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Results for “Competency framework”

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PubMed2007

First-line nurse managers in university hospitals--captives to their own professional culture?

AIM: This study investigates whether first-line nurse managers in hospitals share common dispositions related to managerial work and leadership, what they are like, and what their relationship is with the various expectations set on them. METHODS: The first data were collected by focus group interviews in the autumn of 2000 and analysed using qualitative content analysis and frame analysis. The second data set were part of a questionnaire survey addressed to the same managers in 2001 with a focus on their diverse leadership roles. RESULTS: Among first-line nurse managers, the management frameworks of a nurturing mother and an administrative nurse displayed the strongest prominence, and the emphasis seemed to be evolving towards the administrative. The results from the survey confirmed the findings of this study in relation to first-line nurse managers' management frameworks. CONCLUSION: The line of development found in this study may add to the permanence of operations and the stability of the operative culture at a university hospital. It may also diminish the opportunities for nursing development in university hospital wards and weaken the potential for a new kind of competence among both managers and their subordinates.

Attitude of Health Personnel↗

PubMed1991

[School psychology in conflict between the individual and the system].

Viewing literature about aspects, goals and methods of school psychology a conceptual framework for the work of a school psychological counselling center is described. A broad perspective is intended through two guiding principles: Polarities like individual and system, single case counselling and school organisation development are connected; the role bearers--counsellors and the addressees of this counselling--take part as active and competent fashioners of the guidance process within the system of relationships growing from this process.

Child↗

PubMed1991

Quality assurance: a process for continuous improvement.

As E.S. Woodlard Jr., Chairman of Du Pont states, "Continuous improvement is vitally important in today's environment. The world is full of savvy, agile competitors who know quality makes a difference." Dentists are part of the health care industry and compete for their patients' discretionary dollars. Careful attention to the development of an integrated RM/QA program for their dental offices is one means of ethical marketing for patient satisfaction. Lessons from the competitive hospitals in the United States and current practices of successful service industries should form part of the framework of the QA component of a practice. A marketing plan is good sense in today's turbulent economic environment and ethical marketing will make the risky "selling" of dental treatment unnecessary.

Dental Care↗

PubMed2004

[Clinical research in the "acute and chronic leukemias"competence network ].

Goal of the network is the construction of an exemplary cooperative leukemia network for the improvement of medical care and of health related research in acute and chronic leukemias. This is achieved by improved mechanisms of cooperation among all major groups in Germany that deal with the leukemias in research and in patient care. In practice, cooperation between clinical groups and scientists in research institutes is mediated by various instruments that improve communication, flow of information and interdisciplinary cooperation and also increase information transfer from top research institutions to clinical translation. The network comprises more than 1400 participants in about 400 university centers, large community hospitals and specialty practices with functional communication structures, interdisciplinary cooperation and nation-wide logistics. The improved cooperation and the accelerated information transfer from the bench to the "bedside" results in an added value that ultimately results in improved survival results of patients and in superior competitiveness of involved research workers and clinicians. Sustainability is addressed by establishing a leukemia foundation to support long term financial coverage of the network and by negotiating a proposal for a European Network of Excellence against leukemia within the Sixth Framework Programme of the European Union.

Acute Disease↗

PubMedDate not supplied

Organizational responses to a changing aid environment: the German Agency for Technical Cooperation (GTZ).

As a major European donor, German government development assistance faces a series of challenges. Recent political changes have raised expectations for demonstrable health outcomes as a result of German development assistance; there has been a deepened commitment to collaboration with other bilateral and multilateral donors; and partner countries are increasingly open to new approaches to development. German development assistance also reflects a new ethos of partnership and the shift to programmatic and sector based development approaches. At the same time, its particular organizational structure and administrative framework highlight the extent of structural and systems reforms required of donors by changing development relationships, and the tensions created in responding to these. This paper examines organizational changes within the German Agency for Technical Cooperation (Deutsche Gesellschaft für Technische, Zusammenarbeit) (GTZ), aimed at increasing its Regional, Sectoral, Managerial and Process competence as they affect health and related sectors. These include the decentralization of GTZ, the trend to integration of projects, the increasing focus on policy and health systems reform, increased inter-sectoral collaboration, changes in recruitment and training, new perspectives in planning and evaluation and the introduction of a quality management programme.

Community Participation↗

PubMed1978

Perspectives on community as a social system.

This paper seeks to analyze processes and roles within the community as a setting for mental health work. The author contends the social workers can utilize linkages and resources more effectively by training community as a social system. Furthermore, the community approach to mental health problems appears to be a logical framework to organize and harmonize different subsystems. A two-dimensional, conceptual model brings into focus two mutually supportive considerations within this framework: community and mental health. Systemic linkages between the mental health group and the welfare community are further conceptualized to signify their importance in the MR programs. A critique is presented of the changing professional roles of the community organizer in a society where welfare services are organized for the less competent individuals within a complex web of values and antivalues. Social workers' dynamism in self-shaping their professional roles toward improving the quality of life is highlighted.

Communication↗

PubMed1998

[Health for all--the last progress assessment before the year 2000].

In the framework of the tri-annual report to WHO of progress towards "Health for all" the specific question concerning reduction of inequity in health is addressed. Regional variations in health status represent an important aspect of that question which is of particular interest in a federal country where major public health competencies are located at the regional level (cantons in Switzerland). Health status is described by both mortality measures (main causes of death) in the population aged 0-64 years and morbidity indicators (rates of disability pensioners) in the same age group. In addition to the comparison of mortality and morbidity rates between cantons an "index of dissimilarity" (DI) was used. For both criteria, changes over a time period of 10 to 12 years were considered. Results show decreasing trends of mortality from all and main causes of death in both sexes. While this tendency goes along with decreasing dissimilarity as to male overall mortality, the corresponding female DI increases, indicating an increase in inequity between the cantons. A similar pattern is observed as to morbidity: although rates of disability pensioners went up for both sexes, this increase resulted in a lower DI-value for men but a higher one for women. The results are discussed against the background of socioeconomic differences (e.g. unemployment) between the cantons studied.

Adolescent↗

PubMed1993

Interpersonal skills training in nurse education: some theoretical and curricular considerations.

Interpersonal skills training continues to be an important, but ill-defined aspect of nurse education. The author explores some theoretical and curricular issues that need to be considered when designing interpersonal skills training. He argues that Beattie's fourfold curriculum can be used to integrate the often opposing theoretical and educational frameworks used. The need for concept clarification and development to underpin this training is highlighted, within the context of the complex political and organisational factors that influence its process and outcome.

Clinical Competence↗

PubMed2005

Reference assignment: using language breakdown to choose between theoretical approaches.

We report results of an experimental study with Dutch agrammatic aphasics that investigated their ability to interpret pronominal elements in transitive clauses and Exceptional Case Marking constructions (ECM). Using the obtained experimental results as a tool, we distinguish between three competing linguistic theories that aim at determining principles responsible for pronoun distribution: Government and Binding (Chomsky, 1981), Reflexivity (Reinhart & Reuland, 1993), and Primitives of Binding (Reuland, 2001). The obtained results are inconsistent with Government and Binding, but consistent with the latter two theories. We further show that the Primitives of Binding framework most naturally explains our results. Our proposal is based on the different performance demonstrated by patients in transitive clauses and ECM constructions, in combination with the often-made claim in the literature regarding the limitation of processing resources in this population (e.g., Haarmann and Kolk, 1991, Haarmann and Kolk, 1994 and Zurif et al., 1993, among others).

Adult↗

PubMed2005

Multidimensional assessment of resilience in mothers who are child sexual abuse survivors.

OBJECTIVE: There has been relatively little attention given to positive adaptation following childhood sexual abuse (CSA), and typically such resilience has been explored primarily in the intrapersonal domain. This study explored questions about later resilience following CSA within a multidimensional framework by assessing resilience across intrapersonal, interpersonal, and intrafamilial domains. METHOD: This community sample consisted of 79 mothers with a history of CSA who had a child living at home with them. Participants completed four outcome measures (Center for Epidemiologic Studies--Depression Scale, Parenting Stress Index [PSI] Health Scale, PSI Parenting Competence Scale, and a measure of marital satisfaction). Risk and protective factors examined in relation to outcome included mother's age, socioeconomic status, severity of the CSA experience, coping strategy (avoidance, seeking social support, and problem solving), child characteristics, and spousal/partner support. RESULTS: Results indicated that when multiple adaptational domains were assessed, mothers showed discrepancies in how adequately they functioned across domains. While severity of the CSA experience was only weakly associated with outcome, use of avoidant coping emerged as a significant risk factor and was strongly and consistently associated with negative outcome across domains. Spousal/partner support was a strong protective factor and buffered the relationship between depressive symptoms and parenting competence. Difficult child characteristics were significantly associated with mothers' perceptions of physical health and parenting competence. CONCLUSIONS: The findings suggest the importance of comprehensive multimethod assessments of resilience and extend the knowledge of factors associated with positive outcome. The results highlight the need for further research exploring current contextual risk and protective factors associated with resilience in each domain.

Adaptation, Psychological↗

PubMed1997

Wrapping things up: a qualitative analysis of the closing moments of the medical visit.

The purpose of this preliminary study is to develop an operational definition of the closure phase of the medical visit. A listening group developed a definition of closure by consensus based on audiotaped data from 22 office visits to physicians. The group noted new problems in closure not previously raised. Closure was defined as the final phase of the medical visit in which the doctor and patient shift perspective to the future, finalize plans, and say goodbye. Two distinct organizational frameworks of closure are outlined. Thirty-six percent of closures were interrupted in some way. New problems occurred in 23% of visits, even those with open-ended beginnings and early physician requests for all patient concerns. Doctors' communication involved expression of emotion, patient education, clarification, summary, and parting comments. Patient communication included expression of emotion, information sharing, and parting comments. Doctors' communication skills for closure are proposed. Closure is a distinctive phase of the visit with an organizational framework and specific tasks. The frequency of new problems in closure suggests that physicians may have the potential to improve their effectiveness.

Clinical Competence↗

PubMed2004

Demonstrating the synergy of synthetic, mechanistic, and computational studies in a regioselective aniline synthesis.

Tri- and tetrasubstituted anilines are formed in good to excellent yields by the addition of ketones to vinamidinium salts (up to 98%). The reaction proceeds via the formation of dienone intermediates, which react to form an enamine with the liberated amine. In the case of a nitro, or dimethylaminomethylene substituent, the enamines undergo a facile electrocyclic ring closure to form a cyclohexadiene, which goes on to form anilines with a high degree of selectivity (up to 50:1) with a minor competing pathway proceeding via the enol providing phenols. Competition experiments using isotopic substitution reveal that the rate determining step en route to dienone is enol/enolate addition to the vinamidinium salt, which is characterized by an inverse secondary isotope effect (k(H/D) 0.7-0.9). Computational studies have been used to provide a framework for understanding the reaction pathway. The original proposal for a [1,5]-H shift was ruled out on the basis of the calculations, which did not locate a thermally accessible transition state. The minimum energy conformation of the enamine is such that a facile electrocyclic ring closure is ensured, which is corroborated by the experimental studies. A framework for understanding the reaction pathway is presented.

Journal Article↗

PubMed2000

STDs aren't sexy: health professionals' lack of adherence to clinical guidelines in an area of high STD endemicity.

BACKGROUND: In 1997 the Health Department of Western Australia distributed clinical guidelines aimed at improving the outcomes of care of patients with STDs. In recognition of the high STD rates and issues peculiar to the Kimberley region, a Kimberley Supplement was inserted into copies distributed in the region. Since then, annual STD workshops have been conducted for all Kimberley health professionals involved in any aspect of STD management. This study aimed to assess whether health professionals were observing the Guidelines and its Kimberley Supplement, and whether adherence improved after the 1998 Kimberley STD workshop tour. METHODS: Over two periods, pre- and post-STD workshops, all pathology request forms for gonorrhoea and chlamydia tests were collected from all laboratories in the region. The outcomes of interest were which of the recommended tests had been requested. Logistic regression was used to analyse associations between adherence to the Guidelines and patient's age, sex and postcode, profession of practitioner, reason for testing and whether the test was performed pre- or post-STD workshops. RESULTS: Minimum appropriate tests were ordered on only 14.5 per cent (98/676) of request forms. Univariate and multivariate analyses showed that minimum appropriate testing was more likely to have been requested on male patients and if the practitioner was a doctor. No improvement was observed after the STD workshops. CONCLUSION: The poor adherence and lack of improvement observed can be explained by Kotter's framework on why transformation efforts fail. This study demonstrates that clinical guidelines are of little value unless they are continuously evaluated.

Adolescent↗

PubMed2000

Through the eye of the beholder: multiple perspectives on quality in women's health care.

Quality is an illusive concept with different meanings to different people. Providers often define quality in terms of patient outcomes, professional standards of practice, predetermined criteria used to measure quality, and even subjective opinion. Patients describe quality in terms of the interpersonal aspects of care, how well they were treated, and the responsiveness of the provider to their needs. This qualitative study using a semi-structured interview defined quality from the perspectives of patients, physicians, nurses, and payers associated with a hospital-based women's service line, and how the attributes of quality varied among the multiple groups. The study also described how stakeholders become aware of quality and how they determined a hospital's quality. From the findings of the study, a conceptual framework of quality in women's health was developed.

Attitude of Health Personnel↗

PubMed2005

Meeting the non-clinical education and training needs of new consultants.

This review highlights the non-clinical training needs of new consultants, identifying strategies for meeting these needs. Non-clinical activities are integral to the consultant's role and senior clinicians need training in these areas. Concerns over the quantity and quality of current provision are compounded by changes the European Working Time Directive and Modernising Medical Careers initiative will bring. Accelerated progression to senior level and reduction in time for training suggest a pressing need to respond to the needs of new consultants. Ad hoc initiatives in a range of healthcare contexts offer examples of how training needs may be met, including mentoring and continuing professional development schemes. A multi-professional strategy, incorporating elements of higher professional education in general practice and other NHS initiatives (particularly management/leadership training), may offer an appropriate framework within which to capitalise on existing opportunities. There are, however, resource implications that need to be addressed.

Education, Medical, Graduate↗

PubMed2006

Decision making in acute care: a practical framework supporting the 'best interests' principle.

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components pain and suffering, body functioning, and autonomy and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations.

Decision Making↗

PubMedDate not supplied

Critical companionship: Part 1.

This article is the first of two presenting critical companionship as a metaphor and framework for learning from healthcare experiences. Critical companionship is a helping relationship in which an experienced facilitator (often, but not necessarily, a colleague) accompanies another on an experiential learning journey, using methods of 'high challenge' and 'high support' in a trusting relationship. The overall purpose of critical companionship is to enable others to practise in ways that are person centred and evidence based. Critical companionship is effective in a variety of one-to-one or group learning contexts, such as practice development projects, organisational change, practitioner research, work-based learning, clinical supervision and action learning. In this article, the development and testing of the critical companionship framework, through action research, are briefly described. The framework is then presented and illustrated with exemplars of critical-companionship expertise in an acute medical ward. Part 2 highlights how the framework was used in a practice development programme with NHS trusts for older people's services, to help nurses to become critical companions.

Attitude of Health Personnel↗

PubMedDate not supplied

[Child and adolescent psychiatry in the Public Health department--a status survey].

Child and adolescent psychiatry is still a neglected discipline in Public Health, despite the fact that a high degree of effectiveness can be definitely achieved especially as regards prevention if physicians specialising in child and adolescent psychiatry are employed by Public Health services. Thus avoiding that children develop into psychiatrist-prone adults after taking up a career or profession. The child and adolescent psychiatrist in Public Health services is not only competent in respect of giving advice and mediating help in the areas of kindergarten and school problems, but is also a significant key person in health education. It is urgently recommended to recruit a sufficient number of child and adolescent psychiatrists for Public Health service or to train them within the framework of their activities as Public Health physicians. Prevention is better than cure--this is especially true for children and adolescents.

Adolescent↗