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Riegel B, Page SD, Aryal S, Lee CS, Belfiglio A, Freedland KE, Stromberg A, Vellone E, Westland H, van Rijn MM, Pettersson S, Wiebe DJ, Jaarsma T. Symptom characteristics, perceived causal attributions, and contextual factors influencing self-care behaviors: An ecological daily assessment study of adults with chronic illness. Patient Educ Couns 2024; 123:108227. [PMID: 38430731 DOI: 10.1016/j.pec.2024.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Insights into how symptoms influence self-care can guide patient education and improve symptom control. This study examined symptom characteristics, causal attributions, and contextual factors influencing self-care of adults with arthritis, asthma, chronic obstructive pulmonary disease, diabetes, or heart failure. METHODS Adults (n = 81) with a symptomatic chronic illness participated in a longitudinal observational study. Using Ecological Daily Assessment, participants described one symptom twice daily for two weeks, rating its frequency, severity, bothersomeness, duration, causes, and self-care. RESULTS The most frequent symptoms were fatigue and shortness of breath. Pain, fatigue, and joint stiffness were the most severe and bothersome. Most participants engaged in active self-care, but those with fatigue and pain engaged in passive self-care (i.e., rest or do nothing), especially when symptoms were infrequent, mild, somewhat bothersome, and fleeting. In people using passive self-care, thoughts, feelings, and the desire to conceal symptoms from others interfered with self-care. CONCLUSION Most adults with a chronic illness take an active role in managing their symptoms but some conceal or ignore symptoms until the frequency, severity, bothersomeness, or duration increases. PRACTICE IMPLICATIONS When patients report symptoms, asking about self-care behaviors may reveal inaction or ineffective approaches. A discussion of active self-care options may improve symptom control.
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Affiliation(s)
- Barbara Riegel
- Center for Home Care Policy & Research at VNS Health, New York, NY, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Subhash Aryal
- Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Andrew Belfiglio
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Anna Stromberg
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Ercole Vellone
- University of Roma Tor Vergata, Rome, Italy; Wroclaw Medical University, Department of Nursing and Obstetrics, Wroclaw, Poland
| | | | | | - Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | | | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden; University Medical Center Utrecht, Utrecht, the Netherlands
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Lee CS, Freedland KE, Jaarsma T, Strömberg A, Vellone E, Page SD, Westland H, Pettersson S, van Rijn M, Aryal S, Belfiglio A, Wiebe D, Riegel B. Patterns of self-care decision-making and associated factors: A cross-sectional observational study. Int J Nurs Stud 2024; 150:104665. [PMID: 38103267 DOI: 10.1016/j.ijnurstu.2023.104665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The aim of this study was to identify for the first time patterns of self-care decision-making (i.e. the extent to which participants viewed contextual factors influencing decisions about symptoms) and associated factors among community-dwelling adults with chronic illness. METHODS This was a secondary analysis of data collected during the development and psychometric evaluation of the 27-item Self-Care Decisions Inventory that is based on Naturalistic Decision-Making (n = 430, average age = 54.9 ± 16.2 years, 70.2 % female, 87.0 % Caucasian, average number of chronic conditions = 3.6 ± 2.8). Latent class mixture modeling was used to identify patterns among contextual factors that influence self-care decision-making under the domains of external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment. Multivariate multinomial regression was used to identify additional socio-demographic, clinical, and self-care behavior factors that were different across the patterns of self-care decision-making. RESULTS Three patterns of self-care decision-making were identified in a cohort of 430 adults. A 'maintainers' pattern (48.1 %) consisted of adults with limited contextual influences on self-care decision-making except for urgency. A 'highly uncertain' pattern (23.0 %) consisted of adults whose self-care decision-making was largely driven by uncertainty about the cause or meaning of the symptom. A 'distressed concealers' pattern (28.8 %) consisted of adults whose self-care decision-making was highly influenced by external factors, cognitive/affective factors and concealment. Age, education, financial security and specific symptoms were significantly different across the three patterns in multivariate models. CONCLUSION Adults living with chronic illness vary in the extent to which contextual factors influence decisions they make about symptoms, and would therefore benefit from different interventions.
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Affiliation(s)
- Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | | | | | - Ercole Vellone
- Tor Vergata University of Rome, Rome, Italy; Wroclaw Medical University, Poland
| | | | | | | | | | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Andrew Belfiglio
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Page SD, Souders MC, Aryal S, Pinto-Martin JA, Deatrick JA. A Comparison of Family Management Between Families of Children With Autism Spectrum Disorder and Families of Children With Down Syndrome. J Pediatr Health Care 2024; 38:61-73. [PMID: 37725028 DOI: 10.1016/j.pedhc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This cross-sectional study aimed to (1) compare family management between families of children with autism spectrum disorder (ASD) or Down syndrome and (2) evaluate the contribution of the child (ASD behaviors, feeding difficulties, sleep disturbances), caregiver (mental health) and family (social support) factors to the caregiver's perceived condition management ability and effort. METHOD Eighty-five caregivers (56 ASD, 29 Down syndrome) completed quantitative instruments online. Data analysis included independent samples t-tests and multiple linear regression. RESULTS There were no significant differences in the dimensions of family management between groups. More ASD behaviors were associated with lower condition management ability and higher condition management effort. Lower perceived social support and higher caregiver age were associated with lower condition management ability. DISCUSSION Integrating care into family life may be more challenging when the child has more social differences and behavioral rigidity. Nursing care should include an assessment of family social support.
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Westland H, Page SD, van Rijn M, Aryal S, Freedland KE, Lee C, Strömberg A, Vellone E, Wiebe DJ, Jaarsma T, Riegel B. Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study. Heart Lung 2022; 56:40-49. [PMID: 35709644 DOI: 10.1016/j.hrtlng.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions. OBJECTIVE To create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms. METHODS A two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis. RESULTS A total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors. CONCLUSIONS The list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands.
| | | | - Michelle van Rijn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands
| | - Subhash Aryal
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | | | - Christopher Lee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Barbara Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Page SD, Lee C, Aryal S, Freedland K, Stromberg A, Vellone E, Westland H, Wiebe DJ, Jaarsma T, Riegel B. Development and testing of an instrument to measure contextual factors influencing self-care decisions among adults with chronic illness. Health Qual Life Outcomes 2022; 20:83. [PMID: 35606792 PMCID: PMC9125861 DOI: 10.1186/s12955-022-01990-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Decisions about how to manage bothersome symptoms of chronic illness are complex and influenced by factors related to the patient, their illness, and their environment. Naturalistic decision-making describes decision-making when conditions are dynamically evolving, and the decision maker may be uncertain because the situation is ambiguous and missing information. Contextual factors, including time stress, the perception of high stakes, and input from others may facilitate or complicate decisions about the self-care of symptoms. There is no valid instrument to measure these contextual factors. The purpose of this study was to develop and test a self-report instrument measuring the contextual factors that influence self-care decisions about symptoms. Methods Items were drafted from the literature and refined with patient input. Content validity of the instrument was evaluated using a Delphi survey of expert clinicians and researchers, and cognitive interviews with adults with chronic illness. Psychometric testing included exploratory factor analysis to test dimensionality, item response theory-based approaches for item recalibration, confirmatory factor analysis to generate factor determinacy scores, and evaluation of construct validity. Results Ten contextual factors influencing decision-making were identified and multiple items per factor were generated. Items were refined based on cognitive interviews with five adults with chronic illness. After a two round Delphi survey of expert clinicians (n = 12) all items had a content validity index of > 0.78. Five additional adults with chronic illness endorsed the relevance, comprehensiveness, and comprehensibility of the inventory during cognitive interviews. Initial psychometric testing (n = 431) revealed a 6-factor multidimensional structure that was further refined for precision, and high multidimensional reliability (0.864). In construct validity testing, there were modest associations with some scales of the Melbourne Decision Making Questionnaire and the Self-Care of Chronic Illness Inventory.
Conclusion The Self-Care Decisions Inventory is a 27-item self-report instrument that measures the extent to which contextual factors influence decisions about symptoms of chronic illness. The six scales (external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment) reflect naturalistic decision making, have excellent content validity, and demonstrate high multidimensional reliability. Additional testing of the instrument is needed to evaluate clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01990-2.
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Affiliation(s)
| | - Christopher Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, US.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, PA, US
| | | | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Douglas J Wiebe
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, US
| | - Tiny Jaarsma
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,University Medical Center Utrecht, Utrecht, the Netherlands
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, US.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Luciani M, De Maria M, Page SD, Barbaranelli C, Ausili D, Riegel B. Measuring self-care in the general adult population: development and psychometric testing of the Self-Care Inventory. BMC Public Health 2022; 22:598. [PMID: 35346104 PMCID: PMC8960109 DOI: 10.1186/s12889-022-12913-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to develop and evaluate the Self-Care Inventory (SCI), a theory-based instrument to measure self-care in the general adult population. Methods Based on the Middle Range Theory of Self-Care, the 20-item SCI was developed with three scales: Self-Care Maintenance (8 items), Self-Care Monitoring (6 items), and Self-Care Management (6 items). A cross sectional study with a US-based sample (n = 294) was conducted to test the SCI. Internal validity was assessed with Confirmatory Factor Analysis. Internal consistency reliability was assessed with Cronbach alpha for unidimensional scales or composite reliability and the global reliability index for multidimensional scales. Construct validity was investigated with Pearson correlation to test the relationship between general self-efficacy, positivity, stress, and self-care scores. Results The Self-Care Maintenance and Management scales were multidimensional and the Self-Care Monitoring scale was unidimensional. The global reliability index for multidimensional scales was 0.85 (self-care maintenance) and 0.88 (self-care management). Cronbach alpha coefficient of the self-care monitoring scale was 0.88. Test-retest reliability was 0.81 (self-care maintenance), 0.91 (self-care monitoring), and 0.76 (self-care management). The General Self-Efficacy Scale was positively related to all three self-care scale scores: self-care maintenance r = 0.46, p < 0. 001, self-care monitoring r = 0.31, p < 0. 001, and self-care management r = 0.32, p < 0. 001. The positivity score was positively related to self-care maintenance (r = 0.42, p < 0. 001), self-care monitoring (r = 0.29, p < 0. 001), and self-care management (r = 0.34, p < 0. 001) scores. The perceived stress was positively related to the self-care management (r = 0.20, p < 0. 001) score. Conclusions The SCI is a theoretically based instrument designed to measure self-care in the general adult population. Preliminary evidence of validity and reliability supports its use in the general adult population.
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Page SD. Schools Need Universal Nursing Coverage. J Pediatr Nurs 2021; 58:95. [PMID: 33303280 PMCID: PMC8815102 DOI: 10.1016/j.pedn.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
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Dickson VV, Page SD. Using mixed methods in cardiovascular nursing research: Answering the why, the how, and the what's next. Eur J Cardiovasc Nurs 2021; 20:82-89. [PMID: 33570592 DOI: 10.1093/eurjcn/zvaa024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/31/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Mixed methods is an innovative research approach that can be applied to understand complex cardiovascular phenomena. A mixed methods study involves collecting both quantitative and qualitative data and intentionally integrating the data to provide a better understanding of the phenomena than can be achieved by using a quantitative or qualitative approach alone. Conducting a mixed methods study requires planning and careful attention to methodological rigour in the data collection, analysis, and integration phases. This paper provides an overview of the mixed methods approach and describes its application to cardiovascular nursing science.
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Affiliation(s)
- Victoria Vaughan Dickson
- Pless Center for Nursing Research, New York University Rory Meyers College of Nursing, 431 First Ave, #742, New York, NY 10010, USA
| | - Shayleigh Dickson Page
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Page SD. Harmonizing controls for chemicals and radionuclides. Health Phys 2001; 80:388-389. [PMID: 11281208 DOI: 10.1097/00004032-200104000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Risk harmonization means more than harmonizing the way that the risk from ionizing radiation is managed by regulatory agencies. It also means bringing a common language and approach to the management of all environmental carcinogens. If this goal is accomplished, it can result in better communication between radiation and chemical risk managers and a better informed public. If the public understands that there is consistency and coherence in how risks are managed, they are more likely to accept risk management decisions.
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Affiliation(s)
- S D Page
- Office of Radiation and Indoor Air, USEPA Headquarters, Washington, DC 20460, USA
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Raszka WV, Page SD, Mead PB. Transmitting varicella to a gravida. J Reprod Med 2000; 45:862-3. [PMID: 11077643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Page SD. Indoor radon: a case study in risk communication. Am J Prev Med 1994; 10:15-8. [PMID: 7917448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two key questions have influenced the development and implementation of the Environmental Protection Agency (EPA) program to reduce the public health risks of indoor radon gas; the answers may also apply to other preventive health care programs. First, how can we best communicate risk? Risk communication research indicates that simple message, persuasion, and prescriptive guidance will best encourage citizens to protect themselves from voluntary risks (within the control of the individual), such as radon. However, scientists expect technical information, logical and unemotional appeals, and detailed explanations of uncertainty. An appropriate balance between the persuasive and the technical will encourage public action and assuage the scientific community. Second, what environmental health care problems should we focus on? Public concern with involuntary risks imposed by an external force, such as hazardous waste dumps, drive our environmental health agenda. Consequently, because government decision-makers respond to public perceptions and pressures, which they frequently support, the largest fraction of the government's resources and the most aggressive protection programs are typically reserved for environmental health problems that pose involuntary risks. The experience of the EPA's Radon Program suggests that major gains in public health protection could be achieved through communication that effectively persuades people to accept personal responsibility for preventing voluntary risks, such as radon, and a more informed dialogue between the scientific community and the public concerning national priorities for environmental health protection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S D Page
- Radon Division, U.S. Environmental Protection Agency, Washington, DC 20460
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Reed JP, Fike DJ, Page SD, Sullivan AM, Breen ME. A model career ladder approach to medical technology education. Am J Med Technol 1980; 46:96-101. [PMID: 7355906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The medical technology program at the University of Vermont was modified in 1972 to create a 2 + 2 integrated curriculum with specialty options progressing that associate degree to baccalaureate degree. This design allows the fundamentals acquired in the associate degree curriculum of the medical laboratory technician (MLT) to serve as a practical and theoretical foundation that can be expanded upon in the baccalaureate degree curriculum of the medical technologist (MT). Options in the baccalaureate degree curriculum are generalist, specialist in clinical chemistry, in hematology, and in clinical microbiology. The design of this program provides a response to the changing role of the clinical laboratory practitioner.
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