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PubMed2003

The occupation of healthcare management: relating core competencies to growth as a distinct profession.

There are many questions regarding the education of the healthcare manager. Some would argue that rather than focus on specific issues of core competencies and licensing, the discussion should be directed toward the successful development of healthcare management as a distinct profession. Two elements in defining a profession, education and legal restraints, are particularly relevant to healthcare management. It would be extremely difficult, if not impossible, for healthcare management to achieve recognition as a distinct profession in the traditional sense. There is no unique body of knowledge on which the profession is based, and no mechanism for credentialing to restrict practice. The organizational framework, however, does exist to better position the MHA-prepared graduate as the preferred candidate to manage healthcare organizations. A professional society needs to be identified as the representative society for the generalist healthcare manager. Core competencies should articulate the integration of academics and practice preparation. To accomplish the latter, academic accreditation requirements relating to faculty credentials should encourage practice-based credentials in addition to the current exclusive focus on academic credentials.

Credentialing↗
PubMed2001

Uncertainties in model-based outcome predictions for treatment planning.

PURPOSE: Model-based treatment-plan-specific outcome predictions (such as normal tissue complication probability [NTCP] or the relative reduction in salivary function) are typically presented without reference to underlying uncertainties. We provide a method to assess the reliability of treatment-plan-specific dose-volume outcome model predictions. METHODS AND MATERIALS: A practical method is proposed for evaluating model prediction based on the original input data together with bootstrap-based estimates of parameter uncertainties. The general framework is applicable to continuous variable predictions (e.g., prediction of long-term salivary function) and dichotomous variable predictions (e.g., tumor control probability [TCP] or NTCP). Using bootstrap resampling, a histogram of the likelihood of alternative parameter values is generated. For a given patient and treatment plan we generate a histogram of alternative model results by computing the model predicted outcome for each parameter set in the bootstrap list. Residual uncertainty ("noise") is accounted for by adding a random component to the computed outcome values. The residual noise distribution is estimated from the original fit between model predictions and patient data. RESULTS: The method is demonstrated using a continuous-endpoint model to predict long-term salivary function for head-and-neck cancer patients. Histograms represent the probabilities for the level of posttreatment salivary function based on the input clinical data, the salivary function model, and the three-dimensional dose distribution. For some patients there is significant uncertainty in the prediction of xerostomia, whereas for other patients the predictions are expected to be more reliable. In contrast, TCP and NTCP endpoints are dichotomous, and parameter uncertainties should be folded directly into the estimated probabilities, thereby improving the accuracy of the estimates. Using bootstrap parameter estimates, competing treatment plans can be ranked based on the probability that one plan is superior to another. Thus, reliability of plan ranking could also be assessed. CONCLUSIONS: A comprehensive framework for incorporating uncertainties into treatment-plan-specific outcome predictions is described. Uncertainty histograms for continuous variable endpoint models provide a straightforward method for visual review of the reliability of outcome predictions for each treatment plan.

Humans↗
PubMed2003

Pharmacology education: a theoretical framework of applied pharmacology and therapeutics.

United Kingdom Government initiatives such as The NHS Plan (DoH 2000) identified the need for nurses to undertake multi-skilled professional roles. In the United Kingdom, the transition to a larger graduate nurse workforce continues, as Universities offer nurse pre-registration courses at diploma and degree levels. Concomitant with the change in educational standard is the need to teach student nurses the theoretical principles of medication management and to develop skills in clinical reasoning skills. Both elements are limited in current educational pre-registration nurse programmes, in order to develop the future, multi-skilled workforce such courses should incorporate the theory and skills of health assessment, physical examination, applied pharmacology and clinical reasoning. This paper aims to examine how knowledge of applied pharmacology and therapeutics can be integrated into an undergraduate pre-registration nursing programme. Discussion focuses on how this generic framework can provide educators with an outline of the theoretical constructs, their application, the teaching strategies involved and instruction on how to prepare nurses to clinically reason with regard to medication management issues. This framework can be adapted to accommodate nurses studying for all parts of the register.

Clinical Competence↗
PubMed1994

A concept analysis of personal knowledge: application to nursing education.

A concept analysis of personal knowledge is completed using the Walker and Avant method. The analysis is based on Polanyi's concept of personal knowledge with a working definition being extrapolated from his writings combined with Belenky and colleagues' concept of constructed knowledge. The goal is to construct a definition of personal knowledge which recognizes the multifaceted processing used by humans in the endeavour to perceive new patterns, and which is free from discrimination based on age, sex, culture, discipline, world view or learning style. Knowledge is defined as pattern recognition which may be probabilistically rather than exactly predictive. Personal knowledge is defined as recognition of a new pattern through processing by the human being. The processing may consist of any combination of human and environmental interaction, 'rational intuiting', appraisal, active comprehension and personal judgement, all in a setting of departure from the current conceptual framework. The pattern may be new to the person or to humanity. Personal knowledge is denoted by perception of the person. The antecedents, attributes and consequences are taken from the literature. The empirical referents are hypothesized from a review of the nursing, social work and education literature. After defining personal knowledge and differentiating it from other phenomena, it is integrated into nursing education. An educator accepting personal knowledge as an expectation for students approaches the teaching/learning situation by planning to create an atmosphere in which individual growth and illumination can occur. Therein personal knowledge is integrated into nursing education using the most barrier-free theoretical frameworks in the areas of learning, curriculum and instruction.

Attitude of Health Personnel↗
PubMed2002

Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project.

This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotion. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organization. It was identified that the critically important elements in achieving the aims of the project-partnership, leadership and commitment-were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion.

Competency-Based Education↗
PubMed2005

Critical thinking of student nurses during clinical accompaniment.

The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators' perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts 'critical thinking' and 'facilitation' were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.

Attitude of Health Personnel↗
PubMedDate not supplied

Putting education into practice for pre-operative patient assessment.

This article provides a background to current practice in pre-operative assessment (POA) and outlines a POA lead nurse role that was successfully introduced in two acute hospital trusts. The education, training and assessment programme that was developed for POA nurses is also discussed. The aim of the programme was to offer an educational framework for nurses at different levels of practice in POA.

Acute Disease↗
PubMed2002

Pain during spinal cord injury rehabilitation: client perspectives and staff attitudes.

Pain after spinal cord injury (SCI) is well documented in the literature. Effective treatment for pain after SCI remains elusive and treatment protocols have not been well researched. Staff on a 32-bed SCI rehabilitation unit designed and implemented a descriptive research study to improve pain management outcomes. An interdisciplinary plan to improve pain management practices was developed as a result of the study. Guidelines of the American Academy of Pain Medicine and the American Pain Society (1997) and the Agency for Healthcare Policy and Research (1992 [now called Agency for Healthcare Research and Quality]) provided the framework for the interdisciplinary management of pain.

Adult↗
PubMed1990

Role development: the nursing quality assurance coordinator.

This application of the Benner Model to the role experiences of the NQA coordinator demonstrates the usefulness of this framework to describe the progressive development of the role. In Benner's model, there are three distinct areas for discussion. First, as the nurse moves from the expert role of staff nurse or head nurse to the role of novice NQA coordinator, many very real situations are encountered that have the potential to create frustrations and adverse feelings within the nurse. It is equally important for the position holder, as well as the supervisor, to recognize these as the normal growth stage of the novice, so that appropriate actions can be taken to positively help the NQA coordinator through these early developmental stages. Secondly, initial acceptance of the NQA coordinator role creates feelings of anticipation, challenge, and excitement. However, in spite of this, the novice is soon likely to feel threatened and alone. This feeling is related to various situations, such as the lack of formal guidance and role preparation. As a result, the novice NQA coordinator often needs to accept the responsibility for self-direction in role preparation. At this point, it may be quite overwhelming for the NQA coordinator to take personal responsibility for obtaining the knowledge and skills necessary to be successful in the role. To be successful, it is vital for the novice and advanced beginner to identify developmental needs and to obtain the resources and support needed during these crucial stages. Finally, the personal reflection on the experiences of two NQA coordinators demonstrates that, although the developmental stages are relatively well defined, they may not always be clear-cut, and there may be vacillation between stages. These are normal phenomena for which strategies can be identified to enhance adaptation and growth within the particular stages of skill acquisition. The proposed time frames noted for each stage of role development may be somewhat arbitrary. Many variables, such as degree of specialization, urgency of the task, and characteristics of the position holder, organization, and health care environment will influence role development. Thus, the individual may not experience a straightforward and clear-cut progression but rather a back-and-forth movement through the various stages. The role experiences of the NQA coordinator are easily conceptualized using the Benner framework.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical Competence↗
PubMed2006

Ethical considerations in CT angiography.

The rapid development and clinical deployment of CT angiography raises several important issues, including assurance of professional competence and technical quality, self-referral, the relative role of radiologists and cardiologists, appropriateness and proper indications, the detection and disposition of unexpected or incidental findings and the concern for the rapidly increasing costs of health care and imaging. These questions are properly addressed within the framework of medical ethics, including principles of beneficence, autonomy and justice.

Advertising↗
PubMed2003

Revisiting Bloom's taxonomy for ethics and other educational domains.

In the process of developing competency-based health services administration education, the Ethics Faculty Forum Co-Chairs from the Association of University Programs in Health Administration (AUPHA) were asked not only to identify their domains and competencies, but also to review six other faculty fora research outcomes. This article was written by the Ethics Faculty Forum Co-Chairs in response to the AUPHA request. Reviewing the work of the original six faculty fora using Bloom's taxonomy, we found that the fora focused mainly on the cognitive objectives and generally did not consider the affective objectives. The intent of this paper is to help those who teach healthcare ethics refine their current courses to include both cognitive and affective objectives. The paper pursues five objectives: 1. review of Bloom's taxonomy as a framework for creating course objectives in both the cognitive and affective domains; 2. present fora research and their domain outcomes; 3. present an overview of healthcare ethics literature; 4. provide a demonstration of healthcare ethics competencies in both the cognitive and affective domains; and 5. present possible directions for healthcare ethics and other educational domain research.

Affect↗
PubMed1990

Framework for reform.

Ordinary people are starting to add their voices to the debate on the U.S. healthcare system. But the chorus is not yet loud enough to transcend a budget crisis, a savings and loan bailout, competing interests of other industries and a siege of self-interest within the healthcare industry.

American Hospital Association↗
PubMed1998

Telemedicine: responsibilities and contractual framework.

The rapid growth of telemedicine has created a need for a definition of the responsibilities of the doctors involved. These responsibilities must be analyzed according the tort of negligence as a function of the level of competence of each doctor, their unequal access to the relevant information and their command of the telemedicine system. This analysis leads on to a study of the legal value of the electronic records kept and the ways in which the doctors are remunerated.

Clinical Competence↗
PubMed1999

The kinetics of nerve-evoked quantal secretion.

Current views on quantal release of neurotransmitters hold that after the vesicle migrates towards release sites (active zones), multiple protein interactions mediate the docking of the vesicle to the presynaptic membrane and the formation of a multimolecular protein complex (the 'fusion machine') which ultimately makes the vesicle competent to release a quantum in response to the action potential. Classical biophysical studies of quantal release have modelled the process by a binomial system where n vesicles (sites) competent for exocytosis release a quantum, with probability p, in response to the action potential. This is likely to be an oversimplified model. Furthermore, statistical and kinetic studies have given results which are difficult to reconcile within this framework. Here, data are presented and discussed which suggest a revision of the biophysical model. Transient silencing of release is shown to occur following the pulse of synchronous transmitter release, which is evoked by the presynaptic action potential. This points to a schema where the vesicle fusion complex assembly is a reversible, stochastic process. Asynchronous exocytosis may occur at several intermediate stages in the process, along paths which may be differentially regulated by divalent cations or other factors. The fusion complex becomes competent for synchronous release (armed vesicles) only at appropriately organized sites. The action potential then triggers (deterministically rather than stochastically) the synchronous discharge of all armed vesicles. The existence of a specific conformation for the fusion complex to be competent for synchronous evoked fusion reconciles statistical and kinetic results during repetitive stimulation and helps explain the specific effects of toxins and genetic manipulation on the synchronization of release in response to an action potential.

Action Potentials↗
PubMed2002

Discussing treatment options and risks with medical patients who have psychiatric problems.

Discussing medical treatment options and risks becomes a more complicated task when patients have psychiatric problems. Such patients may perceive risk and judge options differently from usual, they raise special issues about informed consent and competency, and they may present special needs and stresses in the physician-patient relationship. This article addresses how to approach such treatment discussions within the framework of 3 content areas of the medical interview (medical decision making, informed consent, and the physician-patient relationship) and 2 formal techniques of the interview (exploration and assertion). Clinical research regarding how psychiatric problems may affect each of these areas of concern is reviewed. Ultimately, the goal of understanding such variations--and of possessing methods to address them in discussing treatment options and risks--is to help the patient be as free as possible from the burden of biases or distortions in making his or her decisions and to promote the best fit between the patient's wishes and the physician's medical judgment.

Adult↗
PubMed1993

Quality of care in family planning in Latin America.

The majority of family planning programs in Latin America have been implemented in response to the region's population growth and aimed mainly at obtaining quantitative results, leaving quality, from the user's point of view, in second place. Recent decades have witnessed an increasing concern for quality of care in family planning because most researchers and service providers began to realize that when contraceptive methods are delivered without maintaining high quality levels, continuation rates are usually low and the image of methods and services is impaired. This paper reviews the level of quality of services in family planning in Latin America following Judith Bruce's framework and proposes, some activities that may improve it. The analysis found severe deficiencies in almost all the elements mentioned by Bruce, mainly in choice, technical competence, and mechanisms for improving continuity. The authors propose that to improve quality, services should (a) generate top management commitment to quality, (b) stay close to the client/user, (c) improve work conditions of providers/health workers, (d) measure quality, and (e) reward quality. The authors' conclusions are that (a) better quality services lead to better program results, (b) high quality is cost-effective, (c) managerial commitment is critical to improvement of quality, and (d) quality of care is not a luxury; it is necessary and possible in all settings.

Clinical Competence↗
PubMed2004

[The well-informed patient from the statutory health insurance standpoint].

By introducing competition into the statutory health insurance system the model of the informed patient has obtained new importance. As corporations of public law,more than 350 statutory health insurance funds (SHI funds) fulfil original tasks of in-forming and counselling patients. Although the SHI funds lack incentives for more patient orientation due to an inadequate risk equalization scheme, the SHI funds are extending their competences to support health consumer protection. On the one hand, attractive offers for information and counselling are being regarded as an important competitive field in the framework of the respective corporate strategy. On the other hand, the SHI funds are highly interested in having well-informed patients assume personal responsibility and through their well-directed demands contribute to more quality and efficiency in the healthcare system. Which objective need for in-formation does the population still have?What are the effects of medical lay knowledge on the communication between doc-tor and patient? From the SHI funds' point of view, however, there are many relevant questions still unsolved. Therefore, they consider health care research desirable to help them make user-oriented information avail-able for different target groups.

Counseling↗