Critical thinking: a central element in developing action competence in health and environmental education. (1/315)

In the field of educational philosophy, health and environmental education share many common goals and challenges on the level of curriculum theorizing as well as the level of pedagogical practice. One of these challenges is to develop a radical philosophy of education which is critical and takes a controversial point of departure rather than the one of accommodation. It highlights, in other words, the socially critical role of education. From this point of view some key concepts are discussed in the paper in relation to health and environmental education: democracy as means and end, critical thinking, the critical orientation, and the action perspective. One of these concepts, critical thinking, is elaborated in particular as it is considered to be essential to pupils' development of action competence. A description is given how it can be seen from four perspectives: the epistemological, the transformative, the dialectical and the holistic.  (+info)

Global health promotion models: enlightenment or entrapment? (2/315)

This paper suggests that there is a tendency for health promotion to be located within models that consider health to be a product of a range of forces, with practice itself assumed to comprise a similarly wide range of activities. This paper develops a critique of this tendency that is essentially accommodating, all embracing and 'neutral'. It is argued that this leads to the masking of tensions between the conflicting values contained within the different elements of the models. We suggest that for health promoters, this is neither conceptually appropriate nor practically sensible. These notions are developed in five main stages. We start by defining some of the key concepts in the piece, e.g. the nature of a 'model' and examples of 'global' models. We then examine some of the general reasons why global models are favoured, with respect to the emergence of the UK's strategy for health, The Health of the Nation. The third stage of the discussion identifies and considers, within the British context, professional and governmental factors perceived to have driven this choice. The fourth aspect of the paper will introduce a critique of the use of global modelling. The paper concludes by critically questioning this evolving relationship, and suggests that it will be essentially conservative and unproductive. We end by reviewing the implications for practice and suggesting a useful way forward.  (+info)

Chronic ambulatory outpatients and four-vector management. (3/315)

Many psychiatrist and other mental healthcare professionals consider the availability of atypical antipsychotic drugs a welcome advance in the treatment of schizophrenia. Atypical agents have show to be effective against both positive and negative symptoms of schizophrenia, and in general, their efficacy makes patients more responsive to rehabilitation efforts. Although drugs are a cornerstone of treatment, optimal management of chronic ambulatory outpatients with schizophrenia also depends of psychosocial and other approaches. Still, noncompliance needs to be addressed as schizophrenia patients often fail to take their medications for a variety of reasons, including undesirable side effects and lack of insight or denial of having a mental disorder. A four-vector model for optimal management of chronic ambulatory outpatients includes the biological, psychological, social, and spiritual domains. Although the resources for providing comprehensive, forward-looking management are not universally available in many areas of the United States, clinicians should always strive for the ideal.  (+info)

The virtue of nursing: the covenant of care. (4/315)

It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing.  (+info)

The myth of objectivity: is medicine moving towards a social constructivist medical paradigm? (5/315)

Biomedicine is improperly imbued with a nomothetic methodology, which views 'disease' in a similar way to other 'natural' phenomena. This arises from a 300-year history of a positivist domination of science, meaning that objectivist research (e.g. randomized controlled trials or biochemical research) attracts more funding and is more readily published than 'softer' qualitative research. A brief review of objectivism and subjectivism is followed by a definition of an emerging medical paradigm. Current 'inappropriate' medical practices become understandable in this broader context, and examples are given. A constructivist paradigm can continue to incorporate 'objective' clinical findings and interventions, as well as the recent evidence for the doctor-patient relationship as a major contributor to patient outcomes.  (+info)

Backing onto sacred ground. (6/315)

It is widely recognized that the health of individuals and communities is determined by the interaction of physical, mental, social, and spiritual factors. Public health leaders can find precedent for the resulting holistic strategies in the collaboration with religious structures that characterized the early years of public health. The modern context is more pluralistic, democratic, and complex in terms of its institutional array of partners.  (+info)

Reflexivity--a strategy for a patient-centred approach in general practice. (7/315)

Reflexivity as a strategy in general practice can be used to implement a patient-centred approach in the consultation. General practice has long represented a tradition attempting to integrate both illness and disease. For the GP, it is natural to focus on the patient's whole situation, and the GP's experience with patients is often based on a long-term relationship. Reflexivity implies having a self-conscious account of the production of knowledge as it is being produced. We believe that GPs can gain access to additional knowledge by consciously using reflexivity as a strategy in the consultation. In the present article, we discuss reflexivity in relation to the notions of empathy, personal experience and self-knowledge. By using reflexivity in order to rely on personal experience, the GP can gain access to patients' understanding of their health. Reflexivity can be a valuable concept for the GP in patient-centred medicine and can contribute to bridging the gap between the patient's perspective and the doctor's understanding of the patient's health.  (+info)

Spirituality in history taking. (8/315)

Andrew Taylor Still, MD, DO, included in his founding postulates of osteopathy the concept that a patient's health includes the health of a patient's spirit. In the recent past, medicine as a whole, and osteopathic medicine specifically, has neglected this postulate. Recent research has confirmed the validity of Still's postulate, and many medical training institutions have received grants and established programs to incorporate spirituality into their curriculum. As with any patient evaluation, the history and physical examination is the starting platform. This article describes several tools that can be easily incorporated into the history and physical examination, along with some of the obstacles in evaluating the health of the patient's spirit.  (+info)