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PubMed2005

Teaching thinking and reaching the limits of memorization: enacting new pedagogies.

Contemporary practice environments are complex and require students and new graduates to possess high-level thinking capabilities to ensure patient safety and quality of care. To achieve this goal, many nurse educators are exploring new pedagogies (critical, feminist, phenomenological, and postmodern) to teach students the practices of thinking that contemporary clinical situations demand. These new pedagogies offer alternatives to the predominant use of conventional pedagogies, which emphasize students' memorization of content and its subsequent application in practice situations. This study, using Heideggerian hermeneutics, documents how teachers are using new pedagogies in ways that shift their attention to teaching thinking and away from devising strategies to help students memorize and apply more content. One of the themes that emerged from this study, Teaching Thinking and Reaching the Limits of Memorization, and two subthemes, Thinking AS Memorization and Recall, and Beyond Memorization: Thinking in Context are presented.

Education, Nursing↗

PubMed1999

Baccalaureate nursing education and home health: a collaborative alliance.

Nursing educators are challenged to prepare practitioners to move out of acute care and perform competently in nontraditional settings. Faculty from a university college of nursing and registered nurse preceptors from 13 home health agencies formed an alliance to serve as co-educators for junior-level baccalaureate nursing students in a 35-hour, two-semester home health clinical rotation. The outcomes of this alliance were evaluated with a qualitative descriptive study that evaluated the effectiveness of the model. Content analysis of students' journal reflections revealed that the collaborative alliance in home health enabled students to integrate practice with theory and to view the new practice environment as a meaningful learning experience. Nurse preceptors serving as co-educators in the home setting were viewed as valuable role models who provided opportunities for active participation of students. In addition, this collaborative alliance enhanced students' assimilation of the principles of nontraditional practice and facilitated the personal and professional growth they needed to prepare them for nursing practice in the future.

Community Health Nursing↗

PubMed1998

Clinical nutrition: opportunity in a changing health care environment.

This article summarizes presentations from a satellite symposium, "Clinical Nutrition: Opportunity in a Changing Health Care Environment," held July 26, 1997, at the 37th annual meeting of the American Society for Clinical Nutrition in Montreal. The symposium was cosponsored by the American Society for Clinical Nutrition and the American Society for Parenteral and Enteral Nutrition. The diverse topics served as a practical forum for sharing information on innovative responses, concerns, and impediments in the rapidly evolving practice environment.

Enteral Nutrition↗

PubMed2004

Nurse burnout and patient satisfaction.

BACKGROUND: Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. OBJECTIVES: This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. RESEARCH DESIGN/SUBJECTS: We conducted cross-sectional surveys of nurses (N=820) and patients (N=621) from 40 units in 20 urban hospitals across the United States. MEASURES: Nurse surveys included measures of nurses' practice environments derived from the revised Nursing Work Index (NWI-R) and nurse outcomes measured by the Maslach Burnout Inventory (MBI) and intentions to leave. Patients were interviewed about their satisfaction with nursing care using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). RESULTS: Patients cared for on units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice likely as other patients to report high satisfaction with their care, and their nurses reported significantly lower burnout. The overall level of nurse burnout on hospital units also affected patient satisfaction. CONCLUSIONS: Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care.

Adult↗

PubMed2005

Recruiting undergraduates to rural practice: what the students can tell us.

INTRODUCTION: There are still large gaps in the evidence base for the effectiveness of Australian undergraduate rural coursework and placements programs designed to increase the numbers of health graduates choosing rural practice. This article reports on an online survey conducted in 2004 of health science students at the University of Tasmania, Australia, designed as a part of a long-term study to test coursework interventions by tracking students' attitudes to, and experience of, rural practice from course entry to eventual practice. METHOD: All first and final year students in medicine, nursing and pharmacy in the Faculty of Health Science were invited to complete an online survey exploring the undergraduate experience of rural health. RESULTS: The survey was completed by 148 first year and 87 final year students, a response rate of 32.4% and 23.1% respectively. Over one-third (38.5%) of first years and 56.3% of final years indicated a general preference for rural life and practice and almost 90% expected to spend at least some of their career in rural practice. There was a statistically significant relationship between rural practice orientation and rural origin among first years, although this relationship was weaker among final years. Of first years, 82.4%, and 82.7% of final years appear to have made at least some commitment to a particular career path, and two-thirds to a particular practice environment. Rurally oriented first year students were significantly more committed to a career path than those without that orientation, although this did not hold for final years. When asked how much of their careers they expected to spend in capital city, rural, remote and/or overseas practice, both first and final year students' responses were notable for their spread. Few ruled rural or urban practice in or out entirely with most opting for middle range responses of 'most', 'about half' or 'part' of their career. Over half of both years expected to spend some time in remote practice and 75.1% of first years and 66.6% of final years some time in overseas practice. The factors rated most important in relation to career choice were those related directly to the realities of day-to-day professional practice--professional and peer support, work conditions and variety of work. Approximately three-quarters of those entering undergraduate education felt themselves to be at least 'somewhat informed' about rural practice but, apart from medical students, were little better informed by final year. The only perception of rural practice very widely shared (by more than 80% of respondents) was the possibility of developing better patient relations. Many of the other factors frequently identified as major issues in the rural practice literature--locality, flexibility, opportunities for further study, and spouse/partner and children's needs - while recognised by some, do not appear to loom large with undergraduates either in terms of career choice or perceptions of rural practice. Most final year students recalled receiving specific rural health training through rural placements and/or rural curriculum content. Overall recall of coursework was patchy, although placements were well-remembered and there was good support for increases in both. None of those who recalled undertaking rural coursework felt that it had influenced them towards a rural career and over two-thirds (n = 37, 69.8%) felt that this exposure had actually influenced them away from such a career. Three students reported that undertaking a rural placement influenced them towards, and 35 away from, a rural/remote career. CONCLUSION: The ultimate measure of the success of undergraduate interventions will be workforce changes over time. In the meantime more research is needed into undergraduate experience of rural health to provide the data needed for the careful design of coursework, detailed planning of the placement experience and long-term strategies to address those aspects of rural practice that are of most concern to these emerging health professionals.

Career Choice↗

PubMedDate not supplied

High-tech high-touch: mission possible? Creating an environment of healing.

As the result of assuming the role of a family member of a patient, the authors discovered that the stress made them really see how many nurses respond to patients' needs on a busy shift. They were dismayed at their reaction and immediately reverted to "Nursing 101." This article will describe the journey to establish the mission of restoring "Nursing 101" to the practice environment of an intensive care unit (ICU) and an intermediate care unit.

Attitude of Health Personnel↗

PubMedDate not supplied

Multisystem factors contributing to disparities in preventive health care among lesbian women.

Lesbians experience significant health disparities in preventive care utilization and health outcomes compared to heterosexual women. In this study, a multisystems ecologic approach is taken to identify barriers to access, treatment, and preventive care among lesbian women. Recommendations include increasing knowledge of lesbian health care needs, developing cultural sensitivity and competence in communication and care for lesbian women, and creating practice environments that convey respect, acceptance, and welcome to all women, regardless of sexual orientation.

Attitude of Health Personnel↗

PubMed2002

Seeing need and developing care: exploring knowledge for and from practice.

The use and creation of knowledge by practitioners is complex. There is a contemporary emphasis on the implementation of knowledge, or evidence, derived from outside the immediate practice environment. However, there is also an appreciation of the context-specific nature of practitioner knowledge that they use to inform patient care, and that is derived from their intimate contact with patients. This paper described one study that sought to analyse the impact of developments in practice on the wider professional and organisational community. Three case study sites were identified through a multidimensional sampling matrix, and interviews conducted with 41 practitioners of various organisational positions and professions. The primacy of context-specific, or proximal knowledge was highlighted, together with a manipulation of evidence and policy to fit understandings of local patient need.

Health Knowledge, Attitudes, Practice↗

PubMed2004

A regulatory framework for controlling effluent discharges using toxicity testing in the UK.

Legislation designed to regulate effluent discharges is expressed in terms of minimising the risk of harm of that discharge to the environment. Practical implementation is usually based on the control and measurement of a limited number of individual chemicals. However, this is not always effective because of the complex nature of some discharges or the lack of data for some chemicals, preventing the definition of acceptable levels in the environment. Direct Toxicity Assessment (DTA) clearly has a role in such circumstances because it avoids the need for a comprehensive chemical characterisation of effluent discharges. Several scenarios in which DTA can play a useful role in water quality management under current legislation have been identified. A 'generic' framework for the implementation of bioassays for effluent control is proposed. This provides a number of options in terms of the level of environmental protection afforded and the 'starting point' for a DTA programme (i.e. whether it is based on local measurable impacts on water quality or directed from the outset towards the risk assessment of particular discharges). A DTA programme can be developed that meets both the technical and regulatory requirements of these different scenarios. Guidance on the design of such programmes for different scenarios is provided.

Animals↗

PubMedDate not supplied

Intimate partner violence screening practices of certified nurse-midwives.

It is estimated that 324,000 pregnant women are abused by their partners in the United States each year. The purpose of this qualitative study was to explore the intimate partner violence-screening practices of certified nurse-midwives (CNMs). In-depth interviews were conducted with a sample (n = 8) of CNMs, and the data were analyzed by using with-case and across-case methods. The findings demonstrate that the midwives were inconsistent in their intimate partner violence-screening practice during pregnancy and increase or decrease screening in response to a woman's cultural background. Screening in a culturally competent manner is expected of all clinicians, but the demands of an increasingly complex, culturally diverse practice environment make it difficult. Consistent intimate partner abuse screening in a culturally competent manner is a challenge for all primary care providers.

Adult↗

PubMedDate not supplied

Implementation of medical-surgical nurse extern and student nurse aide programs in critical care.

In an effort to deal with the critical nursing shortage, new graduate nurses are entering highly specialized areas that once were available only to experienced nurses. A critical challenge exists for the new graduate when faced with the application of intensive theoretical knowledge in practice, and implementation of high-technology interventions, to meet the needs of patients and families. Innovative strategies are required to prepare the new graduate for this high-acuity practice environment and lessen the impact of reality shock. This article describes the implementation of medical-surgical nurse extern and student nurse aide programs that expanded to critical care. Program outcomes included positive feedback from participants about increased clinical experience, RN role perception, and comfort in the clinical practice setting. Program components are detailed, outcomes discussed, and implications for practice presented.

Attitude of Health Personnel↗

PubMed1984

Interspecialty variation in office-based care.

Analysis of national survey data on physician-patient encounters raises questions about physician education and manpower policy. Data compiled by the University of Southern California Medical Activities and Manpower Projects and the United States Bureau of Health Professionals reveal differences among internists, cardiologists, family practitioners, and pediatricians in procedures used for diagnosing and treating several frequently encountered conditions. Differences are observed in expenditure of time and use of a broad range of diagnostic and therapeutic techniques. These differences remain significant even after several important characteristics of individual physicians, patients, and the practice environment have been controlled. Findings from this study underscore the necessity of reviewing the content of medical education and policies that encourage a broad range of specialists to provide primary care. The findings also emphasize the need to address the physician's knowledge base in promoting changes in practice patterns.

Cardiology↗

PubMed2005

Training models for psychiatry in primary care: a new frontier.

OBJECTIVE: Under policies implemented by the Australian Government, the success of community mental health care has increasingly relied upon general practitioners (GPs) assuming an enhanced role in the delivery of evidence-based psychological treatment. In undertaking this role, it is crucial that GPs significantly build upon limited training in evidence-based psychological therapies such as cognitive behaviour therapy (CBT). This pilot study investigates the potential role of CBT group supervision as a training model. METHOD: Two groups of GPs (n = 9) and one comparison group of psychiatric registrars (n = 4) completed eight 1.5 h sessions of CBT group supervision over an 8 month period. Pre- to post-training measures were taken of GP performance (skills, knowledge and confidence) and the mental health outcomes of their patients. On the completion of group supervision, focus groups were conducted for in-depth feedback. RESULTS: Randomization tests indicated that GPs' confidence and knowledge in using CBT had improved over the course of group supervision. Results from focus groups confirmed that GPs' CBT skills had improved. CONCLUSIONS: Findings suggest that group supervision is a promising training model for psychiatry in primary care. Cognitive behaviour therapy should be replaced, however, with a briefer therapy model, such as brief CBT, better suited to a general practice environment. Future research needs to replicate these findings on a larger scale.

Adult↗

PubMed1994

Creative problem-solving techniques: relevance to doctors in management?

Recent NHS reforms have had a profound impact on the role of clinicians in the field of management. Traditionally this has been a role eschewed by clinicians, but the evolution of the clinical directorate model has now encouraged senior members of the medical profession to address more positively managerial and management issues. If clinicians are to embrace enthusiastically the management role, it is clear that their awareness of the range of techniques available to them is raised to its maximum potential. In this respect, explores the relevance of some more radical creative problem-solving techniques within a practical environment. The concentration is on two specific techniques which were put to trial in real working situations. However, in addition to the techniques addressed, there are a range of alternative problem-solving techniques which may be more appropriate. Having piloted the two creative problem-solving techniques described, the practical conclusions were that their application had developed better team working and spirit, enhanced the quality of patient care delivered by the team and improved productivity and outcomes.

Aged↗

PubMed2006

The Unitec/Waitemata Simulation Learning Lab: A partnership to prepare New Zealand's next generation of nurses.

There is a growing concern in New Zealand about the need to better prepare clinicians for the real world of nursing practice. The increased use of human patient simulations is one approach to addressing this concern by offering a well-organized and standardised way to provide content and encourage critical thinking in a safe practice environment. Unitec New Zealand has embraced the use of simulations in their undergraduate nursing curriculum and has partnered with Waitemata District Health Board (WDHB) to develop a state of the art interdisciplinary simulation lab. The simulation lab has been designed using wired and wireless technologies to accommodate various clinical and informatics practice scenarios. Supervision of students uses mounted cameras, and video-conference technology. The Unitec/Waitemata Simulation Learning Lab has the potential to enhance the education of nursing students by offering them a safe place to gain valuable experience with patient car delivery and informatics tools. This paper is designed to summarize the planning process used to develop this partnership, describe the vision of the centre and note the progress to date.

Cooperative Behavior↗

PubMed2004

The "every child deserves a medical home" training program: more than a traditional continuing medical education course.

OBJECTIVES: 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels. METHODS: Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child's care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs. CONCLUSION: A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.

Child↗

PubMed1998

Mutual recognition: response to the regulatory implications of a changing health care environment.

Mutual recognition offers a regulatory solution for dealing more effectively with the changes that have occurred, and continue to occur, in health care. To meet the demands of the integrated delivery system, the challenges of technological advances, and the public need for access to nursing care, nursing regulators have explored ways to make state boundaries more permeable while maintaining critical standards for consumer protection. This article discusses the evolution of regulation, the dilemma caused by the changing practice environment, why mutual recognition was chosen as the model for regulatory reform, and how mutual recognition will work from the perspective of the National Council of State Boards of Nursing.

Health Care Reform↗

PubMed1997

Physician job satisfaction: developing a model using qualitative data. SGIM Career Satisfaction Study Group.

The purpose of this study was to develop a current and comprehensive model of physician job satisfaction. Information was gathered by (1) analysis of open-ended responses from a large group practice physician survey in 1988, and (2) analysis of focus group data of diverse physician subgroups from 1995. Participants were 302 physicians from large-group practices and 26 participants in six focus groups of HMO, women, minority, and inner-city physicians. Data were used to develop a comprehensive model of physician job satisfaction. The large group practice survey data supported the key importance of day-to-day practice environment and relationships with patients and physician peers. Future concerns focused on the effect of managed care on the physician-patient relationship and the ability of physicians to provide quality care. Focus groups provided contemporary data on physician job satisfaction, reinforcing the centrality of relationships as well as special issues for diverse physician subgroups of practicing physicians. New variables that relate to physician job satisfaction have emerged from economic and organizational changes in medicine and from increasing heterogeneity of physicians with respect to gender, ethnicity, and type of practice. A more comprehensive model of physician job satisfaction may enable individual physicians and health care organizations to better understand and improve physician work life.

Adult↗