PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Professional Practice”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,027 records · Page 57Linked to original sources
PubMed2001

Whither nursing? Discourses underlying the attribution of master's level performance in nursing.

AIM: Drawing upon the selected findings from a multidisciplinary study that sought to explore the meaning of master's level performance in health professional practice, the characteristics which nurse educators attributed to the practice of master's level nursing graduates are analysed to reveal underlying discourses. BACKGROUND: Although master's level programmes for nurses have been available in the United Kingdom (UK) for the past three decades and current heath policy directives link master's level qualifications with senior clinical nursing roles, the contribution that master's level education might make to the future direction of nursing is unclear. RESEARCH DESIGN AND METHODS: In-depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the UK who were responsible for master's level programmes in nursing. The interview agenda explored participants' perspectives of the characteristics of master's level performance. Drawing upon the methodology of discourse analysis, interview transcripts were interpreted in such a way as to show the implicit discourses underlying the participants' claims regarding their graduate's attributes of professional practice. FINDINGS: The characteristics attributed to master's graduates were categorized under (a) cognitive competencies, (b) practice-related competencies, (c) research orientation and (d) personal dynamism. However, these attributions are not empirical generalizations, developed inductively. Rather, they draw on socially available discourses regarding the future direction of the profession. CONCLUSION: The nurse educators drew on the following socially available discourses: (a) a discourse in which nursing is construed as involving great competence in practice, but without radicality of thought. Associated with this is a pervasive rhetoric of pragmatism; (b) a discourse of interprofessional practice in which nursing has a role of leadership. This is associated with a view of the location and power of nursing within the structure of the National Health Service and (c) notably lacking were discourses of care-giving, and of academic/intellectual aspiration. The implications of these discourses for the future direction of nursing are considered.

Attitude of Health Personnel↗
PubMed2000

Palliative care nursing in rural Western Australia.

This article presents the findings of a study of rural palliative care nurses in Western Australia. The number of rural centres in Western Australia offering palliative care services is increasing; however, at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examined basic social processes associated with the role of rural palliative care nurses, and identifies issues that affect the nurses' professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in the study. Data were generated using in-depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed is the all-consuming nature of the rural palliative care nurse's role. Three subthemes relating to multiple roles, expectations of nurses, and coping strategies are also discussed. This research explored issues that rural palliative care nurses feel are relevant to their professional practice, and it describes the basic social processes inherent in the rural palliative care nurse's role. Recommendations for nursing research, education, administration and clinical practice are presented.

Adaptation, Psychological↗
PubMed1998

Implementing the differentiated pay structure model. Process and outcomes.

OBJECTIVE: A salaried Differentiated Pay Structure (DPS) model based on the work of Dr. Virginia Cleland was tested on two units. The project objectives were to: 1) create a budget-neutral compensation distinction for different competencies and educational levels; 2) evaluate the effect of the new salaried model on unit costs and pay; 3) determine the effect of the DPS model on job satisfaction, organizational commitment, and anticipated turnover; and 4) assess the impact of professional commitment, professional practice climate, perception of staffing adequacy, and dispositional optimism on job satisfaction, organizational commitment, and anticipated turnover. BACKGROUND: Although there has been long-standing interest in salaried models and reward methodologies, there is a dearth of systematic research associated with specific compensation models. METHODS: A quasi-experimental, non-equivalent control group design was used to examine the effects of the DPS model. RESULTS: Findings demonstrated that nurses were paid more under the DPS model, and that they were paid for more hours than they actually worked (N = 68). No difference in job satisfaction was found between experimental and control groups. For all nurses (N = 232) dispositional optimism was associated with all job satisfaction subscales except pay. Organizational commitment, professional commitment, professional practice climate, and staffing adequacy were also correlated with job satisfaction, perceptions of care quality and anticipated turnover. Older nurses who had worked longer in nursing, and who had more tenure were less satisfied with their coworkers and care quality. CONCLUSION: Further longitudinal research with larger experimental samples is required in order to fully understand the effects of the DPS model in nursing.

Adult↗
PubMed2003

Some benefits experienced by hospice nurses from group clinical supervision.

A small clinical supervision group consisting of five hospice nurses met together in their workplace 1 h weekly for 12 weeks. Issues concerning professional practice were examined with the help of a researcher (A.J.) who acted as facilitator. At the end of the group's life A.J. asked all nurses to complete a questionnaire related to the workplace and 12 identified helpful factors. Two weeks later the hospice nurses were interviewed in group format and asked to consider the reasons for their choice of answers. The data revealed that collectively--interpersonal learning (output), identification, catharsis, family re-enactment, group cohesiveness and self-understanding were experienced by the hospice nurses as the most helpful factors to the group. Existential factors, guidance, universality, interpersonal learning (input), instillation of hope and altruism were identified as less important. Variations in individual responses showed different ways in which a group might meet the needs of its members. The study concludes with the suggestion that work discussion groups can offer nurses the means to calm, regulate and plan their interactions with themselves and others. Clinical supervision is an effective format for exploring issues concerning professional practice, allowing nurses to: learn from each other, offer support, recognize how others see and esteem them as fellow workers, and moderate concerns and anxiety related to their work. Group work is likely to raise anxiety in all participants, however, and preparation and support are required for the group facilitator. Carefully chosen membership is also considered important to the safety of members and successes of the group.

Attitude of Health Personnel↗
PubMed2006

Using human error theory to explore the supply of non-prescription medicines from community pharmacies.

BACKGROUND: The importance of theory in underpinning interventions to promote effective professional practice is gaining recognition. The Medical Research Council framework for complex interventions has assisted in promoting awareness and adoption of theory into study design. Human error theory has previously been used by high risk industries but its relevance to healthcare settings and patient safety requires further investigation. This study used this theory as a framework to explore non-prescription medicine supply from community pharmacies. The relevance to other healthcare settings and behaviours is discussed. METHOD: A 25% random sample was made of 364 observed consultations for non-prescription medicines. Each of the 91 consultations was assessed by two groups: a consensus group (stage 1) to identify common problems with the consultation process, and an expert group (stages 2 and 3) to apply human error theory to these consultations. Paired assessors (most of whom were pharmacists) categorised the perceived problems occurring in each consultation (stage 1). During stage 2 paired assessors from an expert group (comprising patient safety experts, community pharmacists and psychologists) considered whether each consultation was compliant with professional guidelines for the supply of pharmacy medicines. Each non-compliant consultation identified during stage 2 was then categorised as a slip/lapse, mistake, or violation using human error theory (stage 3). RESULTS: During stage 1 most consultations (n = 75, 83%) were deemed deficient in information exchange. At stage 2, paired assessors varied in attributing non-compliance to specific error types. Where agreement was achieved, the error type most often selected was "violation" (n = 27, 51.9%, stage 3). Consultations involving product requests were less likely to be guideline compliant than symptom presentations (OR 0.30, 95% CI 0.10 to 0.95, p = 0.05). CONCLUSIONS: The large proportion of consultations classified as violations suggests that either pharmacy staff are unaware of professional guidelines and thus do not follow them (therefore these acts would not be violations), or that they knowingly violate the guidelines due to reasons that need further research. The methods presented here could be used in other healthcare settings to explore healthcare professional behaviour and to develop strategies to promote patient safety and effective professional practice.

Clinical Competence↗
PubMed1993

Reliability of psychiatric and psychological diagnoses of mental retardation severity: judgments under naturally occurring conditions.

The reliability of diagnoses of mental retardation severity was examined through the comparison of psychiatric and psychological case reports found in client records. For a sample of 126 dually diagnosed clients, overall chance-corrected agreement was .47, ranging from .38 (for diagnoses of moderate mental retardation) to .55 (for diagnoses of borderline mental retardation). Results showed that the analysis of naturally occurring variation in diagnostic practices (including variability in professional judgment and assessment methods) may offer a more realistic appraisal of the reliability of diagnostic decisions in professional practice situations than do studies in which important sources of diagnostic error are controlled.

Adolescent↗
PubMed1995

[Systematic aspects of problem-based, case-related, practice-oriented, professional continuing education].

Traditional CME using lectures has not been shown to improve patient care, which is the purpose of all learning in medicine. As knowledge taught mainly by lecturing is not useful for dealing with clinical problems, problem-based courses were developed to integrate general principles of basic and clinical sciences in undergraduate education. Case-based teaching is used for effective teaching of patient care. Six components were defined as a case system for clinical education: 1. Demonstration of patients; 2. free access to patients or data of patients, 3. responsible care of the patients, 4. acquisition of basic knowledge integrated in clinical problem-solving, 5. evaluation of documented work and 6. participation in patient related research. Surveys of general physicians showed that they regard a multitude of the components of the case system as desirable for learning in quality circles. Small group work can be implemented using computer supported work.

Education, Medical, Continuing↗
PubMed2004

Differences between left and right suboccipital and intracranial vertebral artery dimensions: an influence on blood flow to the hindbrain?

BACKGROUND AND PURPOSE: Although vertebral artery (VA) blood flow is adequate in normal circumstances, reduction in the dimensions of the vessel because of atherosclerosis, or compression or stretching, may lead to hindbrain hypoxia with serious clinical manifestations. Such effects may be more pronounced in VAs that are naturally smaller than the norm. Because normative data for the suboccipital (VA3) and intracranial (VA4) vertebral artery are not readily available, it was the aim of the present study to measure the dimensions of these distal parts of the VA, to inform professional practice of the possible influence of different vessel dimensions on blood flow to the hindbrain. METHOD: The study was a laboratory-based observational or descriptive study. A total of 40 and 54 left and right, suboccipital and intracranial parts of the VA (n = 188 vessels), obtained from cadavers of females and males aged 20-80 years, was processed for light microscopic study and measurement of the dimensions of the vessels. The left and right inner and outer diameters, cross-sectional areas and the tunica media thicknesses were calculated in each part of the vessel and compared by use of t-tests. RESULTS: The histological structure of the VA was typical of a muscular or distributing artery. Although, in the total number of specimens, no statistically significant differences were found between left and right sides in either part of the vessel, a larger left than right VA4 was demonstrated in the females. The VA3 was significantly larger than VA4 in males and females, and all dimensions in both parts of the vessel were greatest in the older age group. CONCLUSIONS: Reduced VA blood flow, whether because of atherosclerosis or compression or stretching of the vessel, is more likely to occur in arteries that are smaller than normal. This information is of value to clinicians in avoiding further compromising the VA and its blood flow during professional practice.

Adult↗
PubMed2001

Development of an exposure database and surveillance system for use by practicing OSH professionals.

This report summarizes the development of an occupational exposure database and surveillance system for use by health and safety professionals at Rocky Flats Environmental Technology Site (RFETS), a former nuclear weapons production facility. The site itself is currently in the cleanup stage with work expected to continue into 2006. The system was developed with the intent of helping health and safety personnel not only to manage and analyze exposure monitoring data, but also to identify exposure determinants during the highly variable cleanup work. Utilizing a series of focused meetings with health and safety personnel from two of the major contractors at RFETS, core data elements were established. These data elements were selected based on their utility for analysis and identification of exposure determinants. A task-based coding scheme was employed to better define the highly variable work. The coding scheme consisted of a two-tiered hierarchical list with a total of 34 possible combinations of work type and task. The data elements were incorporated into a Microsoft Access database with built-in data entry features to both promote consistency and limit entry choices to enable stratified analyses. In designing the system, emphasis was placed on the ability of end users to perform complex analyses and multiparameter queries to identify trends in their exposure data. A very flexible and user-friendly report generator was built into the system. This report generator allowed users to perform multiparameter queries using an intuitive system with very little training. In addition, a number of automated graphical analyses were built into the system, including exposure levels by any combination of building, date, employee, job classification, type of contaminant, work type or task, exposure levels over time, exposure levels relative to the permissible exposure limit (PELS), and distributions of exposure levels. Both of these interfaces, allow the user to "drill down" or gradually narrow query criteria to identify specific exposure determinants. A number of other industrial hygiene processes were automated by the use of this database. Exposure calculations were coded into the system to allow automatic calculation of time-weighted averages and sample volumes. In addition, a table containing all the PELs and other relevant occupational exposure limits was built into the system to allow automatic comparisons with the current standards. Finally, the process of generating reports for employee notification was automated. The implementation of this system demonstrates that an integrated database system can save time for a practicing hygienist as well as provide useful and more importantly, timely information to guide primary prevention efforts.

Colorado↗
PubMed2005

Organizational attributes valued by hospital, home care, and district nurses in the United States and New Zealand.

PURPOSE: To determine whether hospital-based, home care, and district nurses identify a core set of organizational attributes in the nursing work environment that they value as important to the support of professional practice. DESIGN: Survey data, collected in 2002-2003 from 403 home care nurses in the United States (US) and 320 district nurses in New Zealand (NZ), were pooled with an existing data set of 669 hospital-based nurses to conduct this descriptive, nonexperimental study. METHODS: The importance of organizational attributes in the nursing work environment was measured using the Nursing Work Index-Revised (NWI-R). Frequency distributions and analysis of variance were used to analyze the data. FINDINGS: At least 80% of hospital-based, home care, and district nurses either agreed or strongly agreed that 47 of the 49 items comprising the NWI-R represented organizational attributes they considered important to the support of their professional nursing practice. Mean importance scores among home care nurses, however, were significantly lower than were those of the other two groups. CONCLUSIONS: Overall, hospital-based, home care, and district nurses had a high level of agreement regarding the importance of organizational traits to the support of their professional practice. The intensity of the attributes' importance was less among home care nurses. Further research is needed to determine whether this set of organizational traits, measured using the NWI-R, is associated with positive nurse and patient outcomes in home care and district nursing practice, as has been shown in acute care settings.

Adult↗
PubMedDate not supplied

Employment choices in conditions of physician oversupply: a study of graduates of San Francisco internal medicine programs, 1979-1984.

The authors surveyed 297 internists who completed residency or fellowship training at six San Francisco institutions from 1979 through 1984 to assess how the recent expanded supply of physicians has affected their intensity of practice and their decisions about location of practice. The vast majority of internists (93%) settled in metropolitan areas, with 56% remaining in the San Francisco Bay Area, despite that region's already high concentration of physicians. Mean annual income, in 1984 dollars, was slightly more than figures from national surveys of physicians of similar age ($72,560 vs. $71,900), but reported mean work week was shorter (54.8 hours vs. 60.5). Although subspecialists earned significantly more than generalists, this was because they worked more hours. Those who graduated later were significantly less likely to be in private practice in 1985, mainly because they initially selected salaried institutional work more often than earlier graduates (p less than 0.001). Women worked 85% of the men's work week and subspecialized significantly less often (p less than 0.05). These findings suggest that internists trained in already "over-doctored" areas will continue to settle there or in similar communities.

Adult↗
PubMed1990

Creating self-care units in the acute care setting: a case study.

Creating an environment in which patient's responsibility for self is fostered and nurses can practice professional and autonomous nursing practice is a challenge in today's hospitals. Innovative systems and structures need to be developed to assure quality of patient care and a high quality work environment. Newark Beth Israel Medical Center responded to the many demands of the mid-1980s, including increasing acuity of patients hospitalized, personnel shortages in nursing, physical therapy and other disciplines, and diminishing dollars available to the health care institution, through the creation of Self-Care Units. This article reviews how they came about, the way in which Self-Care Units function within the acute care setting and the management philosophy and structure which make them work. The experience at Newark Beth Israel Medical Center demonstrates that the potential exists to put control back at the bedside with the patient and the health care team working with the patient to achieve mutual goals. The focus of care has shifted from a "doing for" to a "working with" patients to identify interventions which promote active participation in hospitalization and a sense of self responsibility.

Health Facility Environment↗
PubMed2001

Dealing with diversity: incorporating cultural sensitivity into professional midwifery practice.

In the Australian College of Midwives, Code of Ethics, Section 11. Practice of Midwifery, the following is stated "A. Midwives provide care for women and childbearing families with respect for cultural diversity while also working to eliminate harmful practices within those same cultures." However, it is difficult to know what is meant by "respect for cultural diversity". This paper presents the results of a critical review of the health literature. There is surprisingly little consensus about the meaning of terms such as cultural sensitivity and cultural appropriate care. Nor are there reflections on incorporating these concepts into practice. It could be argued that until there is greater clarity about these concepts and more discussion of how they may be used in practice, midwives would have to continue to rely on their individual knowledge and experience.

Attitude of Health Personnel↗
PubMed1989

A new policy initiative. Infants and toddlers with handicapping conditions.

Past legislation related to children and families has been used to improve services to specific target groups of children and families in need (i.e., poor, handicapped, etc.) Current legislation, notably Public Law 94-142, the Education for All Handicapped Children Act, and Public Law 99-457 (Part H), Services for Infants and Toddlers with Handicapping Conditions, also includes elements of mandated reform of certain professional practices (i.e., inclusion of parents in planning and requirements for multidisciplinary cooperation). Such a mandate has the effect of putting into practice changes that many professionals have said were needed but were unable to achieve, but it also makes the implementation of these policies more difficult.

Child Welfare↗