelationships of data which were supported by case stories. The study yielded thick, rich narrative descriptions and the original commentary was retained to preserve the language, imagery and reflections of the physician-educator's experiences, styles and approaches. The findings suggest that some physician-educators use several different approaches to the medical ethical decision making process including the care perspective. They believe the care perspective: is implicit in medical practice; is essential and should be made explicit in the medical ethical decision making process, where as an ethical approach, it may avert certain ethical dilemmas and even lawsuits; must be made explicit in medical ethics education, both in the classroom and clinical setting; and instruction should be extended over the entire period of a medical student's education. The purpose of this study is to learn how the care perspective is regarded, understood and used, if at all, by physicians who are directly involved in medical ethics education. While the findings contribute to a larger understanding of the place of the care perspective in medical practice and in medical ethics education, they also raise new questions that suggest further study.

This descriptive, correlational study explored the relationship between nurse practitioner students' (NPSs') (N = 238) perceptions of mentoring by their nurse practitioner preceptors (NPPs') and NPSs' self-efficacy. Bandura's Self-Efficacy Theory (1977) and Role Theory provided the theoretical framework. NPSs in this study overall were highly mentored and highly self-efficacious as their mentoring and self-efficacy scores demonstrate (mean mentoring scores = 4.3, range 1-5; mean self-efficacy scores = 4.15, range 1-5). Significant findings (p. =.0000) included a positive correlation between mentoring and self-efficacy (r =.37), positive correlations between two measures of mentoring (r =.81) and two measures of self-efficacy (r =.54), higher self-efficacy scores among mentored NPSs (mean = 4.4) compared with non-mentored NPSs (mean = 3.9) (p. =.00006), and significant differences in mentoring scores (p. =.029) among NPSs depending on the manner of the initiation of the NPS/NPP relationship. NPSs who chose NPPs whom they knew from a previous relationship had higher mentoring scores (mean = 4.5, p. =.031) than those who accepted faculty assignment (mean = 4.2). Multiple regression analysis showed that the mediating variables most predictive of increases in mentoring scores included NPSs' length of time in the clinical practicum (p. =.025) and the precepting experience of the NPPs (p =.042). Nine characteristics of mentoring emerged from interview data with selected NPSs (n = 33), whose experience contrasted sharply with that of the non-mentored. The interviewed NPSs confirmed that they were well mentored in direct patient care by humanistic NPs or MDs, but they rarely saw or participated in other advanced practice nursing activities. The interviews also suggested difficulties in NPS/NPP relationships for NPSs whose age varied widely from that of the NPP, very young and inexperienced NPSs, older NPSs who have not practiced clinically for sometime, or NPSs who were experts in another nursing role previously. NPSs' choice of NPPs whom they knew from a prior relationship, length of time in the practicum, NPP precepting experience, age and experience of NPSs have implications for the clinical placement of NPSs. Capacity of NPPs to model fully the advanced practice nursing role remains an issue and NPP preparation as part of NPS graduate study may be one way to address this problem.

The United States is rapidly becoming a more racially diverse nation. Racial minority groups are projected to make up 47% of the total population in 2050 and if current population trends continue, they are projected to surpass the non-minority population by the end of the twenty-first century. Furthermore, the Latino population, already the nation’s largest minority group, is expected to triple in size and is projected to account for 29% of the total U.S. population by 2050. Unfortunately, the educational pipeline has created a shortage of Latinos in higher education. At the same time, the United States is suffering from a national shortage of registered nurses. It is, therefore, of great concern that the proportion of minority students in nursing education programs is also not keeping up with population trends. Moreover, persistent inequalities in educational opportunities have led to persistent social inequalities between majority and minority groups, including inequalities in healthcare. Increasing racial diversity among health professionals is essential, not only as a matter of educational equity, but also because evidence indicates that diversity among providers is associated with improved access to healthcare for racial minorities. A main route to upward mobility and equality of opportunity for minorities in the healthcare industry is equity of access and success in achieving the baccalaureate nursing degree. There is an increasing body of literature which addresses retention and persistence of minority nursing students; however, the greater majority has focused on Chicano Hispanics and Black students. Further research is needed to identify factors associated with retention and persistence of other Latino groups. This study uses a qualitative design with Spradley’s method of ethnographic interviewing to learn about the experiences of Puerto Rican nursing students attending college in the Northeast. Obligations to family, financial constraints and academic under-preparedness are some of the key findings gleaned from analysis of the data.

Background: Women have experienced increased mortality from coronary heart disease over the last two decades, while men's rate has declined. This suggests that current treatment and prevention strategies are less effective for women. Furthermore, since most women don't participate in cardiac rehabilitation, alternatives to these programs must be explored. Purpose: This study sought to refine an intervention for rural women with coronary heart disease designed to promote self-management and provide pilot data evaluating the efficacy of the intervention. Design and Methods: The study design was mixed methods. Focused qualitative interviews provided data regarding the self-management program. In-depth interviews determined the efficacy of the intervention including adoption of health promoting behaviors, self-awareness, and self-efficacy. The Self-efficacy for Managing Chronic Disease 6-Item Scale provided additional efficacy data and was administered over the course of the study. Ten women from rural New England, diagnosed with coronary heart disease within the last year, comprised the purposeful sample. Findings: The self-learning program met the women‘s needs; however they provided suggestions for improvement. While the women reported varying degrees of self-awareness, many believed the self-learning program influenced their adoption of health-promoting behaviors. In the interviews, the women expressed confidence in their ability to manage their disease; a finding that was congruent with the findings of the self-efficacy scale. Improvement was seen in five of six items on the self-efficacy scale from pre- to post intervention. The women‘s confidence in managing other symptoms or health problems and management of problems related to heart disease saw a statistically ( p > .05) significant increase post intervention, and that increase persisted. One item, emotional distress, was flat over the series of administrations. Conclusions: Since women differ from men in the development, expression, and treatment outcomes for coronary heart disease, educational programs that address those differences and meet their needs must be developed. This study demonstrated that a paper-based, holistic, self-management program is a viable alternative or supplement to traditional cardiac rehabilitation programs. Using the self-and family management framework, this intervention enabled women to learn how to care for themselves. Key words: coronary heart disease (CHD), women, self-management, self-efficacy

With less than a decade of experience as a compulsory graduate discipline, Physical Therapy (PT) is a relative newcomer to the culture and expectations of graduate faculty roles. Legitimacy as a graduate discipline and progress in development of a cogent professional science depend on the extent to which PT faculty members fulfill their roles as scholars. The purpose of this study was to understand how individual, environmental, career and work factors influence the publishing and other scholarly productivity of faculty members in PT education programs. I conducted a survey of faculty members in accredited entry level PT programs in the United States. The survey was administered electronically via the Internet with follow up to nonrespondents via standard mailing. Survey data included sociodemographic characteristics, career factors, environmental factors, and measures of scholarly productivity. Following cleaning and coding of data and descriptive analysis, I constructed blocked hierarchical regression models to investigate factors that explain or predict productivity in publishing and other forms of scholarship. I obtained a total usable response rate of 520, or 58% of faculty surveyed. The sample obtained was representative of faculty by sex, institutional type and academic credentials. There are relationships among factors such as gender, highest degree, discipline of highest degree, work preference, work allocation and scholarly productivity. The regression models explain half the variance in career publishing productivity and 28% to 44% of the variance in productivity in presentations and grants. Career factors such as appointment, rank and degree, and work factors such as work preference and time allocation explain the majority of the variance for most models. The negative relationships between gender and a variety of career, environmental and productivity factors suggest a pattern of cumulative disadvantage for women that are important for this majority-female profession to recognize and address. Gender issues as well as the important career and work issues highlighted by the results require the attention of the national leadership, academic administrators and individual faculty members in PT if the profession is to move forward with its scholarly agenda.

According to Chinese government's policy, all students attending medical universities and colleges are required to study English for two- or two-and-a half years of their five- or six-year program. However, an English curriculum especially designed for medical students has never been developed. Currently, the English curriculum for science and technology (ECST) is being used in medical schools. The ECST is not based on any needs assessment of medical students, medical professionals, and medical professors, and lacks credibility. Without an adequate curriculum, the available English courses for medical students are irrelevant and ineffective. This study discussed and analyzed the problems relating to the English curriculum in medical schools and designed a relevant English curriculum for medical students. In doing so, the study utilized the following research procedure: (1) review of government's policy; (2) review of literature in English for specific purposes and curriculum development; (3) review of the current English curriculum for science and technology (ECST); (4) review of medical English textbooks; (5) review of English textbooks for Chinese secondary school students; and (6) field observation. Although there are no specific figures available, a growing number of Chinese medical students have been studying in English-speaking countries for the past decade. Considering that the Chinese government is likely to maintain its "open door" policy, students will continue to participate in advanced studies overseas. As part of their academic work, they are required to write papers in English. This strongly suggests that there is a need to design an English writing curriculum to help students develop needed writing skills in the English language. The curriculum developed in this study is for medical students who specifically need to improve their English writing skills in medical science. Based on the students' needs, goals and objectives were developed, and a syllabus was specified, teacher-training, materials and methods, as well as evaluation procedures were also defined. The curriculum is relevant for Chinese medical students, however, its effectiveness and sufficiency need to be field-tested and appropriate modifications must be made.

The battering and abuse of women is a problem which adversely affects the health of millions of women in the United States. Nurses are in a particularly strategic position to identify and provide helpful interventions for women who come in contact with the health care establishment. The feminist literature argues for helping strategies which do not blame women for their abuse and which attempt to empower women to take control of their own lives. However, often the past educational preparation of the nurse has not included content on battering, leaving them unprepared to assess for abuse or to provide intervention aimed at fostering independence and personal empowerment. The purpose of this study was to determine the perceived model of helping preferred by nurses in their interventions with battered women and to determine those factors in the nurses' educational experiences and clinical practice which affect their preference for a specific helping model. Data was obtained from 116 registered nurses, 57 nurses practiced in the emergency department setting, and 59 nurses had attended a three day national nursing conference on violence against women. The data of this study were collected through self-administered questionnaires: the Education/Experience Questionnaire and the Help Orientation Test. The results of this study indicate that the medical model of helping, in which the client is attributed low responsibility for both problem cause and solution, not a particularly empowering model but one tending to foster dependency, is characteristic of the helping orientation of all nurses in the study sample. This is true regardless of practice setting, or whether or not nurses have acquired specific knowledge on the topic of battering. All nurses reported significant clinical and personal contact with battered women but few reported having acquired specific education on battering. It was found that nurses who had acquired specific knowledge on battering did perceive themselves as knowledgeable and well prepared in their practice with battered women. This research pointed to the relevance of the type of education about woman abuse which is necessary to permit nurses to not just help battered women but to help in such a way as to foster independence.

Little research has been done to identify effectiveness in nursing practice. This is especially true in home care nursing practice. Nurse leaders and educators express concern for effectiveness, and the profession seems to be advancing in the development of that body of knowledge. The purpose of this study was to examine effectiveness in home care from the perspectives of those intimately involved with its enactment: the nurse, the nurse supervisor, and the client. Conceptually organized within the particular philosophic context of the interpretive paradigm, this study employed the ethnographic methodology of focused interviews as the main resource for gathering data. Findings. The definition of effective nursing was a complex mixture of structure, process, and outcome activities. There were shared perceptions among the subjects and subject groups in this study about knowledge, skills, and personal qualifications and attributes of the effective nurse. There was also considerable agreement about effective home care nursing behaviors which included a range of complex clinical activities, communication, teaching, and the ability to cultivate family involvement. Each sample group also identified unique categories of effective home care nursing behaviors based on its own subjective view of ideal practice. Effective care outcomes were not readily identified by any of the groups except in vague terms. The implications for nursing practice, education, and research were discussed.

This study shows the relationship of a theoretically based nursing curriculum and the integration of the specific conceptual model by students as a technique for thinking and/or delivering care. A descriptive correlational design was used to evaluate the integration of the Neuman Systems Model into a baccalaureate nursing program and measures the degree of student integrated learning. This summative evaluation identifies baseline data on ten baccalaureate nursing programs and the degree of model integration into the philosophy of the program, course objectives, course syllabi, classroom and clinical areas, and teaching-learning activities such as student papers and nursing care plans. Ten baccalaureate nursing programs and 94 senior nursing students from the eastern and midwestern United States participated in the study. Schools were selected because of model use. All participant programs claimed the use of the Neuman Systems Model as the theoretical framework of the nursing program. National League for Nursing Self-Study reports were reviewed and scored as to degree of integration on the Neuman Systems Model Integration Grid. Results of this study confirm a positive relationship between an integrated nursing curriculum and integrated student learning. A direct correlation between program score of levels of model integration and student scores from written papers and nursing care plans was observed.

African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-to-creatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathy and the related health utilization factors in this population. Positive social change might be effected by using results from the study in planning and developing effective public health interventions targeting specific African American populations, which might result in a reduction of the associated physical and socioeconomic burdens on these populations.