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PubMed2005

Views of physicians, disciplinary board members and practicing lawyers on the new statutory disciplinary system for health care in The Netherlands.

The introduction of the Individual Health Care Professions Act (IHCP Act) at the end of 1997 brought a change in various aspects of the disciplinary proceedings. The opinions of those directly involved give an overview of the way in which the disciplinary proceedings functions under the IHCP Act in daily practice, and thus an indication of the contribution made by the disciplinary system to fostering and monitoring high standards of professional practice. Questionnaires were sent to 1300 physicians: 400 general practitioners, 350 internists, 250 gynaecologists and 300 psychiatrists (response 69%, 65%, 60% and 60%, respectively), all 388 disciplinary board members (response 89%) and 43 practicing lawyers (response 65%). Almost all of the disciplinary board members and the practicing lawyers, compared to less than one-third of the physicians, were of the opinion that in their judgement of the complaints the disciplinary boards complied adequately with the concept of good professional practice. A large majority of the disciplinary board members and the practicing lawyers regretted that a complaint could not be declared justified without a sanction being imposed. Most of them were of the opinion that there would be an increase in the number of justified complaints if this possibility were incorporated in the Act. According to the majority of the disciplinary board members and practicing lawyers, the change in the composition of the disciplinary boards had not strengthened the position of the complainant. Most of the respondents were of the opinion that the inclusion of a health professional instead of a legally qualified member was necessary in order to promote consistency in the verdicts concerning professional practice, and thought that a member from the same specialism should always be involved in the judgement of a complaint. A further contribution to the fostering and monitoring of high standards of professional practice could be made by increasing the number of health professional members, adapting the composition of the disciplinary boards to suit the specialism of the accused professional, and introducing the possibility to justify a complaint without imposing a sanction.

Attitude of Health Personnel↗
PubMed1998

Knowledge and opinions about dental human health resources planning in Mexico.

Dental human health resource planning (DHHRP), or manpower planning in Mexico has been plagued by fundamental contradictions. In spite of having trained a great many dentists in the past two decades, the dental health status of the population has not significantly improved. Concurrently, the relative scarcity of patients in relation to the number of practising dentists seems to be more marked, a critical issue since most dental care is delivered under private schemes. In the present investigation, 196 practising dentists in Mexico City were interviewed to establish their knowledge and opinions about DHHRP, and their views about the introduction of innovative alternatives in transforming, evaluating and planning human health resources. Concerns were: a need to examine and re-define the aims, skill content and marketability of professional training in professional practice; a lack of consensus as to how this is to be achieved; and a degree of awareness that professional practice has a limited scope in meeting the challenge of providing adequate care because of maldistribution of dentists and of limited financial resources of patients.

Adult↗
PubMed2001

Practice and professional development plans (PPDPs): results of a feasibility study.

BACKGROUND: Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development. AIMS: Test the feasibility of introducing practice and professional development plans using a centrally sponsored project in Wales. DESIGN: Qualitative observational study. STUDY SAMPLE: All 541 practices in Wales were alerted to the project and invited to apply. A selection process was suggested to Health Authorities but not always efficiently conducted: 23 practices were selected and 18 participated in the process. METHOD: Central funding was made available to health authorities. The project framework was designed by an educational department and conceptualised as the development of personal portfolios linked to one key organisation change in each practice, facilitated by external consultants who would typically hold workshops or other events. An independent researcher using non-participant observation techniques at workshops and practices undertook documentary analysis and fieldwork in four health authorities. RESULTS: Difficulties were encountered with the process of implementing the project: marketing and practice selection inconsistencies delayed the work and it was difficult to recruit practices into the project. The lack of experienced individuals to do the work and practitioner suspicion about perceived 'management' agendas were significant problems. After initial hesitancies most practices appreciated the value of developing wider ownership and commitment to proposed practice changes. Organisations found it difficult to support individual completion of the personal portfolio component of the plans. The ability to develop systems for clinical services was dependent on having already established a culture of effective teamwork in the organisation. CONCLUSIONS: This work supports the view that organisational development has considerable potential for bringing about effective change, and individual contributions could form a valuable component of personal portfolios. We believe that the existing structures in education and management in the health service are not yet able to support these processes. Evidence from the fields of risk management and quality improvement all point to the need to develop effective organisational systems and the results of this feasibility study indicate that alternative models of sustaining organisational development need careful evaluation.

Education, Medical, Continuing↗
PubMedDate not supplied

The professional code--10 years later.

In 1974, following an extensive eight-year review of professional practices in the Province of Quebec, the Professional Code and the 21 professional bills associated with it became operational. Thirty-eight professional corporations encompassing the fields of health, administration, finance, applied sciences and justice were named in the Code, and each was assigned an exclusive mandate to protect the public. The mechanisms outline for controlling professional practice and promoting public service included professional inspection and discipline, as well as regulations regarding ethics, the arbitration of accounts, the keeping of client records, and publicity. This paper discusses the effectiveness of these mechanisms over the past 10-year period. It also looks at the capabilities of the corporations to achieve their mandates in light of the legal status assigned to each--whether that be exclusive right of practice and reserve of title (21 corporations), or reserve of title only (17 corporations).

Physical Therapy Modalities↗
PubMed2002

The influence of a move to program management on physical therapist practice.

BACKGROUND AND PURPOSE: The purpose of this qualitative study was to examine how a move to program management (PM) from a traditional department structure affected the professional practice of physical therapists in a large Canadian teaching hospital. SUBJECTS: Twenty-five physical therapists participated in 1 of 5 focus groups, and 4 physical therapists participated in individual interviews. METHODS: Focus groups and structured interviews were conducted by an experienced facilitator who was not a physical therapist. All focus groups and interviews were audiotaped and transcribed. Using an open-coding technique, 2 investigators undertook line-by-line analysis of each transcript to identify and code specific events related to the physical therapists' experiences. The investigators reached a consensus on all coding categories and then identified themes. RESULTS: Seven themes that addressed issues of affect (a sense of loss, low morale, and positive coping), professional practice (loss of professional development activities, professional advantages, the assuming of multiple roles), and patient care were identified. DISCUSSION AND CONCLUSION: Physical therapists who were deployed from a department to a program described both positive and negative effects of the move to PM on their practice. There were reported influences on their personal affect, professional practice, and patient care. Staff and physical therapy administrators need to be aware of potential implications of an organization's move to PM on the professional practice of frontline staff.

Adaptation, Psychological↗
PubMed1995

[Doctorates in medicine and pharmacy].

Pharmacists had to wait until the Delong Act in 1979 to obtain a diploma of professional practice giving them the title of doctor. Since 1898, some of them could be called "Doctor of Pharmacy", but this title was neither a university degree nor a diploma of professional practice. A state doctorate of pharmacy was created in 1939 and replaced in 1977 by the doctorate of pharmaceutical sciences which was suppressed in 1984, like all other doctorates as university degrees. With the present reform, the doctorate of medicine, which was both a university degree and a diploma of professional practice, has only kept this latter qualification as "state diploma of doctor of medicine", like the pharmacists new diploma of professional practice. Physicians and pharmacists can now only obtain the highest university grade with the "doctorate" created in 1984. The conditions of obtention are indicated.

Education, Medical, Graduate↗
PubMed1998

The Professional Transitions Workshop. Cornerstones of practice.

The Professional Transitions Workshop is a new program that integrates the Professional Advancement Program (clinical ladder) and the Professional Model of Practice (primary nursing). Together, these two programs provide the philosophical and structural foundations of professional practice and empower nurses to articulate the defining features of their clinical experiences. Educating staff members about these programs emphasizes critical thinking and storytelling as important skills for the professional nurse. The authors describe the advantages, processes, and outcomes of this change.

Career Mobility↗
PubMed2002

Entry one: striving for best practice in professional assessment.

The aim of this study was to develop a best practice model of professional assessment to ensure efficient and effective delivery of home-based services to frail and disabled elders. In 2000, an innovative model of professional assessment was introduced by one of Australia's largest providers of home-based care in order to reduce multiple assessments and to reduce the utilisation of assessment as a gatekeeping tool for limiting access to services. Data was analysed from a random sample of 1500 clients drawn from a population of 5000 as well as through the use of a survey tool administered to the Organisation's assessment staff and other key stakeholders. Results revealed that, contrary to popular belief, carer advocacy plays a significant role in the professional assessment process to the point that clients with carers received significantly more services and service time that clients without such support. However, if not monitored, assessment can also be used as a gate-keeping tool as opposed to one that can provide significant benefits to the consumers through comprehensive need articulation. We argue that the "professional" approach does not preclude empowerment and that assessment should not be used as a gate-keeping tool.

Aged↗
PubMed2007

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions.

BACKGROUND: The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. METHODS: A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. RESULTS: Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. CONCLUSION: Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.

Administrative Personnel↗
PubMed2003

Risky professional boundaries. Articulations of the personal self by antenatal screening professionals.

This paper examines the role of various boundaries in giving both professional groups and individuals a sense of identity that provides both with status and legitimacy. Close attention is paid to the boundaries between personal and professional identities and values. Sociologists working with a discursive approach argue that professional identity and status are achieved through the rhetorical presentation of certain values and responsibilities as personal, and therefore outside the boundaries of professional practice. This paper takes this argument forward, by arguing that in particular contexts, certain kinds of values are consciously articulated as personal and incorporated into the defence of professional legitimacy. Bringing personal claims inside professional boundaries is further evidence of the fluid and negotiated quality of the boundary between personal and professional values and notions of self. The paper consists of a discussion of the construction of professional boundaries, professional involvement in risk, issues raised by antenatal screening and analysis of a study of a group of professionals involved in antenatal screening. The paper explores the circumstances within which even senior professional groups and individuals look to representations of the personal self as a defence against critiques of their professional practice. Where the risks that professionals generate and interpret are medically ambiguous and socially contentious the abstract professional and medical framework is insufficient and other rhetorical values become resources in securing the professional role.

Female↗
PubMed1997

Practical and professional aspects of i.v. therapy.

The basic principles of good i.v. practice provide a firm foundation for the continued expansion of i.v. therapy. Nurses must be aware of the professional documents that underpin nursing practice, and how these relate to i.v. therapy. Nurses must understand the legal implications of care delivery and ensure they have the necessary knowledge to expand their practice safely.

Clinical Competence↗
PubMedDate not supplied

The ASK model: a bare bones approach to the critique of nursing research for use in practice.

Professional nurses are expected to read and evaluate nursing research. Many nurses' report feeling intimated by research studies. The Applicability, Science, Knowledge Model offers the basics needed to quickly review and grasp the potential clinical significance of a journal study. Using a research report previously published in the Journal of Trauma Nursing, the authors demonstrate the critique process. Key points for critical understanding and guidelines for application to practice are presented.

Emergency Nursing↗
PubMedDate not supplied

The practice of professional nurse case management.

Professional Nurse Case Management began at Carondelet St. Mary's Hospital 13 years ago with a goal of delivering direct nursing services to high-risk chronically ill clients in the community. Nurse case management has evolved as the healthcare delivery environment has changed. This study revisits this well-described model and assesses the impact of managed care on the practice of professional nurse case management. Concept mapping was used to describe the current practice of nurse case management at Carondelet Health Network. Professional nurse case managers modeled their practice as a series of concentric spheres, each subsuming the spheres within it. Moving from the outside to the core, the spheres represent developmental framework; practicing the Carondelet mission; group practice; integration, education, and acculturation of clients within the health system; and client-focused therapeutic relationship. One final sphere of practice, bridging the gaps, represented actions that cross all spheres of nurse case management.

Case Management↗