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PubMed2005

Maintenance of skills for today's family physician: the SAGE approach to physician learning.

Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for today's military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.

Clinical Competence↗

PubMedDate not supplied

Performance logic: a key to improving dental practice.

The efficient delivery of oral health services is heavily dependent on the process of intraoral performance used by the dental practitioner. Yet, little attention has been paid by practitioners, educators and researchers to this most basic aspect of dental practice. The study and application of the principles of Performance Logic is providing the dental community an opportunity to identify and apply an optimal process of oral care delivery. A primary objective of Performance Logic is optimal control of the task-at-hand while minimizing psycho-physiologic stress. This is accomplished through the proprioceptive self-derivation of an ideal posture and position and a complementary performance process from which a supporting practice environment is then specified. Through a worldwide network of collaborating research and practice sites, Performance Logic is being explored and applied to a variety of clinical settings. Performance Logic may alter and improve the way dentists work in the future.

Dental Care↗

PubMedDate not supplied

Tuberculosis prevention practices and perspectives of physicians in DeKalb County, GA.

Knowing the reasons some physicians do not adhere to the disease prevention and treatment recommendations of expert committees can assist in the development of future recommendations more likely to be adopted by physicians. The authors describe the attitudes and practices of physicians relative to tuberculosis prevention in DeKalb County, GA. Tuberculosis is an important problem in the county, which includes part of the City of Atlanta, as well as suburban areas. Questionnaires for anonymous reply were mailed to 1,621 physicians in the county in 1991, and 848 (53 percent) were completed and returned. The final sample was 793 physicians, who were grouped into 5 specialty areas. Primary care physicians were the group most commonly involved in specific tuberculosis screening and prevention activities. Medical and pediatric specialists, surgeons, obstetricians-gynecologists, and other physicians were significantly less likely to be involved in such activities. Given that primary care physicians constitute a decreasing proportion of physicians in the United States, the findings suggest the importance of ensuring that future strategies for tuberculosis prevention take into account the increasingly specialized nature of the medical practice environment.

Family Practice↗

PubMedDate not supplied

Factors related to research utilization by registered nurses in Kentucky.

The current health care environment mandates an outcomes-driven approach to care. Outcomes-based, and practice-driven, nursing research can be an essential organizational investment to maintain viability. Registered nurses in Kentucky appear motivated and ready to participate in and use relevant nursing research in their practice environment. Administrative support for those endeavors can be a key component in the successful conduct of clinical research and translation into clinical practice. Participation in research endeavors by both nursing staff and management can support the value of nursing in the current health care delivery system. This study adds to the literature in the area of research utilization in that random selection, a relatively large sample size, and all RNs in the state (not just members of the professional nursing organization) were used. Hopefully, the results of this study can be used to bring together all important parties in the research utilization process--experts, quality assurance nurses, managers in control of resources, risk managers, and those providing patient care.

Attitude of Health Personnel↗

PubMed2004

The problem of postoperative pain: issues for future research.

Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.

Analgesia↗

PubMed2000

Practice management for academic dermatology departments.

Practice management in the academic medical center (AMC) is different than in other environments. Practice is only a part of the practitioner's mission within an AMC. Practice revenue will be subject to a tax or overhead by both the school and the department. Contract and practice guidelines cannot be tailored to the needs of the dermatology practice, because contracts and guidelines are negotiated globally for all of the practices within the AMC. Personnel, on which the practice depends, may report to hospitals and clinics rather than to the practice's management. Even control of the practice's manager may be diluted by a dual or "dotted line" reporting relationship between the department manager and the school practice manager. Although more constraints exist within the AMC, there are some strategic and operational choices that affect a practice's success. Among these are: (1) selection of services offered; (2) creation of satellites; (3) stimulation of faculty effort; (4) enhancement of faculty billing knowledge; and (5) creation of a "tie" between staff and the practice.

Academic Medical Centers↗

PubMedDate not supplied

The scholarship related to nursing work environments: where do we go from here?

Nursing shortages within American hospitals are in part associated with problematic work environments. Scholarship related to work environments is multidisciplinary and has been conducted using traditional and constructivist approaches to science and knowledge development. Nursing research related to nurses' work environments in hospitals is often conceptualized around variables such as job satisfaction, professional practice environment, and job stress. Macro-level variables associated with political, economic, and social aspects of the work environment have received less attention. Philosophical issues are considered. Person-Environment Congruence Theory is proposed as a framework capable of addressing environmental incongruence in hospital nursing work environments. Implications for theory and research using the framework are described.

Humans↗

PubMed2002

The efficient, enjoyable, and profitable orthopedic practice.

For the practicing orthopedist to achieve his personal practice goals of developing an efficient, enjoyable, profitable orthopedic practice, he must commit himself to restructuring his practice environment. This restructuring involves bringing in-house as many ancillary services as the practice can support, creating efficiencies in the clinic and surgical practice, and increasing the size of the group to attempt to exert some control of the payers in the marketplace. By doing so, the orthopedist will improve the quality of his practice, increase his income, and dramatically improve the quality of his life.

Ambulatory Care Facilities↗

PubMedDate not supplied

Structural empowerment, Magnet hospital characteristics, and patient safety culture: making the link.

Nurse managers are seeking ways to improve patient safety in their organizations. At the same time, they struggle to address nurse recruitment and retention concerns by focusing on the quality of nurses' work environment. This exploratory study tested a theoretical model, linking the quality of the nursing practice environments to a culture of patient safety. Specific strategies to increase nurses' access to empowerment structures and thereby increase the culture of patient safety are suggested.

Attitude of Health Personnel↗

PubMedDate not supplied

Management curriculum redesign: integrating customer expectations for new leaders.

Tumultuous and dynamic changes in the healthcare environment have resulted in unprecedented stresses and challenges for both nursing education and nursing practice. It is essential that nursing education curricula reflect the rapidly changing technologies and dramatically expanding knowledge and changes in the practice environment and incorporate theory, science, professional standards, and consumer/service input. The authors describe a redesigned undergraduate management curriculum.

Clinical Competence↗

PubMed2005

Characterization of the microbial community in indoor environments by chemical marker analysis: an update and critical evaluation.

UNLABELLED: We published recently an integrated procedure for applying chemical marker analysis to characterize the microbiology of indoor environments comprising a scheme for extraction and analysis of markers of endotoxin, peptidoglycan/bacterial biomass, and fungal biomass. In the present paper, we report some significant improvements and also new possibilities of the described approach. We found that while 3-hydroxy fatty acids (3-OH FAs) of 10-14 carbon chain lengths are useful endotoxin markers, longer 3-OH FAs (i.e. with 16 carbon atoms and more) may rather serve as markers of Actinobacteria. We introduced 13C-labeled 3-hydroxytridecanoic acid, from labeled Pectinatus cerevisiiphilus, as an internal standard to improve quantification of the 3-OH FAs in the gas chromatography-mass spectrometry analysis. Finally, in experiments aiming to identify a suitable method for collection of house dust for chemical marker analysis, we found that the marker compositions of dusts sedimented on plexiglass plates that were spatially well-distributed in a studied room at different heights above floor level, were undistinguishable. This type of sampling thus appears to be well suited for use, e.g. in epidemiological studies. In summary, the presented work describes important new capabilities of chemical marker analysis in defining human exposure to microorganisms in indoor environments. PRACTICAL IMPLICATIONS: We are developing an integrated methodology for characterizing the microbiology of indoor environments where specific microbial monomeric constituents in building materials and inhalable house dust particles are determined by using mass spectrometry-based methods. The methodology should represent a firm basis in research aiming to relate microbial exposure indoors to well-being and health.

Air Microbiology↗

PubMed2003

Patient safety to frame and reconcile nursing issues.

Canadian nursing leadership is called to advance a national patient safety agenda for the delivery of safe, quality care in professional practice environments. Yet, the nursing discipline is burdened by issues and challenges related to clinical practice and workplace dilemmas that contribute to barriers and obstacles to safe, quality and humane care. We propose that the many clinical challenges faced by nurses in Canada can be more fully understood when framed by a patient safety perspective. Nurse executive leaders and nurse scientists are called to reform clinical practice and conduct research to reconcile patient care safety issues. This paper applies findings obtained from nurses via focus groups led by the Academy of Canadian Executive Nurses (ACEN) and integrates these findings into a patient safety perspective via a conceptual framework.

Attitude of Health Personnel↗

PubMed2005

Features of medical records in community practices and their association with preventive service delivery.

BACKGROUND: Medical records are important for facilitating the process and quality of care. However, little is known about their current state in primary care practices. This article describes features of medical record systems in diverse practices and examines their association with preventive service delivery rates. METHODS: Medical records were reviewed from a consecutive sample of outpatients seen by 198 family physicians in 79 community-based practices in Northeast Ohio. The physicians were participants in a clinical trial designed to increase preventive service delivery. Research nurses performed baseline medical record reviews and used ethnographic field notes and a practice environment checklist to provide global assessments of features of medical records. RESULTS: In 79 practices, 3462 medical records were reviewed. Medical records were rated as highly easy to use in 52% of practices; outpatient visit notes were dictated in 54%. Nine percent of practices grouped individual charts by family. Patient notes were computerized in 1% of practices, although several practices had previously tried and abandoned computerized systems. Flow sheets for immunization, screening, and counseling were present on 71%, 63%, and 16% of charts and were used on 34%, 33%, and 3% of charts, respectively. The presence and use of flow sheets were associated with higher preventive service delivery rates. CONCLUSION: Medical record organization, completeness, and use vary widely, and computerized records remain rare. The association of flow sheet presence and use with preventive service delivery rates shows the potential importance of medical records for enhancing the process and outcome of patient care.

Adolescent↗

PubMed1993

Physicians' strategies for safeguarding confidentiality: the influence of community and practice characteristics.

BACKGROUND: Confidentiality is an issue of particular importance in rural communities where it seems everyone knows everyone else. Privacy may be compromised when professional relationships are interwoven with personal ones. We conducted a study to determine the influence of practice characteristics on safeguarding confidentiality. METHODS: A survey was mailed to all family and general practice physicians in Kansas. Differences in confidentiality strategies were studied to determine if they were related to characteristics of the respondents and their practice environments. RESULTS: A total of 510 physicians (55%) responded to the survey. Only in practices in which more than 5% of the patients were personal acquaintances was a strategy for preserving confidentiality affected: of seven specific strategies, only one, speaking with office personnel about confidentiality, was statistically associated with this practice characteristic. CONCLUSIONS: Physicians practicing in smaller communities and areas with more extensive social interconnectedness may need to address the issue of privileged communication to a greater extent. If other options are exhausted, physicians may need to send patients with particular needs for confidentiality outside their communities to obtain care.

Adult↗

PubMed2002

Balancing values and imperatives: a study of nursing service in an ICU.

There has been significant attention from the managers and purchasers of health services regarding the economic advantages that result from changes to the patterns of health care delivery in the acute hospital setting. The impact of these changes, whilst often rendering advantage at the economic management level of health care, can have different consequences for the people who deliver and the people who receive health service. This paper reports on a study that was conducted with a group of nurses to investigate the practice milieu of a critical care unit in the context of changes to health service management. Interpretive methods were used to capture the perspective of the nurses and the way they interpret the multiple factors that influence their practice and their practice environment. The findings indicate that the nurses in the study setting interpret these factors according to the influences they have on the structure, the geography and the value of their work. Explication of these findings provides a research base to inform recommendations relating to improving the practice milieu of the critical care environment.

Adaptation, Psychological↗

PubMed1989

Factors influencing the success of academic radiologists in publishing research.

To guide changes that might improve radiologists' research productivity, we surveyed 1400 members of the Association of University Radiologists. We evaluated the impact of influences related to background, education, training, attitudes, and practice environment on 558 respondents' frequency of research publication. Attending medical school, obtaining radiology training, and practicing at an institution among the 20 with the highest amount of research funding was associated with the highest research productivity in academic practice. Taking a radiology research fellowship, regularly attending research seminars, and association with a research mentor during training were also associated with higher career productivity. Virtually all aspects of the academic practice milieu, and particularly having time set aside for research, were significant influences on radiologists' frequency of publication. Men published research more frequently than women. This phenomenon appears related to women being afforded fewer research experiences during radiology training and a greater concern on the part of women about obstacles that hinder their doing research. These data might be employed to guide changes that would improve the selection and nurturing of individuals likely to be productive in research.

Attitude of Health Personnel↗

PubMedDate not supplied

Developing leadership: management skills for small group practices.

The role of group administrators is changing as quickly as is the group practice environment. The results of a survey of physicians and administrators in physician-owned group practices with fewer than 15 physicians offers some guidance. Physicians and administrators, the results show, have similar expectations for administrators. They also agree that physician-administrator teamwork has become more professional. The results also suggest that administrators need the tools to be proactive planners for their organizations, rather than passively responding to change.

Administrative Personnel↗

PubMedDate not supplied

Confronting unsafe practice: ethical and legal issues.

Confronting unsafe practices in the workplace requires careful ethical and legal analysis and a supportive practice environment. Nurses should collaborate with their colleagues to create mechanisms to review and monitor clinical practices, investigate questionable occurrences, and collaborate with licensing boards to respond to infractions.

Child↗