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PubMed2006

The history of preconception care: evolving guidelines and standards.

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail.

Family Practice↗
PubMedDate not supplied

Educational and experiential effects on radiographers' radiation safety behavior.

Forty-four radiographers from 11 hospitals in Northern California were observed for radiation safety behaviors in six categories. A multiple regression analysis was performed to determine if there was a significant relationship between the six radiation safety behaviors and the radiographer's age, sex, type of professional training, years since completion of professional training, years of professional practice, time of day, and exposure frequency. The multiple regression analysis showed that there was a significant relationship between use of gonadal shielding and years since completion of professional training, years of professional practice, type of training, and age. The multiple regression analysis also showed that the number of repeated films due to technical error was significantly related to the type of professional training a radiographer received.

Adolescent↗
PubMedDate not supplied

Enhancing presentation skills for the advanced practice nurse: strategies for success.

Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.

Attitude of Health Personnel↗
PubMedDate not supplied

Breast and testicular self-examination in primary care.

Among a random sample of Michigan family physicians, attitudes about encouraging patients to perform breast and testicular self-examination were very positive. The physicians' self-reported incorporation of such encouragement into their practices was much lower for testicular than breast self-examination. Two hundred seventy-eight randomly selected family physicians in Michigan were surveyed about their beliefs about and professional practices regarding encouraging patients to perform breast self-examination (BSE) and testicular self-examination (TSE). Attitudes were very positive about both techniques. Self-reported incorporation of patient encouragement into professional practice was much lower for TSE than for BSE. The physicians' own personal practices were similarly skewed: female physicians performed BSE for themselves far more regularly than young male physicians did TSE. The barriers they identified to incorporating encouragement into their practices were similar for testicular and breast self-examination, with lack of patient motivation the leading barrier seen.

Adult↗
PubMedDate not supplied

Physical therapy competencies: a market study.

As an initial step toward curricula reevaluation and change, this study was designed to develop a list of competencies, applicable for entry-level physical therapists and appropriate to the present-day rehabilitation needs in the province of Québec. A comprehensive set of competence statements or items concerning physical therapy practice was compiled. These were subsequently edited, field tested and, through the mechanism of a questionnaire, sent to practising physical therapists in Québec for verification and rating. The level-of-importance ratings in professional practice of the 224 competence statements or items (which had been grouped into 11 categories encompassing ethics, evaluation, treatment skills, research, professional growth, administrative skills and theoretical knowledge) gave indications as to their applicability in the work market. The ratings of importance of each category were further analyzed in relation to the respondent's years of professional practice, place of training, type of position held, and work setting. Only for the variables years of experience and place of training were there any significant differences in importance ratings. The response ratings given to the competence statements and the categories can result in the determining of possible directions for educational curricula changes that would meet market demands, both at the undergraduate and graduate levels as well as in the area of continuing education programs.

Analysis of Variance↗
PubMed2001

New-world and transcultural impact on Thai medical practices and professional behaviour.

Thailand, which is barely recovering from the 1997 economic collapse, has passed a new constitution, has a new government and all of this will have a profound effect on the way doctors practice and interact with their patients. Some of the factors that have been responsible for this are 1) Passage of a patient's rights bill 2) Legal definition of what is a proper consent form 3) The public's demand for openness, better communication and transparency in medicine These concepts, which now have a legal as well as moral basis, will impact directly on doctors and nurses as their practices will be subject to increasingly intense scrutiny and criticism. Doctors and nurses in past generations were among the most respected members of Thai society. They were trusted almost without exception and their judgment was not questioned. Only rare cases of malfeasance and malpractice came to public notice though, no doubt, they existed but to a much lesser degree. A physicians' life was much simpler for our teachers, fathers and grandfathers. Life was inexpensive, families were less demanding and the doctor did not have to surround himself with expensive foreign-made apparatus which can bankrupt the doctor as well as the patients who have to pay the bills. Medical decisions were made mostly on the basis of observation, past experience at the bedside and not in the laboratory or imaging rooms. Honest errors in diagnosis were common, treatment was limited and simple and this was all tolerated or expected by the public. Few if any disappointments on the part of patients ended up before a judge.

Attitude↗
PubMed2003

Technology and medical practice.

One of the most significant developments in healthcare over the past 25 years has been the widespread deployment of information and communication technologies. These technologies have had a wide-ranging impact on the organisation of healthcare, on professional practice and on patients' experience of illness and its management. In this paper we discuss the ways in which Sociology of Health and illness has provided a forum for the analysis of these new technologies in healthcare. We review a range of relevant research published in the Journal; papers that address such issues as dehumanisation and emotional labour, professional practice and identity, and the social and institutional shaping of technology. Despite these important initiatives, we suggest that information and communication technologies in healthcare remain relatively under-explored within the Journal and, more generally, by the sociology of health and illness and point to developments in cognate areas which may have some bearing upon the analysis of technology in action.

Bibliometrics↗
PubMed2002

[Pharmacists' role in smoking cessation activities in Alsace].

In May 1999, France launched a plan to implement a range of tobacco control measures focusing on reducing tobacco use. This study evaluated two professional assistance measures for smoking cessation included in the plan: the over-the-counter sale of nicotine substitutes and replacement therapies and pharmacist training. The article describes the role of pharmacies in smoking cessation and analyses the impact of training on professional practices. The survey was conducted in the year 2000 through a mail poll sent to a random representative sample of 290 pharmacies in the French region of Alsace selected from the Ministry of Health's FINESS database. The cross-sectional survey requested data on the pharmacy and its staff, as well as its role in tobacco prevention and its practices regarding individual smoking cessation interventions (capacity to provide assistance once information is obtained on the patient's smoking status, assessment of the patient's tobacco dependence and their will to quit smoking, initial prescription of a nicotine substitute, and provision of practical advice on maintaining smoking cessation and medical care recourse). Among a total of 82 respondents, 85% proclaimed having provided smoking cessation activities and 37% had undergone training. All of the pharmacies had been declared as tobacco prevention areas. For the pharmacies offering smoking cessation assistance, the methods and activities were in accordance with best practice standards. A comparison between the group of trained pharmacists and those who were untrained did not show any significant difference for the items concerning professional practice. In spite of certain barriers linked to pharmaceutical practice, improvements in the quality of smoking cessation assistance activities provided by pharmacists are possible, such as providing confidential space to advise the client, knowing when referral to a doctor is necessary, and organising personalized follow-up according to the customer's needs.

Adult↗
PubMedDate not supplied

The proliferation of clinical practice guidelines: professional development or medicine-by-numbers?

In a medical milieu of extensive research, rapidly proliferating information, and a multitude of potential therapies, there has been an escalating trend toward the development and dissemination of clinical practice guidelines outlining investigative and management protocols for clinical problems. There are substantial benefits to providing educational directives and securing widespread adherence to specific clinical practice standards as a means to ensure a consistent acceptable standard-of-care. On the other hand, the increasing tendency to regard authoritative documents as dogma may hinder ongoing medical progress and facilitate the adoption of a "follow-the-recipe" approach to medical practice. A healthy tension between physician autonomy and recommended practice guidelines needs to be cultivated in primary care as well as in specialty clinical practice. In response to increasing concern surrounding issues of impartiality and commercial influence on the development of practice directives, a mechanism designed to assure integrity and credibility of guidelines is required.

Conflict of Interest↗
PubMed2004

Researching patient-professional interactions.

This paper explores the nature and future of social research on patient-professional interactions. It first sketches the historical background to such research and notes that in the UK and US this was characterised by a focus on the doctor-patient relationship. This research embodied a sceptical view of the power of the medical profession in sustaining and promoting social inequalities, and a critique of 'medical dominance' over other health care professionals and patients. The paper then goes on to outline changes occurring in the nature of professional practice that suggest a fundamental shift in the social relations of health care and the role of medicine. These include a putative loss of public confidence in the medical profession and the authority of science, an increased role of the media in informing patients, and a change in the state's relationship with health care professionals. Finally, the paper outlines some items for a future research agenda, including the need to understand better patient preferences about changes in health care delivery, including a willingness to engage in 'partnership', and the possibilities and barriers to change in professional practice.

Health Services Research↗
PubMed1989

Informed consent and moral integrity.

Informed consent is required for any medical procedure although the situations in which it is given are beset by uncertainties and indeterminacies. These make medicolegal scrutiny of such situations very difficult. Although some people find the decision in the Sidaway case incomprehensible because of its continuing regard for a 'professional practice standard' in informed consent, I will argue that an important fact in many cases is the moral integrity of the doctor concerned and the pattern of his practice. This may provide the only morally principled and legally accessible evidence enabling a correct decision to be made in a difficult case. Although the epistemological significance of a professional practice standard is thereby defended the 'prudent patient standard' for what counts as consent is left intact.

Communication↗
PubMed1998

Problem-Based Learning (PBL): Conceptions and Approaches of Undergraduate Students of Nursing.

Objective: A study aimed at exploring the variation in conceptions of problem-based learning (PBL) held by undergraduate nursing students and their approaches to study in PBL in a pre-registration Bachelor of Nursing Course.Method: Students were asked to respond to four open ended questions which focussed on their experience of PBL in a particular subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses. In the second phase the individual responses were classified in terms of the categories. The paper will describe the approach to the analysis, the categories identified, the relationship between the categories and discuss the implications for further research and teaching.Results: The findings indicated that there was a substantial variation in the conceptions and approaches. The majority of students, however, held relatively unsophisticated conceptions of problem based learning which were related to relatively unsophisticated approaches to learning.Conclusion: Students participating in their first PBL subject generally reported unsophisticated conceptions of and approaches to learning which were not linked to professional practice outcomes. However, those completing the last PBL subject had recognised the link between participation in the process and the development of knowledge and skills for professional practice.

Journal Article↗
PubMed2006

[Development and application of a clinical vignette to assess the quality of cancer care].

BACKGROUND: In conjunction with a study focusing on the implementation and effect of an integrated care network for cancer patients in the Monteregie region in Quebec, the vignette research strategy was adopted to assess the quality of care provided by the interdisciplinary teams working with this clientele. This research strategy has only recently been used to assess professional practices. This article adopts a resolutely methodological angle in order to describe a rigorous, innovative, transferable experience from the standpoint of the elaboration of a vignette. METHODS: We adopted a six-step approach to elaborate the vignette. This vignette includes the description of collaboration with clinicians. The approach assured us of attaining high content validity from the standpoint of facets of its relevance, completeness and intelligibility to respondents. Our clinical vignette describes a sequence of events stemming from the care coordination of a 58-year-old man suffering from rectal cancer. Data were collected through group interviews with the interdisciplinary teams (n=5) under study. The professionals present were asked to describe their usual practices with respect to the events described in the vignette. We adopted two data analysis strategies: (i) a comparison of practices revealed through the interviews with anticipated responses in light of the guidelines of the "Programme québécois de lutte contre le cancer"; and (ii) an analysis according to facets of the quality of care. RESULTS: Team professional practices seem to evolve towards the care package valued by the "Programme québécois de lutte contre le cancer". Differences were also observed between the teams from the standpoint of the continuity of care. CONCLUSION: Our study shows that it is possible to develop a vignette that enables us to understand professional practices in an interdisciplinary context provided that a rigorous approach is adopted. This approach, which can be transferred to the study of similar phenomena, makes it possible to document the care offered and contribute to the renewal of professional practices.

Colonic Neoplasms↗
PubMed1997

[To prepare the future: analysis of the occupational changes in the dispensary pharmacist's profession. 2nd: Necessity of a common project linking the university and the chemist's shop: practical proposals].

After having in a first part established facts, the authors in a second part, would like the french pharmacy faculties to be more open to the profession. In order to reach this aim, at least one teacher per faculty must direct a research towards the assessment of professional practices by creating observatories in order to measure better what is going on in the field and consequently make the evolution in teaching possible. The author, a professor in clinical pharmacy, the latter being a discipline which is naturally open to professional practices, relates an original experiences carried out in Grenoble about the activity of a quality assurance centre for the pharmaceutical act.

Education, Pharmacy↗
PubMed1983

Teaching residents the administrative aspects of psychiatric practice.

As the trend toward the organization and bureaucratization of professional practice increases, psychiatrists will require a better understanding of the administrative aspects of their practice. However, a survey of the American Association of Directors of Psychiatric Residency Training indicated that less than one-third of residency programs currently require core training in this area. The author presents a curricular blueprint that specifies learning objectives and a series of graduated training experiences over the course of residency in which essential teaching about the administrative aspects of psychiatric practice can be provided.

Curriculum↗