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PubMed2003

A framework of strategies for client-centred practice.

BACKGROUND: Implementing strategies to overcome barriers to client-centred practice is a challenge encountered by many occupational therapists in their daily practice. The Client-centred Strategies Framework is proposed as a tool to assist occupational therapists to consider barriers and implement strategies from a variety of perspectives. DESCRIPTION: The framework consists of five categories: personal reflection, client-centred processes, practice settings, community organizing, and coalition advocacy and political action. Within each category are a number of actions that can be taken to facilitate client-centred practice. This paper describes the framework with elaboration of each of the five categories. A case example is used to illustrate how a therapist can use the framework to address client-centred practice issues. PRACTICE IMPLICATIONS: This framework will assist therapists and students to problem-solve ways to enhance the use of client-centred processes within their own practice environments.

Communication↗

PubMed2002

Practical implementation of good practice in health, environment and safety management in enterprise in the Lodz region.

OBJECTIVES: Good practice in health, environment and safety management in enterprise (GP HESME) is the process that aims at continuous improvement in health, environment and safety performance, involving all stakeholders within and outside the enterprise. The GP HESME system is intended to function at different levels: international, national, local community, and enterprise. METHODS: The most important issues at the first stage of GP HESME implementation in the Lodz region are described. Also, the proposals of future activities in Lodz are presented. RESULTS: Practical implementation of GP HESME requires close co-operation among all stakeholders: local authorities, employers, employees, research institutions, and the state inspectorate. The WHO and the Nofer Institute of Occupational Medicine (NIOM) are initiating implementation, delivering professional consultation, education and training of stakeholders in the NIOM School of Public Health. The implementation of GP HESME in the Lodz region started in 1999 from a WHO meeting on criteria and indicators, followed by close collaboration of NIOM with the city's Department of Public Health. 'Directions of Actions for Health of Lodz Citizens' is now the city's official document that includes GP HESME as an important part of public health policy in Lodz. Several conferences were organized by NIOM together with the Professional Managers' Club, Labor Inspection, and the city's Department of Public Health to assess the most important needs of enterprises. The employers and managerial staff, who predominated among the participants, stated the need for tailored sets of indicators and economic appraisal of GP HESME activities. Special attention is paid to GP HESME in supermarkets and community-owned enterprises, e.g., a local transportation company. A special program for small- and medium-size enterprises will be the next step of GP HESME in the Lodz region. CONCLUSION: The implementation of GP HESME is possible if the efforts of local authorities; research institutions and state inspectorate are combined with the support of employers' organizations.

Environment Design↗

PubMed1985

Faculty learning styles.

Learning style is defined as an individual's preferred way of acquiring information. The purpose of this study was to determine the predominant learning styles of dental students in five consecutive classes and to determine the extent of the match or mismatch between student learning styles and faculty learning styles. Results indicate that a majority of students in the dental school classes possess one particular learning style--concrete sequential. Although slight differences did exist between the distributions of learning styles of the faculty and the dental school classes, the differences were not significant. Previous research has demonstrated that the typical dental school graduate has attributes similar to the concrete sequential learner. Based on this finding, it seems likely that most concrete sequential learners will adapt well to the private practice environment. An important question, however, is whether the contemporary dental school environment, which seems to encourage concrete sequential learning style, is conducive to the development of the intellectual and technical skills that dentists will need to practice in the 21st century.

Cross-Sectional Studies↗

PubMedDate not supplied

Planning for data processing in medical practices.

Confused about computer technology and terminology? Here is a guide to the applications of data processing in a group practice environment and an outline of the various data processing services available.

Accounting↗

PubMedDate not supplied

The relevance of searching for effects under a clinical-trial lamppost: a key issue.

In economic evaluations of new medical technologies, analysts often need to use data from randomized controlled trials. Trials are designed to achieve high internal validity; however, their selected populations and often highly artificial environments may imply low external validity. Thus, the use of trial data in an economic evaluation may bias the results, since economic evaluation is concerned not with theoretical capability in a trial but with likely performance in the practice environment. This paper indicates both the probable bias of one aspect of artificiality in the trial environment--selected populations--and a method of adjusting the analysis so that results will be more likely to reflect actual practice. The judicious use of extra-trial information can be used to correct the biases of clinical trials.

Antibodies, Monoclonal↗

PubMed2001

PC reporting system for radiologists: practical use under PACS environment.

To evaluate the practical usefulness of several types of the reporting system especially for radiologists, we have developed and employed several reporting systems. We categorized those reporting systems as follows (1) stand alone PC reporting system; (2) linked reporting system with PACS environment; (3) integrated three-dimensional (3D) imaging workstation (WS) with the intranet. We have evaluated the advantages and disadvantages of those three systems, and compared between the reporting system without PACS and network reporting system with PACS. Using linked reporting system with PACS, radiologists could easily reference both previous reports and archived diagnostic images, and also make their teaching files quickly. In conclusion, the reporting system under PACS environment is found to be practical and helpful for Japanese radiologists.

Humans↗

PubMedDate not supplied

Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

Attitude of Health Personnel↗

PubMedDate not supplied

Using the Ottawa Model of Research Use to implement a skin care program.

Addressing skin care issues requires a systematic and comprehensive approach. We used the pragmatic Ottawa Model of Research Use to guide the implementation of clinical practice guidelines in a surgical program of a tertiary care hospital. Assessments were made of existing clinical practice guidelines, the practice environment, and the potential adopters. With this information, we tailored strategies to address the barriers and to implement the guidelines. A formative evaluation demonstrated positive results.

Diffusion of Innovation↗

PubMed2002

Careers of graduates of combined emergency medicine/internal medicine programs.

UNLABELLED: In 1991, the American Boards of Internal Medicine and Emergency Medicine changed their credentialing requirements to recognize training common to both disciplines. This allowed the formation of a five-year track for dual board eligibility. From 1995 to 1998, 28 physicians graduated from eight emergency medicine/internal medicine (EM/IM) programs. This study was an analysis of career outcomes of these graduates. OBJECTIVES: To document career outcomes of EM/IM program graduates, establish a baseline for future studies of EM/IM graduates, and elucidate the role of EM/IM graduates in medicine. METHODS: The 28 EM/IM graduates were mailed a written questionnaire. Endpoints assessed included practice fields, practice environments, ongoing research, publications, academic appointments, board examination scores, career satisfaction, and career goals. RESULTS: Surveys were obtained from 23 of 28 (82.1%) graduates. Seven (30.4%) practice EM and IM, 15 (65.2%) practice EM exclusively, and one (4.3%) practices IM exclusively. Twelve (52.2%) are involved in research. The graduates authored a total of 30 papers or chapters. Ten (43.5%) currently work in administrative positions, but many more aspire to. The most common reasons for having chosen an EM/IM program are to be a better physician (22/23, 95.7%), to practice in both fields (15/23, 65.2%), and to become better prepared for an academic career (15/23, 65.2%). The EM/IM graduates reported high career satisfaction. CONCLUSIONS: Although the majority of EM/IM graduates do not practice both IM and EM, many would prefer to. The graduates are highly satisfied with their choice of residency and career. Early in career development, the graduates appear to gravitate toward academic and leadership positions.

Career Choice↗

PubMed1993

Reallocating power.

Nursing management throughout the country must accept the realization that the "profession" of nursing is at a crossroads. Nursing must either abandon its claim as a profession or revise nursing's support structures in order to provide a professional practice environment. Those who accept nursing as a profession understand the responsibility and authority of the profession. These values involve the desire to assume accountability, articulate the practice of nursing and nursing competence, and define the quality of care provided. As the majority of nurses continue to practice within the hospital setting, the challenge facing nursing management is the implementation of professional governance practices.

Decision Making, Organizational↗

PubMed1993

Physician organizations and physician-hospital organizations: models for managing change.

The health care environment is expected to undergo significant change in the coming years. The continued growth of managed care, in particular will exert a profound impact on medical practice. This trend will be accelerated if a managed competition approach to health system reform is adopted at the federal level. As physicians continue to consider possible strategies by which to adapt to the changing practice environment, two options may merit special consideration: first, integration with other physicians, particularly through formation of a medical group and, second, vertical integration with a hospital, through formation of a PHO. Although PHOs are a relatively recent phenomenon, they represent a potentially powerful strategy by which physicians and hospitals can combine forces to take a leadership role in managed care contracting. Through careful planning, development of a sound legal structure and efficient governance process, and implementation of effective criteria for participation in the PHO, it is possible to further the goals of the physician and hospital participants, while meeting the needs of payers.

Delivery of Health Care↗

PubMed2001

Single subject research designs for disability research.

PURPOSE: The objective of this article is to offer an overview of single subject designs and provide clinicians with information regarding the components of single subject designs and how they can be used in clinical and other rehabilitation environments. METHOD/RESULT: Three basic designs in single subject research are presented, with corresponding examples illustrating each design. A review of visual and statistical analysis techniques commonly used in single subject designs is provided, and the advantages and limitations of each are noted. CONCLUSION: Single subject designs are ideally suited for research in the rehabilitation practice environment. If properly applied, these designs can help establish the efficacy of rehabilitation practice and contribute to rehabilitation science.

Clinical Trials as Topic↗

PubMed2004

Patient experience of time duration: strategies for 'slowing time' and 'accelerating time' in general practices.

Approaches to time management in general practices characteristically focus on objective 'clock time', for example, through appointment scheduling. No less important, however, is how patients experience time duration. Time is experienced as having passed slowly (time prolongation), quickly (time compression) or in rough synchronization with clock time. Duration has been theorized to be positively associated with information processing. This paper builds on that theory to suggest how practices can influence patients' subjective experience of duration in the practice environment, for example, by making waiting times appear to quicken and consultations appear to slow.

Family Practice↗

PubMed2007

Challenges for new nurses in evidence-based practice.

AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. BACKGROUND: These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. EVALUATION: This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. KEY ISSUES: The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. CONCLUSIONS: We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Attitude of Health Personnel↗

PubMedDate not supplied

The electronic medical record in multi-site family practice, Part 1: The planning phase.

Electronic medical records (EMRs) are being successfully implemented on a regular basis. They provide real benefits. This article presents a detailed explanation of how this medical group implemented and created a paperless medical practice environment and an electronic medical record. This includes an explanation of hardware and software components, the method of creating the EMR, benefits, pitfalls, and effect on the practices.

Family Practice↗

PubMedDate not supplied

Creating a curriculum for the 21st century.

The curriculum that was described in this article reflects our school's broad and bold definition of what constitutes knowledge in nursing. It also represents the faculty's dedication to a creative approach to education and practice, as well as a commitment to change in an age of change. It portrays a desire to design education that would develop the full range of human potential, the full potential of the university, and incorporate the full range of approaches to human problems. Our current changing practice environment underscores the challenges and complexities facing faculties and student nurses in pursuit of relevant and useful theoretic and clinical content. In addition, those of us who have practiced in the psychiatric field know that the care of clients with psychiatric problems requires heterogeneous approaches to treatment that vary with respect to type, frequency, severity, and chronicity of their conditions. We know that the impact of certain conditions is linked to age and developmental status, and we know that the effects of deviations from health are mediated by numerous features of ecology, including poverty, job and family instability, parental stress, social isolation, and community violence. As a result, nursing interventions and their outcomes no longer can be viewed in terms of simple cause and effect relationships; nor can they be thought of as occurring in the familiar settings of hospitals or institutions. For better or worse, those facilities have closed. This reality and the enormous complexities of human science speak to the multidimensional factors involved in the construction of new and different models of teaching and learning within a comprehensive conceptual framework to guide both learning and practice.

Curriculum↗

PubMedDate not supplied

Rural nurses as self-directed learners: overcoming obstacles to continuing education.

Evaluation of a fieldtest of a self-directed learning (SDL) program included assessing rural nurses' self-perceived competencies in this method and loci of control for motivation. A significant negative relationship occurred between high scores for learner skills and internal motivation ratings. Sixty-two percent rated themselves above the mean as self-directed learners regardless of perceived loci of control in the stressful rural practice environment. SDL can offer an alternative way to meet continuing education needs of rural nurses in their efforts to overcome the many obstacles to professional growth in rural practice.

Clinical Competence↗

PubMed1999

Between intention and behavior: an application of community pharmacists' assessment of pharmaceutical care.

A new practice philosophy for pharmacists, pharmaceutical care, encourages pharmacists to ensure that medication-related health outcomes are optimized. However, its adoption by community pharmacists has been slow due to numerous barriers including the economic structure of retail pharmacy, interprofessional conflicts, information limitations, gaps in pharmacy training and uneven patient demand. The specific study objectives were to (1) describe self-efficacy, beliefs, evaluations and perceived behavioral control in the provision of pharmaceutical care, (2) quantify intention and behavior to provide pharmaceutical care in a period of two weeks and (3) examine the relationships between intention and behavior. A 20% sample of Alberta community pharmacists received an attitude survey followed in two weeks by a behavior survey. Both surveys were developed for this study. Of the 320 pharmacists receiving the attitude survey, 230 completed surveys were obtained (71.9%). The behavior survey was received from 182 of those completing the attitude survey (79.1%). A causal model was constructed predicting pharmaceutical care behavior/s from pharmacists' self-efficacy, beliefs, evaluations and behavioral control. Behavioral control exerted its effect upon behavior via three pathways and its direct effect on belief was strongest. The only direct predictor of behavior was self-efficacy. The chi2 measure indicated that the model was not a perfect fit (chi2 = 99.24, df = 67, p<0.006), but the goodness of fit index (0.931), adjusted goodness of fit index (0.876), and root mean squared error (0.067) fall within acceptable ranges. Thus, it appears that pharmaceutical care implementation programs which address individual factors singly in providing pharmaceutical care will not be successful. The control pharmacists' perceive over their patient care behaviors in their practice environment is critical. Programs which help pharmacists assess their work environment and determine strategies to impact or reconstruct their environments are required.

Adult↗