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At least 811 records · Page 45Linked to original sources
PubMed2005

[A professional nursing practice environment and its impact on nurses' task motivation].

PURPOSE: This study was aimed at (a) describing professional nursing practice environments embedded in nursing care units and (b) examining its relationships to nurses' task motivation. METHOD: Using the Nursing Work Index Revised (NWI-R) and the Work Preference Inventory (WPI), a descriptive study was conducted with a sample of 320 registered nurses on 26 nursing care units in one University hospital in Korea. RESULT: Mean scores were 12.9 on a 5-20 score range of an autonomous environment scale, 7.3 on a 3-12 score range of a collaborative environment, and 15.8 on a 7-28 score range of control over nursing practice. Nurses' age, educational level, job position, working period at the hospital and employment status were significantly related to the degree of a professional practice environment. The extent to which a professional practice environment accounted for task motivation was 19.5%. CONCLUSION: There is a certain degree of professionalism in the workplace environment that nurses perceived within the nursing care units. When nurses care for patients, the degree of task motivation depends on the work environment supporting the professional nursing practice.

Adult↗
PubMedDate not supplied

Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics.

OBJECTIVE: Ethics training has become a core component of medical student and resident education. Curricula have been developed without the benefit of data regarding the views of physicians-in-training on the need for ethics instruction that focuses on practical issues and professional development topics. METHODS: A written survey was sent to all medical students and PGY1-3 residents at the University of New Mexico School of Medicine. The survey consisted of eight demographic questions and 124 content questions in 10 domains. Responses to a set of 24 items related to ethically important dilemmas, which may occur in the training period and subsequent professional practice, are reported. Items were each rated on a 9-point scale addressing the level of educational attention needed compared to the amount currently provided. RESULTS: Survey respondents included 200 medical students (65% response) and 136 residents (58% response). Trainees, regardless of level of training or clinical discipline, perceived a need for more academic attention directed at practical ethical and professional dilemmas present during training and the practice of medicine. Women expressed a desire for more education directed at both training-based and practice-based ethical dilemmas when compared to men. A simple progression of interest in ethics topics related to level of medical training was not found. Residents in diverse clinical specialties differed in perceived ethics educational needs. Psychiatry residents reported a need for enhanced education directed toward training-stage ethics problems. CONCLUSIONS: This study documents the importance placed on ethics education directed at practical real-world dilemmas and ethically important professional developmental issues by physicians-in-training. Academic medicine may be better able to fulfill its responsibilities in teaching ethics and professionalism and in serving its trainees by paying greater attention to these topics in undergraduate and graduate medical curricula.

Adult↗
PubMed2002

Radiation oncologists in 2000: demographic, professional, and practice characteristics.

PURPOSE: To describe the demographic, professional, and practice characteristics of radiation oncologists, emphasizing comparisons to data from a similar 1995 Survey. METHODS AND MATERIALS: In spring 2000, we surveyed 603 randomly selected radiation oncologists by mail, using a one-page questionnaire-455 responded. We weighted responses to make answers representative of all radiation oncologists in the United States. RESULTS: Approximately 45% of post-training, professionally active, radiation oncologists were <45 years old and 22% were women. Forty-two percent of radiation oncologists in training were women. Thirty-three percent of radiation-oncology-only practices were solo practices. The greatest percentage of post-training, professionally active, radiation oncologists were in nonacademic private radiation oncology practices. Fifty-three percent of post-training, professionally active, radiation oncologists reported that their workload was about right. Eighteen percent of individuals 60-64 years old and approximately two-thirds of those > or =65 years old were not working (retired). The full-time equivalency of those aged 55-74 fell by 12 percentage points between 1995 and 2000. CONCLUSIONS: Most demographic, professional, and practice characteristics remained relatively constant between 1995 and 2000, with the exception of work status patterns. Radiation oncologists reported a more balanced workload than that reported by diagnostic radiologists. The surplus of radiation oncologists, which was predicted in the mid-1990s, was not demonstrated.

Adult↗
PubMed1999

An innovative professional nursing practice model.

Nursing, as with health care delivery, is changing to meet the greater challenges brought about by managed care and the accompanying external forces in the marketplace. Nurses, with their vast resources of knowledge and experience, are crucial in achieving optimal quality care. Given the opportunity to redefine and strengthen the impact of nursing practice at Piedmont Medical Center in Atlanta, Georgia, a group of advanced practice nurses began developing a unique practice model. The resulting Professional Nursing Practice Model--a theoretical framework created for nurses by nurses--presents a common vision of human beings, health, and nursing in accordance with the values and beliefs of nursing. This model demonstrates the importance of a person-centered, value-driven nursing practice across the continuum of health from birth to death.

Empathy↗
PubMed2002

Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified.

Attitude of Health Personnel↗
PubMedDate not supplied

Predictors of professional nursing practice behaviors in hospital settings.

BACKGROUND: Many hospital nurses perform isolated, routine tasks, rather than use their professional training, because they are subject to control by organizational and medical divisions of labor. The environment may interfere with a nurse's ability to practice autonomously and according to professional standards. OBJECTIVES: The purpose of the study was to explore how certain factors in the environment and personal characteristics interact to affect hospital nursing practice behaviors. METHODS: The study used a nonexperimental, comparative design. Surveys were sent to a random sample of 500 nurses throughout the state of Michigan. Three instruments, measuring structural empowerment, self-efficacy for nursing practice, and professional practice behaviors, were included. Path analysis was used for statistical analysis. RESULTS: Three hundred sixty-four nurses responded (73%), of whom 251 provided usable protocols for the final analysis. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors as well as indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Support for the proposed theoretical model was mixed, although the proposed model fit the data well (chi = 11.02 [(5, N = 251), p < .05, CFI = .999, NNFI = .991, RMSEA = .069]). An alternative model emerged from the data analysis. DISCUSSION: Nurses may practice more professionally when the environment provides opportunities and power through resources, support, and information. Self-efficacy may contribute to professional practice behaviors, especially in an environment that has the requisite factors that provide empowerment.

Adult↗
PubMed2002

The impact of restructuring on professional nursing practice.

Through the 1990s most hospitals were involved in restructuring. As a result, maintaining professional nursing practice is challenging in these cost-constrained hospital environments. In new models of care, professional nursing practice expectations are often reconceptualized into multidisciplinary care team structures in which the team is empowered and becomes the focus rather than the individual nurse caring for her or his patient. Given that nurses provide the greatest part of patient care in hospitals, professional nursing practice has the potential to differentiate one hospital from another. Consequently, it is in the strategic interest of organizational policy makers to implement initiatives that support professional nursing practice.

Hospital Restructuring↗
PubMed2000

Organisational development in general practice: lessons from practice and professional development plans (PPDPs).

BACKGROUND: Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. RESULTS: Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. CONCLUSIONS: It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals.

Evidence-Based Medicine↗
PubMed2004

Evidence into practice: a theory based study of achieving national health targets in primary care.

RATIONALE, AIMS AND OBJECTIVES: This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful. METHODS: Sixteen London GPs were interviewed, eight 'high implementers' (having met five or more of six CHD NSF milestones) and eight 'low implementers' (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA). RESULTS: There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care. CONCLUSIONS: This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.

Coronary Disease↗
PubMed2005

Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy.

OBJECTIVE: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. METHOD: A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). RESULTS: Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. CONCLUSION: Health professionals have identified the need for educational materials for themselves and their clients. IMPLICATIONS: FAS is likely to be under-ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.

Adult↗
PubMedDate not supplied

Ethics in professional nursing practice.

With expanded roles in nursing comes increased responsibility, often without clear authority. Understanding professional ethics and their practical application is essential to professional practice. The authors review the concept of ethics and discuss examples for application of ethical judgment from OGN nursing practice.

Ethics, Nursing↗
PubMed2005

Correlates of reflective practice in medicine.

BACKGROUND: The ability of physicians to critically reflect on their professional practice has been increasingly valued. Previous research brought to light the multidimensional structure of reflective practice in medicine. It comprises at least five sets of behaviours in response to complex medical problems encountered in professional practice. Factors associated to reflective practice among physicians have, as far as we know, not yet been explored by empirical study. PURPOSE: To study factors correlated to reflective practice among physicians. METHODS: A questionnaire exploring characteristics of professional practice and educational experiences was administered to primary health care physicians. Measurements were related to scores on a reflective practice measuring instrument developed previously. Associations between variables were examined by statistical analysis with tests of correlation and analysis of variance. RESULTS: Reflective practice is negatively correlated to physician's age and number of years of clinical practice. Working mainly in hospitals and attendance to medical residency programmes in some specialties apparently have a positive effect on reflective practice. CONCLUSION: Reflective practice tends to decrease with experience. Findings are consistent with the literature on medical expertise that shows a decline of analytical reasoning in proportion to the increase in experience. Some specialty programmes seems to enhance concerns with the scientific basis to professional practice, thereby favouring reflective approaches. Local features of primary health care settings probably explain their negative effect on reflective practice. Strategies to develop reflective practice among physicians should be explored by further research.

Adult↗
PubMed2006

Promotion of evidence-based practice by professional nursing associations: literature review.

AIM: This paper reports a literature review examining the activities of professional nursing associations in the promotion of evidence-based practice. BACKGROUND: Professional nursing associations can play a role in the implementation and achievement of evidence-based practice as such associations aim to develop and further educate nurses professionally, build professional networks representing the interests of nurses and the nursing profession, influence the government and policymakers, and support and protect the basic values of nurses. The exact role of professional nursing associations in the promotion of evidence-based practice is as yet unclear, along with just how the role of such associations can be expanded and which strategies can be used to promote evidence-based practice among members. METHOD: A literature and Internet search was undertaken using the PUBMED, CINAHL, SCIRUS, INVERT, and the Cochrane databases using the terms evidence-based practice(s)* or EBP*, which were then combined with Nursing Society*, Nursing Organization*, Nursing Organisation*, Nursing Association* or Nursing Council*. Other sources included a Google search of the Internet, and the sites of various members of the International Council of Nurses. Publications in English, French or German from 1993 to 2004 were used, and the Internet search was conducted on 17 July 2003. RESULTS: Sixty nursing associations described the dissemination of evidence-based practice using one or more types of activities (179 activities in total). All of these activities were of a voluntary nature, with a predominant focus (132/179 activities) on intrinsic motivation of nurses. More specifically, most of the activities were aimed at nurses' competences and attitudes in relation to evidence-based practice. CONCLUSION: Professional nurses' associations are active in promoting evidence-based practice among their nurse members, but only those focusing on changing competences and attitude by addressing intrinsic motivation are well used. Other types of activities deserve to be explored, including behaviour-oriented approaches, approaches using structural, social or financial influence measures and perhaps methods based on 'involuntary involvement'.

Evidence-Based Medicine↗
PubMed2002

Clinical practice opportunities for advanced practice nurses.

With approximately 132,000 practicing APNs and a continued need for APNs, the role will continue to expand. Many different business options and models for healthcare practice exist for the APN. Commonly thought of professional practice options for APNs include private practice, joint or collaborative practice, and group practice. Each model of professional practice brings with it different roles and responsibilities, rewards and challenges, and criteria for success. When evaluating different practice opportunities. APNs must be aware of each of these factors and evaluate each factor based on his or her chosen lifestyle. This article has presented an overview of common practice models and the roles and responsibilities, challenges and rewards, criteria for success, and lifestyle considerations inherent in each.

Career Choice↗
PubMed1986

Professional nursing practice in neurology ambulatory care.

The ambulatory care setting is an important expanding area for professional nursing practice. The demand for ambulatory care nurses is stimulating the definition and development of professional nursing practices in outpatient clinics. Neurology ambulatory care at the National Institutes of Health, Bethesda, Md, is provided in the context of contributing to biomedical research. This article discusses the components of patient selection criteria, experimental therapy, and research data collection that have implications for nursing care. Visit categories are used to discuss administrative and practice issues of the research patient population at all institutes. Management plans are discussed, and a case study is presented along with a care plan.

Adult↗