From CAN: accountability and liability in professional nursing practice.
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Clinical Competence↗
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Results for “Professional Practice”
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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↗
Case study: reconciling the quality and safety gap through strategic planning.
An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance).
Benchmarking↗
[The social representation of nurse's professional autonomy in public health].
The object of this study was the nurse's professional autonomy and had the following specific objectives: describe and analyze the social representations of the nurses 'professional role and analyze the professional autonomy-dependence binomial. As theoretical methodological reference it was chose the Social Representations Theory It was proceeded in-depth interviews with 30 nurses of the basic health system from a county in Rio de Janeiro state. To the data analysis it was used the Alceste 4.5 software. The software generated five classes, two express the professional formation/absorption and three the professional. Practice. The analytical categories were constituted from the dimensions in which the social representations express themselves: the conceptions, the positions and the professional practices autonomy.
Nursing↗
The use of patients in health care education: the need for ethical justification.
This paper addresses ethical concerns emanating from the practice of using patients for health care education. It shows how some of the ways that patients are used in educational strategies to bridge theory-practice gaps can cause harm to patients and patient-practitioner relationships, thus failing to meet acceptable standards of professional practice. This will continue unless there is increased awareness of the need for protection of human rights in teaching situations. Unnecessary exposure of patients, failing to obtain explicit consent, causing harm to vulnerable or disadvantaged groups and inappropriate use of information, though normally regarded as unacceptable professional practices, may go unrecognised in meeting educational needs, widening rather than narrowing theory-practice gaps.
Behavioral Research↗
Redesigning hospital nursing practice: the Professionally Advanced Care Team (ProACT) model, Part 2.
The pressures of the current nursing shortage have created an unparalleled opportunity to restructure hospital nursing practice and care delivery. The potential exists to create new systems which simultaneously advance the goals of the profession and solve the problems of the shortage. Part 1 of this article (JONA, July/August, 1989) examined the similarities and differences among existing models and described the Robert Wood Johnson University Hospital ProACT model. Part 2 outlines the process of developing and implementing ProACT, an alternative nursing practice and care delivery model.
Costs and Cost Analysis↗
Issues for the coming age of continuous glucose monitoring.
PURPOSE: This article reports the results of a symposium in which diabetes educators considered and discussed issues that are likely to arise when continuous glucose monitoring (CGM) becomes available and readily accessible. METHODS: Fifteen certified diabetes educators and 5 others with complementary expertise participated in a discussion based on their responses to 11 questions designed to elicit perspectives on issues related to CGM. Issues for discussion and debate include those related to patient acceptance and lifestyle, implications for professional practice and reimbursement, concerns about professional liability, use of CGM data by insurers and payers, and CGM data transfer. RESULTS: Educators offered varied and sometimes conflicting responses to CGM-related issues. CONCLUSIONS: Awareness of CGM-related issues will likely become an important part of diabetes professional development and perspectives in practice. Identifying and framing the issues before the new technologies become available allow diabetes educators to participate proactively in structuring the emerging policies, procedures, and standards of care.
Attitude of Health Personnel↗
Nursing faculty teaching in the general education sequence: the value of liberal arts as a component of professional nursing practice.
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Curriculum↗
Nuclear medicine in oral and maxillofacial diagnosis: a review for the practicing dental professional.
Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.
Citrates↗
The home as a setting for care. Clarifying the boundaries of practice.
This article has outlined the need for clarification of home care nursing practice to retain the elements essential to professional practice. Home care that is nursing focused, based on concepts of community health nursing, and client/family centered forms the core of professional home care nursing. Technical services that are provided in the home should be clearly delineated so that consumers, payors, and practitioners can determine the roles and functions of the various providers. Professional home care, practiced not just by nursing but by all licensed providers, is practice driven. The boundaries of practice are determined by professional standards with a basis in scientific theory and research. The foundation for this type of practice is strong and should continue to be practiced in the future. Technical house call services, on the other hand, are product driven, often with a zeal for the bottom line profits that does not take into account what is the best product for a specific patient situation or how well that product has been tested. There is definitely a need for both services in delivering health care to people in their homes. It is also hoped that both areas of service can work together to facilitate the management of patient and family needs. It is important, though, to fully define the type and substance of care that is provided in the home setting. Without this ongoing clarification, home care will continue to be fragmented and interpreted differently by everyone involved.
Aged↗
Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.
Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.
Decision Making, Computer-Assisted↗
Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
CONTEXT: Although physicians report spending a considerable amount of time in continuing medical education (CME) activities, studies have shown a sizable difference between real and ideal performance, suggesting a lack of effect of formal CME. OBJECTIVE: To review, collate, and interpret the effect of formal CME interventions on physician performance and health care outcomes. DATA SOURCES: Sources included searches of the complete Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group, supplemented by searches of MEDLINE from 1993 to January 1999. STUDY SELECTION: Studies were included in the analyses if they were randomized controlled trials of formal didactic and/or interactive CME interventions (conferences, courses, rounds, meetings, symposia, lectures, and other formats) in which at least 50% of the participants were practicing physicians. Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors. DATA EXTRACTION: Determinations were made about the nature of the CME intervention (didactic, interactive, or mixed), its occurrence as a 1-time or sequenced event, and other information about its educational content and format. Two of 3 reviewers independently applied all inclusion/exclusion criteria. Data were then subjected to meta-analytic techniques. DATA SYNTHESIS: The 14 studies generated 17 interventions fitting our criteria. Nine generated positive changes in professional practice, and 3 of 4 interventions altered health care outcomes in 1 or more measures. In 7 studies, sufficient data were available for effect sizes to be calculated; overall, no significant effect of these educational methods was detected (standardized effect size, 0.34; 95% confidence interval [CI], -0.22 to 0.97). However, interactive and mixed educational sessions were associated with a significant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1.45). CONCLUSIONS: Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.
Clinical Competence↗
1968 survey of dental practice. IV. Professional expenses. Bureau of Economic Research and Statistics.
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American Dental Association↗
Reflection: does it enhance professional nursing practice?
It is generally accepted that nurses who engage in reflective activity do so to develop their practice. However, there is little empirical evidence to suggest that practice development or improved patient care occurs as a direct result of reflection. The UKCC, as part of its framework for postregistration education, expects all nurses to engage in some form of reflective activity and to provide written accounts within a personal professional profile. This article examines some of the assumptions surrounding the practice of reflection and asserts that, in the main, nurses do not readily engage in reflection in a purposeful way.
Education, Nursing, Continuing↗
Predictors of course satisfaction and perceived course impact of addiction nurses undertaking a postgraduate diploma in addictive behaviour.
The effectiveness and impact of continuing education for specialist nurses working with drug and alcohol had been poorly documented and the purpose of this study was to enhance our understanding of this process. The aims of the study were to identify predictors of course satisfaction and perceived course impact and to examine students' satisfaction with modules' learning outcomes and their applications to practice. This study was a cross-sectional survey of 46 part-time students enrolled a Postgraduate Diploma in Addictive Behaviour. Three instruments were used to measure modules' satisfaction, post-course satisfaction (PCSQ-18) and on-the-job impact (CIQ-17). The findings provided some support on the effect and impact of an educational programme on the practice development of addiction nurses. Within the multilayered hypothesis, the results indicate that expectations on the Health Education and Prevention Module were the only significant predictor of course satisfaction and Expectation of the Special Population Module was the only significant predictor of course impact on professional practice. Clinical placements have had a significant impact on professional practice of addiction nurses. Further evaluative studies need to be undertaken to examine the impact of educational programmes on its applications to clinical practice and the quality of care provided.
Adult↗
Storytelling as inquiry in a mental hospital.
People give meaning to chaotic experiences and try to persuade others of their perspectives by telling stories. In the process of meaning making, some stories gain and maintain the status of a standard story. When people no longer recognize themselves in the standard story, it loses credibility and a different story is needed to endow their lives and practices with meaning. A narrative inquiry of a vocational rehabilitation project in a mental hospital shows that inherited stories sustained the therapists' professional practice but prevented a successful rehabilitation of patients. Several therapists were willing to place this standard story between brackets and to listen to other unheard stories told by patients who participated in the project. These marginalized stories did not replace the standard story but enriched it. New plot lines were woven into the existing story and constituted changes in professional practice.
Adaptation, Psychological↗
Agency characteristics most valued by home care nurses: findings of a nationwide study.
The demand for home care services is continuing to rise at such a rate that the home care nursing workforce will need to double by 2020. Struggling to recruit and retain an adequate clinician supply in the midst of a severe shortage, administrators may find help in the magnet hospital approach, which focuses on creating a professional practice environment. This study identified, in a national sample of home care nurses, organizational traits reported most important in supporting nurses' professional practice and job satisfaction.
Adult↗
The role of the professional nurse. A report from the Task Force of the Department of Nursing at the Montreal General Hospital, Montreal, Quebec.
In order to deal with the nursing shortage the Department of Nursing at the Montreal General Hospital commissioned a series of task forces to study recruitment and retention issues and to develop recommendations for the department. Welcoming the involvement of nurses at all levels in the organization, the task forces became a method of developing objectives and strategies to foster decentralized decision-making and professional practice, to organize care efficiently and effectively and to market nursing. This article examines the work of the Task Force on the Professional Role of the nurse. Background information on the development of the task forces, a description of current behaviours of nurses, a vision of the future role and recommendations for the support required to develop the role are included.
Hospitals, General↗