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PubMed1996

[A survey of the diffusion and impact of consensus development conference on infections caused by central venous catheters in an anesthesiologist team].

OBJECTIVES: To assess the diffusion and the impact on the professional practices of a consensus conference (CC) by the French speaking Society of Intensive Care on "Central venous catheter-related sepsis in intensive care". STUDY DESIGN: Before-after survey with two successive questionnaires. MATERIAL AND METHODS: Two questionnaires (Q1 and Q2) were circulated either to intensivists (group 1) or to anaesthetists (group 2) of a University Hospital, before (Q1) and after (Q2) distribution of the CC conclusions. They aimed to assess the diffusion of the conclusions by the CC; the professional practices before the CC and their modifications after consideration of the recommendations by the CC. RESULTS: Out of the 55 consulted, 85% answered Q1, and 71% Q2. Among them, 42% were aware of the conclusions of the CC before starting the survey-73.5% from group 1 and 28% from group 2. Therefore, conversely to anaesthetists, intensivists, did not significantly modify their professional practices after consideration of the CC conclusions. CONCLUSION: This study shows a satisfactory diffusion of the content of jury's recommendations among anesthetists whereas the impact was less satisfactory with intensivists. The impact of a CC could probably be improved by a better diffusion of the consensus statements and by the intervention of local linkmen.

Anesthesiology↗

PubMed2000

Leadership-scholarship integration: using the Neuman systems model for 21st-century professional nursing practice.

This article describes leadership and scholarship from the Neuman systems model as requisite for a true practice model necessary for 21st-century scientific professional nursing. A rationale for the integration of leadership and scholarship is provided along with markers to guide the leadership-scholarship protocol, which can be viewed as a scholarly research process. An example from a community nursing center demonstrating the application of the integration of leadership-scholarship is presented to support the proposed integration.

Aged↗

PubMed2006

Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements.

BACKGROUND: The Accreditation Council for Graduate Medical Education duty hour requirements may affect residents' understanding and practice of professionalism. OBJECTIVE: We explored residents' perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements. DESIGN: Anonymous cross-sectional survey. PARTICIPANTS: Internal medicine, neurology, and family practice residents at 3 teaching hospitals (n=312). MEASUREMENTS: Using Likert scales and open-ended questions, the questionnaire explored the following: residents' attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism. RESULTS: One hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing professionalism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork. CONCLUSIONS: Residents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.

Attitude of Health Personnel↗

PubMed1994

Adult intubation for beginners.

The UKCC's 'Scope of Professional Practice' validly points out that, 'Practice takes place in a context of continuing change and development' partly 'as a result of new approaches to professional practice'. Consequently, demands are made on educational institutions to prepare professionals for new practice. One of the new skills, which is now being taught to nurses on the Anaesthetic Nursing Course at the Eastern Area College, is that of endotracheal intubation. Bearing in mind the all-important proviso that 'As a registered nurse, midwife or health visitor, you are personally accountable for your practice', it is essential that post registration education 'equips practitioners with additional and more specialist skills necessary to meet the special needs of patients and clients'. This article is therefore designed as an introduction to the basic rationale, anatomy and procedural skills necessary for safe intubation.

Humans↗

PubMedDate not supplied

The integration of research by nurse educators: advancing practice through professional development programs.

BACKGROUND: This article describes how nurse educators at The Hospital for Sick Children, Toronto, have used Benner's findings as a framework to direct the advancement of professional development programs, specifically preceptorship, orientation, and central education programs. METHOD: Narrative methodology was introduced as a key educational strategy to capture the complexity of pediatric clinical practice and enhance learning experiences. RESULTS: The shift in content and structure of the education programs from a structured behavioral teaching-learning framework to the use of narrative methodology has enhanced learning, professional development and clinical practice. CONCLUSION: Participant evaluations of these programs suggest a high level of satisfaction with the use of narrative methodology. Evaluative measures focusing on the relationship between narrative methodology, professional development, and client outcomes is needed. This evaluative approach that measures outcomes is imperative to future directions in program planning.

Career Mobility↗

PubMed2003

Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia.

BACKGROUND: Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice. METHOD: Qualitative approach using non-participant observation of, and semi-structured interviews with, anaesthetic staff in two English hospitals. RESULTS: The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge--clinical, social, electronic, and experiential--and formal theoretical learning. Experts have mastered technical skills but are also able to understand the dynamic and uncertain condition of the anaesthetized patient and respond to changes in it. This expertise is acquired by working with colleagues, and, importantly, by working independently, to develop personal routines. Routines mark the successful incorporation of new knowledge but also function as a defence against the inherent uncertainty of anaesthetic practice. The habits seen in experts' routines are preferred ways of working chosen from a larger repertoire of techniques which can also be mobilized as changing circumstances demand. CONCLUSIONS: Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.

Anesthesia↗

PubMed1998

The use of professional nursing practice standards in nursing labour arbitrations in British Columbia, 1987-1994.

This study examined the use of nursing practice standards in British Columbia in labour arbitrations related to patient care for the years 1987-1994. Retrospective secondary content analysis was the method used to analyse the cases. Although practice standards were referred to in some of the cases, the nature and clarity of these standards were not always evident. In addition, corporate and industrial precedents, rather than health care precedents, formed the basis for much of the arbitration deliberations. The perspectives of nurses, patients, and families were not significantly represented. Many of the arbitration hearings did not get beyond procedural matters, and so did not address substantive patient care situations. Clearly, the visibility and importance of nursing standards need to be raised among nurses and non-nurses alike. Implications and recommendations for nursing practice, administration, education and research, as well as for nursing professional associations and unions are discussed. Research questions for the future are suggested.

British Columbia↗

PubMed2003

[Values and redefinition of professional space. Reflections about nursing].

This article forms part of a much wider ongoing study about professional values in the professional health fields. This reflection centers on the following points: social change and values; traditional values and new values; values on the threshold o fthe 21st Century; redefining values and professional spaces themselves; evolution in professional practices and their adhesion to nursing values; the exercise of professional practice in changing environments.

Nurse's Role↗

PubMed1991

Nursing group practices in hospital settings.

As hospitals continue to face problems with nursing shortages and difficulty in retaining experienced nurses, they are forced to examine the environment of nursing practice to determine how that environment can be improved. At Henry Ford Hospital, a planning process is underway to establish a more truly professional practice environment for nursing. This professional practice environment is based on a group practice model for inpatient nursing. The group practice model offers the potential for greater clinical and administrative autonomy and collaborative practice with physicians, but may require significant changes in internal budgeting and accounting systems. Several different inpatient group practice models and their implications are discussed.

Group Practice↗

PubMed1994

Clinical nurse specialist and staff nurse colleagues in integrating nursing research with clinical practice.

To advocate for cost-effective patient care and to strengthen the registered nurse's professional practice, the CNS must support nursing research in acute care facilities. This support for research includes sparking the staff nurse's interest and involvement in all segments of the research process. We must recognize our clinical nurses' efforts on behalf of research through greater financial reward; the CNS is challenged to use his or her influence to persuade administrators to grant this support. How the CNS and staff nurse, working together, can disseminate the findings of nursing research, thus promoting cost-effective care and solidifying the nurse's professional practice, is discussed in this article.

Clinical Nursing Research↗

PubMed2003

[When graduate education is interested in renewal of rehabilitation practices: study of needs].

BACKGROUND AND PURPOSE: In order to meet the new challenges facing the professional practice in rehabilitation, a study of practitioners in the rehabilitation field in Québec was undertaken to evaluate their needs in terms of continuing education in graduate level studies. METHOD: A total of 99 participants were involved in focus groups and phone interviews. An analysis of the content of the discussions was performed. RESULTS: According to this analysis, the participants wished to develop skills that could be divided into two main categories of competencies: the development of the "self as a tool", that is improving the practitioner's ability to show insight into his professional practice, and the "self as a service provider", that is developing knowledge in the cognitive area associated with the improvement in the quality of service. In addition, the participants favored different teaching methods, such as intensive teaching preferably on week-ends as well as short term training programs (9 to 15 credits). PRACTICE IMPLICATIONS: This study succeeded in identifying the special needs of practitioners in order to face the changes in health services. The need to create a graduate program in rehabilitation was highlighted and the participants were enthusiastic at the thought of the creation of such a program.

Curriculum↗

PubMed1995

Gender comparisons of young physicians' perceptions of their medical education, professional life, and practice: a follow-up study of Jefferson Medical College graduates.

PURPOSE: To obtain information from a group of young physicians and compare men and women on their evaluations of selected areas of the medical school curriculum, their perceptions of issues related to medical practice and professional life, and their specialty choices, professional activities, and research productivity. METHOD: In 1992, a questionnaire was mailed to 1,076 physicians who had graduated from Jefferson Medical College between 1982 and 1986. The responses of men and women were compared using multivariate and univariate analyses of variance, t-tests, chi-square, and median test. RESULTS: Completed questionnaires were returned by 667 graduates (530 men and 137 women). The curriculum areas of interpersonal skills, disease prevention, medical ethics, and economics of health care were rated by both men and women as being the most important in medical training. Conversely, research methodology and statistics received the lowest ratings. Women, in general, valued psychosocial aspects of medical care higher than did men. Among the areas of perceived problems related to practice, lack of leisure time received the highest ratings (as being the greatest problem) and interpersonal interactions received the lowest ratings (as being the least problem) from both men and women. The men were more concerned than the women about the areas of patient chart and documentation, malpractice litigation, physician oversupply, peer review, and interaction with patients. These differences remained when specialties and numbers of hours worked per week were held constant. Generally, the physicians reported satisfaction with their professional lives, but the men tended to be more satisfied than the women about their decisions to become physicians and in their perceptions of medicine as a rewarding career. The proportion of men employed full-time (99.4%) was significantly higher than that for women (84%). Women were more likely to practice general pediatrics, while men were more likely to practice surgery and surgical subspecialties. Full-time--employed women worked fewer hours per week (57) than men (63), and men reported more research productivity than women. CONCLUSION: The implications of the findings of numerous gender differences are discussed regarding the issues of physician workforce, types of care rendered by men and women, and possible changes in the national health care system.

Analysis of Variance↗

PubMedDate not supplied

[Social implications of physician professional and certification quality].

The paper analyzes the social implications of the professional quality of physicians and of their process of certification. The adequate competencies of physicians are especially relevant in countries that have broad social asymmetries and cultural plurality. This diversity of social and epidemiologic conditions demands a profile of physicians able to work in a wide range of environments and able to achieve the best professional practice, making the best use of the available resources for medical care. Medical competencies and quality of care are interrelated. The process of coupling universal knowledge and local conditions creates a synchronic diversity of professional practices. Medical certification must be viewed as part of the process of diffusion of innovations. The development of a variety of abilities to cope with innovations contributes to the production of a diachronic diversity of medical practices. In the light of continuing quality improvement, it is necessary that certification systems be articulated with both continuing medical education and the accreditation and progress of healthcare institutions. Otherwise, there is the risk of increasing inequality in medical practice that, in the last analysis, blames the victim.

Certification↗

PubMedDate not supplied

Standards of holistic nursing practice as guidelines for quality undergraduate nursing curricula.

The accreditation criteria of the Commission for Collegiate Nursing Education (CCNE) direct faculty to select nationally developed standards for professional practice to guide curricula and to articulate curriculum outcomes. Recently, the CCNE proposed that all undergraduate programs should adopt the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education as one set of national standards for undergraduate and prelicensure programs. Standards of Holistic Nursing Practice, developed by the American Holistic Nurses' Association, is an additional set of standards that assists in defining quality for undergraduate nursing education. Standards of Holistic Nursing shares major concepts with Essentials; however, it accentuates the concepts of nurse self-care, articulated nursing theory as a foundation for practice, managing the care environment to promote healing, and care of the environment as essential to professional practice. These standards do not change the care being provided by professional nurses adhering to nursing theory and current evidence, but they do raise awareness and change emphasis of practice to reflect a holistic perspective. Used together, Standards and Essentials provide complementary guidelines for curricula-preparing professional nurses to care for client and self.

Accreditation↗

PubMed1997

Continuing medical education: the question of evaluation.

This paper examines the question of evaluation which has been largely neglected in the credit-based systems of continuing medical education adopted by the Medical Royal Colleges. These systems are seen to encourage a training model of continuing education and a scientific model of evaluation as measurement. By contrast, humanistic evaluation is interpretative and differs not only in its criteria and methods, but also in its underpinning curricular ideologies and values. This model has closer links with concepts of education and professional practice associated with continuing professional development. Decisions about who should conduct the evaluation, what is to be evaluated, how it should be carried out, and about the goals and purposes of evaluation are outlined, noting that they presuppose an ideological view of the relationship of professional knowledge, values and practice. In a concluding discussion of evaluation and the control of professional knowledge, it is argued that the narrow, professional control of evaluation, buttressed by the quality assurance and monitoring mechanisms of the Colleges, is inappropriate, given the increasingly diverse accountabilities which affect medical professionals.

Education, Medical, Continuing↗

PubMed2002

In a secular spirit: strategies of Clinical Pastoral Education.

The Clinical Pastoral Education (CPE) model for the provision of spiritual care represents the emergence of a secularized professional practice from a religiously-based theological practice of chaplaincy. The transformation of hospital chaplaincy into "spiritual care services" is one means by which religious healthcare ministry negotiates modernity, in the particular forms of the secular realm of biomedicine and the pluralism of the contemporary United States healthcare marketplace. "Spiritual" is a label strategically deployed to extend the realm of relevance to any patient's "belief system:" regardless of his or her religious affiliation. "Theological" language is recast as a tool for conceptualizing the "spiritual lens:' Such moves transform chaplaincy from a peripheral service, applicable only to the few "religious" patients, into an integral element of patient care for all. Such a secularized professional practice is necessary to demonstrate the relevance and utility of spiritual care for all hospital patients in an era of cost-containment priorities and managed care economics.

Chaplaincy Service, Hospital↗

PubMed2005

Return to driving after traumatic brain injury: a British perspective.

PRIMARY OBJECTIVE: To identify the current legal situation and professional practice in assisting persons with traumatic brain injury (TBI) to return to safe driving after injury. METHODS AND PROCEDURES: A brief review of relevant literature, a description of the current statutory and quasi-statutory authorities regulating return to driving after TBI in the UK and a description of the nature and resolution of clinical and practical dilemmas facing professionals helping return to safe driving after TBI. Each of the 15 UK mobility centres was contacted and literature requested; in addition a representative of each centre responded to a structured telephone survey. MAIN OUTCOME AND RESULTS: The current situation in the UK is described, with a brief analysis of the strengths and weaknesses both of the current statutory situation, and also the practical situation (driving centres), with suggestions for improvements in practice. CONCLUSION: Although brain injury may cause serious limitations in driving ability, previous drivers are not routinely assessed or advised regarding return to driving after TBI.

Adult↗

PubMedDate not supplied

In their own words: the experience of returning to acute care practice.

The worldwide nursing shortage requires hospitals to utilize innovative recruitment strategies to attract registered nurses. One of these strategies is the "re-entry" program for registered nurses currently employed outside the hospital. Although there is significant literature on the development of such programs and the personal adjustments made by participants, there is a paucity of literature regarding the experience of returning to practice from a professional practice perspective. This study examines the experience of the registered nurse who returns to acute care, using a descriptive, exploratory qualitative design, and asking: (1) What is the meaning of the nurses' experience when returning to acute care practice? (2) To what extent does the practice environment facilitate the retention of nurses who return to practice? (3) To what extent does the practice environment hinder the transition back to practice? Data indicate that returning registered nurses perceptions could be categorized into 3 themes: (1) motivation prior to entry, (2) coping during the process of returning to practice, and (3) the impact of the role of environment in the facilitation of or hindrance to nurse retention. Implications for staff development specialists are discussed.

Acute Disease↗