Focus groups. A unique approach to curriculum development.

The purpose of this article is to describe the use and effectiveness of focus group methodology for curriculum development. This unique approach grew from the investigators' belief in the application of the principles of primary health care in designing a curriculum for community-based nursing education. The specific content and outcomes of the focus groups in relation to three curricular themes are reported in this journal in the article "Community-Based Nursing Education: Research Study from the NLN Vision for Nursing Education--Hawai'i, Phase II." The current article concentrates on the process and methods used.

Directional reflectance of vegetation measured by a calibrated digital camera.

Obtaining directional reflectance information for vegetation canopies is often an expensive and time-consuming process. We present here a simple approach based on the use of an inexpensive digital camera equipped with a wide-angle lens. By the imaging of a large homogeneous area, a single image captures multiple views of a vegetation canopy. This gives a directional reflectance distribution fully sampled for view direction and free of variations in Sun elevation and azimuth. We determined the radiometric response of the camera sensor CCD's at the focal point and then extended this calibration to the full CCD array by using averaged images of clear blue sky. We evaluated the utility of the system by obtaining directional reflectance distributions of two vegetation targets, grass (Lolium spp) and pine forest (Pinus radiata), for red visible light. The precision of the derived biangular pattern of reflectance was +/-7%.

The reflective clinician.

As students struggle to determine what is important in their lives and to incorporate nursing into their existence, they are encouraged to share their thoughts and explore new insights in a nursing/humanities course, The Reflective Clinician. The authors describe the rationale for placing humanities in a nursing curriculum and describe strategies and content to be included in the course. Student narratives of their perceptions of the course are offered for illustration and to give examples of growth experienced by the participants.

Quality care for the seriously mentally ill: a dream deferred.

This is a study of a system in change-a public mental hospital, isolated by the strong Koolau mountains and neglected by its citizens. At the end of 1990, the federal Department of Justice jolted the people of Hawaii into recognizing the poor quality of care provided to their family members at the Hawaii State Hospital (HSH). This model of a recruitment and retention project was developed to address education, professional development, and recruitment needs of nursing staff at HSH to improve quality of care. The interventions were based on a dynamic model of collaboration between a public state hospital and a university school of nursing in the creation of a learning community. The components of the project provide for nursing staff to continue their formal university education, services of advanced practice nurses, and continuing education classes for nursing staff.

In pursuit of excellence: a model of collaboration for nurses at Hawaii State Hospital.

In 1989 the Hawaii Medical Journal devoted an issue to the status of mental health in Hawaii and mental health leaders in the State criticized the lack of involvement by the University of Hawaii. This paper is written in response to the challenge and will discuss a dynamic model based on collaboration between the Hawaii State Hospital (HSH) and the School of Nursing of the University of Hawaii (SoN), that was implemented in September 1990. Since the publication of Magnet Hospitals. Attraction and Retention of Professional Nurses there has been much interest by service organizations in defining the factors that build excellence.

Developing a network of mental health workers for Pacific Islands.

In sum, community participation was central from the inception of this project and throughout the four phases. Participants were involved in trainee selection, curriculum development and modification and negotiation of clinical practicum and evaluation. Their contributions significantly influenced the content and process of the workshops on a daily basis. For the in situ training the indigenous trainers used a similar process of participation and planning, and adapted the workshops specifically to the island culture. Evaluation methods were similarly adapted to the specific communities. High success rate of returns resulted from the evaluators' careful sensitivity to the culture and the adaptation of the Western research process. The team involvement in the participant's transformation and self-reliance created a productive mutual experience.

A comparison of methods for nasal mast cell demonstration.

Nasal turbinates were studied from 14 rhinitis patients following surgical turbinectomy, and from five subjects at autopsy. Mast cell counts on turbinectomy specimens were compared following staining with toluidine blue or Alcian blue and safranin after fixation in either paraformaldehyde or neutral buffered formalin. Mast cell numbers were significantly greater in the superficial submucosa than in the epithelium or deep submucosa in both the rhinitis group and the autopsy subjects. The combination of PFA fixation and ABS staining gave maximum mast cell counts, revealed two morphological mast cell sub-types and gave optimal demonstration of nasal tissue. Nasal mast cells are thus not uniformly distributed, appear heterogeneous under light microscopy, are present in large numbers even in the elderly, and are best demonstrated using PFA fixation and ABS staining.

Mast cell distribution and morphology in human nasal turbinates following decalcification.

Whole inferior nasal turbinates were used to evaluate six different fixatives followed by decalcification. H and E staining was used to assess general fixation and toluidine blue and thionin to stain mast cells metachromatically. We show that neutral buffered formalin or paraformaldehyde give the best overall fixation. Very long times (six days) are needed in TB to show maximum mast cell numbers; these numbers are never as high, nor the cells as densely stained as those in undecalcified controls. The difference in number between the two supports the hypothesis that there is more than one subset of mast cells in nasal mucosa. The more superficial mast cells have a smaller size and may be dendritic, with relatively few granules which stain faintly. Those in deeper situations are often larger, ovoid, very granular and intensely stained.

Community participation in mental health training.

In the Pacific, training in mental health counseling skills must be culturally sensitive, adapted to the needs and resources of the specific emerging island countries and involve community participants in all phases of the training. A context is developed for viewing mental health problems and needs in Micronesia and American Samoa. The paper highlights the process the trainer encounters in preparing the community for the training. The concept of community participation is developed and operationalized. A two-phased training model suggests one way to implement WHO's mandate for partnership and participation.