A discourse on the nature of dental hygiene knowledge and knowing.

OBJECTIVE: Historically, dental hygiene has adopted theory and research from other health disciplines, without adequately modifying these concepts to reflect the unique dental hygiene practice context, leaving dental hygiene's research and theory base underdeveloped. Dental hygiene has yet to articulate its epistemological assumptions--the nature, scope and object of dental hygiene knowledge--or to fully describe the patterns of knowing that are brought to practice. METHODS: This paper uses a method of inquiry from philosophy to begin the discourse about dental hygiene ways of knowing. In nursing, Carper identified four fundamental patterns of knowing: empirics or the science of nursing; aesthetics or the art of nursing; personal knowledge and ethical or moral knowledge. These patterns were used to explore this concept within dental hygiene. RESULTS: There is more to the nature of dental hygiene knowledge and knowing than rote application of technique-related or research-based information in practice, including judgements about when and how to use different types of information that are used. Currently, empirical forms of knowledge seem to be disproportionately valued, yet evidence was found for all of Carper's four patterns of knowing. CONCLUSIONS: Carper's work on patterns of knowing in nursing provided a useful framework to initiate the discourse on ways of knowing in dental hygiene. These results are submitted for others to challenge, refine and extend, for continuing the discussion. Dental hygiene leaders and scholars need to engage in discourse about extending the epistemological assumptions to reflect reality.

Creating a climate for critical thinking in the preceptorship experience.

The impact of the learning climate on students' ability to think critically during preceptorship cannot be underestimated. The success of students in learning to think critically rests largely with the tone set by preceptors and staff (Myrick 1998). Students must be led gently into the active role of discussing, dialoguing, and problem solving (Meyers 1986). They watch very carefully how respectfully preceptors and staff field their comments, quickly notice nonverbal cues that indicate how open, approachable and supportive the preceptors and the staff are to their questions and contributions, and then discern how valued they are as colleagues. When preceptors genuinely value, support, and work with students in the practice setting and staff accept them as part of the team, a climate that is conducive to learning and critical thinking is established. This is due to the fact that students feel safe enough to question, to challenge and be challenged, and to be creative in their problem solving. The purpose of this paper is threefold: a) to identify key factors in the preceptorship experience that contribute to the creation of a climate that is conductive to critical thinking; b) to provide important insights into the role of the preceptor and the staff within that context; and c) to discuss how nursing faculty can more actively contribute to ensuring that such a learning climate is achieved in the preceptorship experience.

Dimeric inhibin A as a fourth marker for Down's syndrome maternal serum screening in native Japanese women.

OBJECTIVE: This study was conducted to assess the usefulness of dimeric inhibin A as a fourth marker for Down's syndrome screening in addition to AFP, hCG and uE3 markers for native Japanese women. METHODS: Serum specimens from 367 native Japanese women in the second trimester were assayed for dimeric inhibin A levels. Day specific dimeric inhibin A medians were established for gestational ages 15.0-21.9. Weekly median values for the native Japanese were compared with those of a U.S. population. Selected Japanese specimens from 15 diagnosed Down's syndrome and 3 trisomy 18 cases were also assayed for dimeric inhibin A. RESULTS: Dimeric inhibin A levels did not vary greatly over the gestational age range as expected. Median value comparison showed that native Japanese dimeric inhibin A medians are higher than the U.S. population medians by an average of 7.95%. Native Japanese dimeric inhibin A median values in this study are 1.77 times higher in Down's syndrome cases than in unaffected pregnancies. Trisomy 18 dimeric inhibin A levels show no significant difference from the unaffected pregnancies. CONCLUSIONS: This report shows for the first time that dimeric inhibin A can be informative as a fourth marker for Down's syndrome screening in native Japanese women. We expect the addition of dimeric inhibin A to a triple marker protocol will increase the accuracy of predicted risk for all pregnancies screened and increase the detection rate of Down's syndrome affected pregnancies.

Triple marker screening for trisomy 21, trisomy 18 and open neural tube defects in singleton pregnancies of native Japanese pregnant women.

OBJECTIVE: To report the results of prenatal triple marker screening on a population of Japanese pregnant women. METHODS: From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed. RESULTS: Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%. CONCLUSIONS: The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.

Amniotic fluid alpha-fetoprotein testing in native Japanese women.

Owing to differences in maternal serum alpha-fetoprotein, human chorionic gonadotrophin and oestriol levels between native Japanese and Caucasian women screened in this laboratory, a study was conducted to measure amniotic fluid alpha-fetoprotein (AFAFP) levels in native Japanese pregnancies. When the native Japanese AFAFP levels were compared with a United States (non-Black) population, the Japanese medians did not decrease as rapidly over the 14 to 22 weeks of gestation period investigated. At 14 weeks, the difference was negligible, graduating to a difference of 20 per cent by 22 weeks' gestation. Native Japanese pregnancy AFAFP levels should be interpreted based upon population data from that group alone. From these findings, prenatal screening laboratories should be encouraged to collect preliminary data for comparison before screening is initiated for a defined ethnic group.

Job satisfaction in preceptorship and its effect on the clinical performance of the preceptee.

This study was designed to examine the relationship between preceptor/preceptee job satisfaction and preceptee clinical performance. A correlational descriptive design using quantitative data was employed through a mailed survey. Seventy-nine questionnaires were mailed to preceptors, 100 to preceptees. The response rate for preceptors was 49.4% while the response rate for preceptees was 33%. Herzberg's theory served as the conceptual framework. Three baccalaureate schools of nursing in Atlantic Canada comprised the setting. Analysis of data included frequencies, percentages, t-tests, and Pearson's product-moment correlation coefficient. Findings indicate that preceptors and preceptees differ significantly regarding aspects of their job, and their job in general. They also differ significantly in their rating of how often preceptees perform the planning/evaluation components of their care. A positive significant relationship exists between preceptee job satisfaction and clinical performance. No relationship was found to exist between preceptor job satisfaction and preceptee clinical performance. Additionally, in view of the limitations of the study (small sample, low response) limited conclusions can be drawn from the study.

Joint nursing appointments: a vehicle for influencing health care change.

With the rapid pace of health care change nurses need to organize and respond quickly to the debate on future health care policy. Nurses from practice and academia working together can capitalize on their unique knowledge and expertise to influence the development of consumer- and health-oriented policies. In the past joint appointments have served to unite nurses in the education and research domains. These appointments must evolve to encompass policy-focused activities that will enable nurses to make a significant contribution to the transformation of the health care delivery system.

Selecting clinical preceptors for basic baccalaureate nursing students: a critical issue in clinical teaching.

The concept of preceptorship in baccalaureate nursing education continues to be endorsed as a viable alternative clinical teaching strategy. However there remains a dearth of research to substantiate many of those benefits vis-à-vis preceptor, preceptee and ultimately the health care consumer. Moreover, there are minimal substantive data regarding the criteria which are required for the actual selection of the clinical preceptor. Not infrequently, preceptors are selected primarily for their availability during the clinical placement of students. As a result, baccalaureate nursing students are being preceptored by staff nurses with little or no preparation for assuming a role in which they are expected to promote the principles and ideology of baccalaureate nursing education. Is this fair to the preceptor, preceptee and the client? Can it be said that the nursing faculty, in promoting such a process, are in fact promoting the status quo?

Preceptorship: a viable alternative clinical teaching strategy?

The difficulty experienced by many baccalaureate student nurses in making the role transition from student to graduate nurse continues to pose problems for nursing education and nursing service personnel alike. A variety of instructional strategies described in the literature which claim to enhance the effectiveness of student learning in the clinical setting and promote role adjustment immediately upon graduation have been used by nursing faculty and nursing service personnel. Preceptorship is one such strategy. The author reviews the evolution of preceptorship within the nursing profession and explores factors which are provoking current interest in this concept. Available empirical data regarding the effect of preceptorship on student and graduate nurse performance in the clinical setting are presented and implications for nursing education discussed.