Gregory A. Bechtel

Problem-based learning in a competency-based world.

This article addresses the needed shift in nursing education from an information-driven approach in teaching to a process that promotes higher level thinking and clinical judgement. Strengths and weaknesses of problem-based learning and competency-based education in nursing are presented. Whereas the former focuses on critical thinking and clinical judgement, the latters emphasis is on clinical competency. The appropriateness of the philosophies in both academic and practice settings is discussed.

The changing role of grandparenthood.

For many grandparents in America, caring for grandchildren has become a full-time responsibility that has led to multiple stresses. Raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation among this group. However, advantages to this role among grandparents can include greater life satisfaction and a positive influence on the other generations within the family. Nurses and other health providers can play an essential role in assisting grandparents caring for grandchildren by strategically building family strengths and cohesiveness.

Infant death rates and animal-shed delivery in remote rural areas of Nepal.

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deitys anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

Family social support and prenatal care among unmarried African American teenage primiparas.

This study determined the relation of family social support and the receipt of adequate prenatal care among 25 unmarried African American teenage primiparas residing in the home. The study also investigated the strength of the family social support system compared to nonfamily support systems. Using the Personal Resource Questionnaire, Part II to measure social support, participants were provided the questionnaire 1 to 2 days after birth, but immediately prior to leaving the hospital. Results of the study determined no significant difference in social support scores among those women who received either adequate or inadequate prenatal care, although the 17- to 18-year-old age group had higher support scores than the 15- to 16-year-old age group. However, findings from the study indicated that family social support between both groups was significantly greater than nonfamily support systems. Thus, interventions by community health nurses to involve family members in all aspects of birthing and parenting can be essential in promoting positive health outcomes.

Patterns of Mental Health Care Among Mexican Americans

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.