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At least 991 records · Page 55Linked to original sources
PubMed1999

An ethnographic study of women's experience of partnership caseload midwifery practice: the professional as a friend.

OBJECTIVES: To explore the experience of a known midwife for labour and birth as provided through the partnership caseload model of care in women who had a previous baby under an alternative system of care. DESIGN: A qualitative study using an ethnographic approach. Data were collected by tape-recorded interviews. SETTING: The maternity unit at Leicester Royal Infirmary NHS Trust, Leicester, UK in 1998. PARTICIPANTS: 10 multiparous women cared for by Birth Under Midwifery Practice Scheme (BUMPS) midwives were interviewed between eight- and 12 weeks' postpartum. KEY FINDINGS: Women's perceptions and experiences were predominantly influenced by the relationships they had with their midwives who they described as 'friends'. All other themes were filtered through these relationships, including previous negative experiences of maternity care, the valuing of a known midwife for labour and birth, their positive birth experiences, expressions of delight at their care, their liking of home antenatal care, and the appreciation of their existing children and partners meeting their midwives. IMPLICATIONS FOR PRACTICE: Partnership caseload midwifery practice has significant positive impact on women's experience of childbirth. The midwife/woman relationship that has evolved in this context is highly valued by women and challenges traditional professional roles. The model should be explored in other settings to see if its benefits to women are transferable.

Anthropology, Cultural↗
PubMed2005

Health 'care' interventions: making health inequalities worse, not better?

AIM: The aim of this paper is to present a model, the 'Effect of the Professional Ego', which provides a psychodynamically informed analytical framework for examining professional practice in arenas where issues of inequalities need to be addressed. BACKGROUND: There is a great deal of literature on the psychosocial aspects of inequalities in health care provision. However, the impact of intrapsychic and professional cultural elements has not been explored in this context. Moreover, the body of work which does explore these elements in relation to health care workers does not address how they might impact on health inequalities. DISCUSSION: Drawing on empirical work, we discuss ways in which intrapsychic and professional cultural elements feed into the dynamic between clients and health care professionals in a way which can subvert espoused, positive client health outcomes. Based on this discussion, we propose the Effect of the Professional Ego model, which identifies two main aspects of the professional ego - the grandiose self and self-preservation - and how they influence the professional/client dynamic. CONCLUSION: Systematic self-reflection on the part of professionals would be a valuable contribution to the development of professional practice. This applies particularly to conceptualizing the links between the actions of service providers and the adverse health of clients.

Attitude of Health Personnel↗
PubMedDate not supplied

Outcomes measurement in healthcare. New imperatives for professional nursing practice.

Quality of healthcare is measurable and nurses in all settings are increasingly being expected to actively participate in identifying and measuring patient outcomes. To do so requires an understanding of the tools and processes currently being used to measure the quality of healthcare in this country. This article provides an overview of current efforts in the healthcare field to develop a shared outcome language and standardized national quality indicators. The challenges professional nurses face in identifying and measuring nursing-sensitive patient outcomes and the responsibility to use that data to shape nursing practice are emphasized.

Humans↗
PubMed2006

Group-format clinical supervision for hospice nurses.

This paper discusses the aspects of a small research study, which used mixed research methods. The study concerned group-format supervision as a means of helping five hospice nurses, four women and one man, discuss their work experiences. An aim of the study was to understand something of the professional work of hospice nurses and how they might best be supported. Ethical considerations and some benefits derived by group members from clinical supervision are summarized in the context. The research method entailed 12 sessions of group-format clinical supervision. The discussion explores the forming, management and dynamics of a small clinical supervision group. Hospice work is emotionally demanding of nurses. Nurses throughout this small study thought over issues concerning serious illness, death and bereavement, as well as working together as a supervision group. Group-format supervision is potentially helpful to nurses examining professional practice. However, group work can be as challenging to participants as it is helpful. The discussion concludes with an appraisal of the potential gains for nurses from clinical supervision in group-format. This paper proposes that supervision groups could help hospice nurses to identify and explore issues related to professional practice. Adequate preparation of nurses, organizational support and the competency of group facilitators should be considered critical to safe and effective management of professional groups.

Adaptation, Psychological↗
PubMed2004

Evaluating student paediatric advanced nurse practitioners' experiences of a paediatric pharmacology module: in the context of reflective learning.

An evaluation of the first paediatric pharmacology module at Master's level was undertaken. The broad aims were: to ascertain whether the participants had achieved the modular learning outcomes; how their pharmacological knowledge base had altered as a result of the module; and whether their professional practice had been influenced subsequent to undertaking the module. The findings of the 12 participants who registered on the module are reported. Three tools were utilized to generate the data for this broadly qualitative study. The findings indicated that reflective thinking at the evaluative level enabled the participants to monitor their professional and personal performance and that their critical thinking skills and confidence had increased. The questionnaire survey had some limitations, but was seen as the only feasible method of achieving a representation as to whether the module had subsequently influenced the professional practice of the participants. The data presented convincing evidence of the relevance of study of a paediatric pharmacology module at Master's level for the professional and personal development of practitioners.

Child↗
PubMedDate not supplied

Power and effective nursing practice.

Underlying the Nursing Knowledge Program were the beliefs that professionals can be prepared to function more effectively in organizations and that organizations can be designed to promote better use of professional skills. The training program, therefore, included both educational and structural solutions for the problems of powerlessness experienced by nurses in the hospital setting. Educationally, the program was designed to empower the participating nurses by teaching them the analytic and interpersonal skills they needed to develop and implement plans for change. Structurally, it established new lines of communication between staff nurses and nurse administrators, linked the nurses to needed resources, and gave the nurses more control over working conditions. Due to the quasi-experimental nature of the research design used in the project, the findings cannot be generalized to all nurses in all hospitals. There is no question, however, that each of the four strategies can be a valuable administrative approach for increasing nursing power. Confirming the strategies and moving groups of nurses through a series of activities specifically designed to use the strategies can bring significant change in the perceptions of nurses about themselves and their profession. For the administrator, the strategies are a way to develop a more effective and satisfied nursing staff, to encourage new leadership, and to create a stronger constituency among staff members. They also create a new source of energy and ideas for resolving the very real problems of professional practice.

Humans↗
PubMed1998

Morally autonomous practice?

The structures and contexts within which nurses work results in the moral agency and moral autonomy of the nurse being compromised. This claim results from a confusion of (1) the concept of autonomy with those of freedom and independence; and (2) a confusion of the notion of moral autonomy with that of autonomous professional practice. The drawing of appropriate distinctions allows clarification of the relevant concepts. It also underlines the responsibility of practitioners to recognize the moral dimension of their practice, and the moral implications of their actions, as they attempt to meet the health care needs of their patients and develop practice professionally.

Ethics, Nursing↗
PubMed1998

[Obstetric nurses: the social inheritance of midwives and nurses].

There are differences in the generation of nursing and midwifery professions that are in the history of professional practice and teaching. The Social Representation Theory is useful as a framework to study the way obstetrics was inserted in nursing, to understand why teaching was united and to make explicit the reflexion on these transformations to the professional practice. A preliminary analysis points out that the consolidation of the social representation of the obstetric nurse has been done with difficulties, as in nursing context, the reified and the consensual universes of thinking related to this question rarely are convergent.

Brazil↗
PubMed1997

The transition in practice: health professionals and patients.

The transition to CFC-free pressurised metered dose inhalers (pMDIs) raises issues for health professionals and patients. Health professionals need to be aware of any differences between old and reformulated products. The currently available reformulated salbutamol is equivalent to the old product so no dosage adjustment is implicated in the changeover. Available information on the new reformulated steroids suggests significantly smaller doses may be required for some reformulations as a result of improved drug deposition. This should not pose a problem if health professionals follow current asthma guidelines and titrate treatment against effect. Patients must be well prepared for transition, be aware of key facts about the new formulation and be aware of the reason their physician recommends change. The likelihood of a seamless transition to the new inhalers will be enhanced if health professionals coordinate the transition in a planned way in each district.

Chlorofluorocarbons↗
PubMed1994

A staff development programme to support the incorporation of the McGill model of nursing into an out-patient clinic department.

In order to adopt a nursing model as a framework for professional practice in an out-patient department of a paediatric tertiary care hospital, a staff development programme was instituted. The nursing model chosen was the McGill model of nursing, which emphasizes the complementary role of nursing and focuses on people's health, strengths and potentials. Staff development initially consisted of a journal club and clinic nurses were exposed to such concepts as family, coping, and health. As the nurses acquired theoretical knowledge, the staff development programme was concerned with applying this knowledge to clinical situations. As well as the nursing in-service training, clinical supervision with small groups of nurses was instituted. A study showed that staff development helped nurses to build a larger repetoire of family nursing skills. The nursing role in the department evolved. Nurses developed a more professional practice and provided health services which were complementary to those offered by other health professionals.

Adaptation, Psychological↗
PubMedDate not supplied

Redesigning hospital nursing practice: the Professionally Advanced Care Team (ProACT) model, Part 1.

Nurse executives must lead in proactively managing care delivery in the face of an increasingly severe nursing shortage. Failure to do so invites the imposition of untenable "solutions" by outside parties. Much has been written about the magnitude and causes of the current nursing shortage. This article focuses on alternative practice models as a viable solution. Part 1 examines similarities and differences among existing models and describes the Robert Wood Johnson University Hospital ProACT model. Part 2 will discuss the process of developing and implementing this alternative nursing practice and care delivery model.

Nursing Service, Hospital↗
PubMed1998

Complementary therapies as a means of developing the scope of professional nursing practice.

The development of the extended role in nursing has been seen by some as primarily a means for nurses taking on tasks that have traditionally been the work of junior doctors. Others object to this view and ascribe to the 'new nursing' perspective of Salvage. She sees the extended role as moving towards increasing autonomy and operating in a professional rather than a bureaucratic occupational model. This view militates against the development of nurses as mini-doctors. This paper discusses the controversy surrounding the development of the extended role, focusing particularly on the use of complementary therapies as a legitimate component of the 'new nurses' role.

Complementary Therapies↗
PubMed2005

The autonomy of professionals and the involvement of patients and families.

PURPOSE OF REVIEW: The involvement of patients/service users and their families/caregivers in the field of mental health has been of interest for several years. It is timely to review what has been learned about involvement; to understand where and how involvement has been implemented; and to explore factors which influence the effectiveness of implementation. Recent literature on user involvement and its implications for professional practice forms the focus of this review. Material is drawn largely from Europe, North America and Australasia, since this reflects where there is most interest in this topic. Papers outside of mental health are included where they further illuminate issues under discussion. RECENT FINDINGS: The involvement of users/patients and their caregivers is an important aspect of the care and treatment of mental illness extending across health and social care. Involvement has implications for professional practice including the negotiation of treatment, the coordination of care and communication strategies. Tensions may emerge during the process of effectively implementing patient/family involvement, but the autonomy of professionals is not usually a factor. SUMMARY: There is no singular definition of involvement. There has been growth in the levels of user/caregiver involvement, particularly in community-based provision and within transition processes from hospital to community-based treatment. There is no suggestion that involvement is widespread. Implementation of involvement should be underpinned by effective communication on the part of professionals and recognition of service users and caregivers as partners in processes of treatment and recovery. Implementation is most effective when supported by appropriate organizational policies and integrated into the education of health professionals.

Journal Article↗
PubMed2005

[A survey on knowledge, attitude, and practice of emergency department practitioners in musculoskeletal injuries].

OBJECTIVES: A knowledge, attitude, and practice study was conducted in relation to musculoskeletal injuries among emergency department practitioners working in the town of Afyon, Turkey. METHODS: Of 40 practitioners working at emergency health services in Afyon, 32 (80%) responded to a 20-item questionnaire that inquired about their knowledge, attitude and practice. A 100-point scoring system was used for the first half of the questionnaire including 10 questions about their knowledge, and a total score of 60 or above was regarded as successful. Inquiry was focused on frequent emergency problems that require intervention by the emergency department practitioners, such as neck examination in trauma patients, treatment of open fractures, intervention to dislocations, treatment in gunshot injuries, and transportation of traumatic amputated organs. RESULTS: The mean duration of professional practice was 7.8+/-3.9 years. The mean achievement score was 66.6+/-15.8, without any significant difference among institutions. No significant relationship existed between the duration of professional practice and knowledge scores. Despite a success rate of 81.3% in knowledge scores, the following shortcomings were notable: neglect in the neurological examination of the lower extremity during neck examination, and inappropriate definitions and interventions in open fractures, tetanus prophylaxis, and antibiotic treatment. CONCLUSION: The survey showed that the practitioners in Afyon have sufficient knowledge levels; however, it seems apparent that there are shortcomings in their practice, which require continuing education for all the staff.

Adult↗
PubMedDate not supplied

The staff nurse decisional involvement scale: report of psychometric assessments.

BACKGROUND: For decades, enhancing staff nurse decisional involvement in matters of nursing practice and patient care has been identified as a long-term strategy to improve the quality of the nursing work environment and the safety and quality of patient care. OBJECTIVE: To describe psychometric assessments of the Decisional Involvement Scale (DIS), a diagnostic and evaluative measure of nurse decisional involvement. METHODS: A series of assessments were conducted to evaluate the psychometric performance of the scale. Content validity was assessed by experts in the field. Descriptive statistics were used to examine the use and performance of the scale. The contrasted groups approach was used to assess construct validity. Item analysis was used to explore evidence of the internal consistency of items and subscales across multiple samples. Structural modeling was used to conduct a confirmatory factor analysis using data from two independent samples of staff registered nurses (RNs; n = 849 and 650). RESULTS: Acceptable content validity indexes (CVIs) were independently generated by three content experts. Construct validity was supported, as hypothesized; nurses working on professional practice units scored significantly higher for all items when compared to nurses working on units without professional practice models in place. Internal consistency (coefficient alpha) was high and nearly identical for the total measure and all subscales across the two independent nurse samples. Six subscales were identified using factor analysis, and these were confirmed by structural modeling. CONCLUSION: Psychometric findings support that the DIS is a valid and reliable measure of staff nurse decisional involvement.

Cooperative Behavior↗
PubMed2000

'Science', 'critical thinking' and 'competence' for tomorrow's doctors. A review of terms and concepts.

CONTEXT: The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare? AIM AND OBJECTIVES: This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement. COMMENT: Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.

Clinical Competence↗
PubMed2006

Assessment practices of professionals serving students who are deaf or hard of hearing: an initial investigation.

Assessment currently plays a critical role in American schools and society, in tasks ranging from ranking schools' effectiveness, to determining individual placement, to planning instruction. The purpose of the study was to gather data about the formal and informal assessment instruments and processes used by professionals in deaf education. Respondents indicated that statewide annual assessments are the most frequently used measures, followed by the Stanford Achievement Test series and the Woodcock-Johnson III Test of Achievement. Commonly used assessment instruments and procedures for each academic area are reported in rank order. Issues about current practices are raised, and suggestions for additional research related to assessment practices in deaf education are provided.

Communication↗