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Nurse education in Mbarara, Uganda.

AIM: To describe the establishment of a professional development programme for qualified nurses at Mbarara University Teaching Hospital, Uganda. BACKGROUND: Between 1997 and 1999, a group of hospital-based nurses and university lecturers in Hull, United Kingdom, planned and delivered a series of modules to set the Ugandan nurses on course for continuing professional development. APPROACH: A descriptive account of the delivery of the programme. FINDINGS: Evaluation of the programme indicates that the nurses' morale was raised by satisfactory completion of the modules and that there were visible improvements in the organization of patient care in the hospital. CONCLUSIONS: This professional development programme was a learning experience for all the parties involved. Support from Hull for the education of nurses in Mbarara will continue.

Curriculum↗

Role development and career stages in addiction nursing: an exploratory study.

AIM: This paper reports a study to explore factors influencing recruitment and retention in addiction nursing, and the stages and features of role acquisition and personal qualities important to that role. BACKGROUND: Specialist addiction nurses engage in a number of roles in the care of individuals with problematic use of psychoactive substances. These include assessment, outreach, prescribing, counselling, and harm reduction. In a climate of increasing demand for specialist substance misuse workers, and a trend to identify key occupational competencies, there is a need for a framework in which career progression can be supported. Studies exploring the roles of addiction nurses are minimal, and there is less comment on how these roles are developed in the context of career stages. METHOD: A qualitative study using focus groups was undertaken with specialist addiction nurses between March and June 2004. The data were transcribed verbatim and analysed using Burnard's six content analysis stages. FINDINGS: Positive factors identified as influencing recruitment and retention included: prior knowledge of the working environment (as a nursing student), opportunities for autonomous practice, the client profile, and associated treatment philosophy and care approach. There was consensus that nurses choosing to work in the field of addiction needed, in addition to being non-judgmental, personal qualities including hardiness, patience and tolerance. Five role development stages, with a set of descriptors, were identified: encounter, engagement, stabilization, competency and mastery. CONCLUSION: Identification of these five role development stages for addiction nurses offers employers, nurse managers, educators and addiction nurses a starting point from which specific occupational competencies can be further explored. In addition, continuing professional development needs can be mapped to specific role development stages. Employers and nurse managers may wish to offer increased learning opportunities to student nurses to gain work experience within specialist addiction units.

Adult↗

Educational needs and employment status of Scottish dental hygienists.

AIMS AND OBJECTIVES: To investigate the educational needs and employment status of registered dental hygienists in Scotland. SUBJECTS: Three hundred and eighty one registered dental hygienists with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 76% response rate was achieved following two mailings. Of the respondents, 43% were in full-time employment albeit in more than one setting, mostly in the 'central belt' of Scotland. It was reported that 41% were employed in general dental practice with both NHS and private lists and 39% worked in a purely private setting. The introduction of extended clinical duties had been well received and 59% of subjects were interested in additional training in dental therapy, should this become available. Absence of funding for CPD was raised repeatedly, with only 41% reporting a degree of financial assistance. Greater accessibility to continuing education via distance learning, particularly in remote and rural settings, was requested by 73% of hygienists. CONCLUSIONS: This study identifies a number of issues in relation to this increasingly important group of healthcare professionals, which will inform the providers of oral healthcare. Although hygienists' involvement in CPD was commendable, results indicated that despite commitment to their profession, respondents did not always feel respected in terms of their employment status or support for continuing professional development.

Dental Hygienists↗

The use of patient group directions in the Royal Naval Medical Services.

As the first primary care nurse practitioner, the author wished to explore the future use of Patient Group Directions (PGD's) within the Royal Naval Medical Services (RNMS). Extensive investigations carried out within the National Health Service (NHS) have resulted in changes in legislation allowing registered nurses to supply medications using PGD's. The design and implementation of PGD's require a cohesive approach of a doctor or dentist, a pharmacist and the lead health care professional. In order that they are implemented in a safe and effective manner all concerned parties must undertake a robust education and training programme. The RNMS will need to address a number of change management issues in order that registered nurses are supported in continuing professional development and PGD's are adopted as practice.

Drug Prescriptions↗

Childhood Miller Fisher syndrome: case report and review of the literature.

Three years ago Ray Buncic and I were having a break from the lectures at an ophthalmology meeting. Ray told me of his earnest desire to provide Canadian ophthalmologists with a series of updates in pediatric ophthalmology. After a few days we were both back to the "busi-ness" of medicine, with little time to devote to such a project. Then, along came the COS Council on Continuing Professional Development (CPD) and the MaintCert program--a bold initiative to draw talent of Canadian ophthalmology into a program of continuing medical education (CME). One initiative was to use the Canadian Journal of Ophthalmology as a CME tool. This article by Eedy Mezer and Ray Buncic is highlighted as a Section 3 learning activity (self-assessment). I am delighted to have seen Ray bring forward his idea in this manner. The Canadian Journal of Ophthalmology has initiated this project in conjunction with the Council on CPD. There are a number of questions that relate to this article that can be answered on the COS Web site (http://www.eyesite.ca). Participants will be provided with an aggregate score and a certificate that can be printed to allow them to record this activity for Section 3 credits with the Royal College of Physicians and Surgeons of Canada.

Child, Preschool↗

The educational needs of non-specialist breast care nurses.

AIMS: To provide an indicative occupational profile and identify the educational needs of non-specialist nurses working with breast cancer patients. DESIGN: A postal questionnaire survey, using a modified, but psychometrically validated, training needs analysis instrument. SETTING: The acute and community sectors of three large trusts. PARTICIPANTS: 119 general nurses working with breast cancer patients. FINDINGS: Significant educational needs were identified for all 30 items of the questionnaire, thereby indicating that participants had both general and cancer-specific training needs. However, 13 of the 14 cancer-related items were among the top 19 training needs, suggesting that these should be a priority focus for targeted educational programmes. No differences were found between acute and community nurses, although D grade (newly qualified) nurses had significantly greater educational needs than E grade nurses (with around 2 years' experience post-qualifying). The indicative occupational profile suggested that the most important tasks were perceived to be communication/team-work, self-management, awareness of special psycho-social problems, knowledge of specific clinical issues, and management of the care package; the least relevant tasks were seen to be specific health promotion activities, supervision, using technical equipment and research/audit. CONCLUSION: This sample of general nurses working with breast cancer patients reported both general and specific educational needs. The information yielded by the current survey could be used to inform continuing educational development for this group, and in this way, could inform the content and mode of delivery of its provision. Continuing professional development (CPD) courses which are based on empirical studies of workforce educational needs could rationalise resources and ultimately enhance patient care. The indicative occupational profile could be used as a competency indicator and might also inform CPD provision.

Analysis of Variance↗

The biological sciences in nursing: a developing country perspective.

AIM: This paper reports a study to inform curriculum development by exploring the contribution of bioscience education programmes to nurses' clinical practice, their understanding of the rationale for practice, and their perceptions of their continuing professional development needs. BACKGROUND: The future of the health services worldwide depends on nurse education programmes equipping practitioners to deliver safe and effective patient care. In the developed world, the structure and indicative content of nursing curricula have been debated extensively. However, despite the rapid expansion in nursing roles brought about by social change, there is little information on the educational needs of nurses in developing countries. METHODS: This study was undertaken in government teaching hospitals in Cape Town, South Africa in 2003. A purposive sample of 54 nurses from a range of clinical settings completed questionnaires and described critical incidents where bioscience knowledge had directed practice. Questionnaires were analysed descriptively, in the main. Analysis of critical incident reports was based on Akinsanya's bionursing model. FINDINGS: Most nurses felt that their understanding of the biological, but not the physical sciences, was adequate or better: all felt confident with their knowledge of anatomy, compared with 57.4% (31/54) for microbiology. Respondents attributed the successes and failures of their education programmes to their teachers' delivery of content, ability to relate to practice and management of the process of learning. The biological, but not the physical, sciences were universally (96-100%) regarded as relevant to nursing. However, the critical incidents and nurses' own reports indicated a need for further education in pharmacology (40/54, 74.1%) and microbiology (29/54, 53.7%). CONCLUSION: To meet the needs of nurses in developing countries, and empower them to meet the increasingly complex demands of their expanding roles, nurse educators need to consider increasing the curriculum content in certain key areas, including pharmacology and microbiology.

Adult↗

Practice-based learning and improvement.

Workplace learning is becoming increasingly important in all fields. While workplace learning in medicine, also called practice-based learning and improvement (PBLI) is not new, understanding how it works and how it fits with an individual physician's continuing professional development is new. In this article, we describe seven issues associated with PBLI and then pose questions for reflections, as continuing medical education (CME) planners consider working with PBLI.

Education, Medical, Continuing↗

Alcohol education for general practitioners in the United Kingdom - a window of opportunity?

Alcohol misuse is a major public health problem. In the UK, general practitioners are perceived as key players in prevention and management of alcohol problems, but may not be prepared sufficiently to undertake this work. A systematic review of the literature by computerized search of the Medline database, hand search of review article citations and a survey of relevant educational and training organizations and agencies were undertaken. Although there is no shortage of educational materials, there has been little evaluation of their effectiveness. A need for more training and support has been identified, but this requires better co-ordination and a more multidisciplinary approach. Forthcoming changes in the National Health Service and the organization of continuing professional development offer a unique opportunity to advance this agenda.

Alcoholism↗

Lifelong learning, CPD and you.

The essence of clinical governance is continuing professional development (CPD) for all professional staff. A system is now in place to disseminate and support CPD throughout the NHS, from national to local level.

Education, Nursing, Continuing↗

Specialist training in rheumatology in Europe.

Rheumatology is a broad discipline managing a spectrum of different conditions and there are divergences in what is routinely treated by rheumatologists both within and between countries. The free movement of doctors throughout the European Community has lead to moves to harmonize specialist training to ensure common standards of care. The Union Européene des Médecins Spécialistes (UEMS) has developed recommendations for the specialist training of rheumatologists in Europe that recognizes the broad definition of the discipline and the diversity of clinical practice in Europe. The core curriculum aims to provide a common standard around which to develop locally applicable national curricula. The provision of high quality care requires some assessment of training and competency as well as continuing professional development and ways of ensuring the provision of this throughout the European Community to a mutually high standard are being developed. The future may see more overlap in the training of all the disciplines concerned with the management of those with musculoskeletal conditions to their benefit.

Curriculum↗

[Continuing medical education in Croatia and the European Union].

The Continuing Medical Education (CME), with attention to other forms of Continuing Professional Development (CPD) in Croatia and the today endeavors in the European Union, are presented. In European Union the formal CME is in its starting. The "European Accreditation Council for Continuing Medical Education" (EACCME) of the UEMS is established, which has formulated the principles of continuing education, the credit hours and their realizing, that would enable the mutual recognition of education in all European countries. In Croatia the starting of CME was at beginning of the 20th century, when the professional societies of Croatian Medical Association were founded. CPD was almost exclusively connected to activities of "Andrija Stampar" School of Public Health, to the School of Medicine in Zagreb and partly in Rijeka, which established a great number of postgraduate studies. The CME i.e. the courses of education were tightly connected to activities of the Croatian Medical Association, of its professional societies and its Academy of Medical Sciences, but also to activities of School of Medicine in Zagreb and Rijeka, and recently in Split and Osijek. Since 1995 the third partner, the Croatian Medical Chamber joined too. The number of CME meetings during 1998 is presented. The approximate calculation for needed annual courses of CME for all medical specialties in Croatia is presented. The formation of the National Authority for CME is suggested, in which all the interested institutions should be represented.

Croatia↗

Care of foot ulcers in the diabetic patient.

Practice profiles are reflective pieces written by nurses in practice, and based on continuing professional development articles. This week Sian Davies discusses diabetic foot ulcers.

Diabetic Foot↗

Taking primary care continuing professional education to rural areas: lessons from the United Arab Emirates.

OBJECTIVE: To assess the impact of a practice based multidisciplinary educational program. DESIGN: A descriptive account of experiences in introducing a new program of continuing professional development. SETTING: Rural primary health care centres in the United Arab Emirates. SUBJECTS: All staff working in the rural health centres. RESULTS: The educational intervention proved popular and appeared to effect a behavioural change. Teamwork in the health centres showed a marked improvement. CONCLUSION: A practice-based, multidisciplinary educational program using case-based learning proved to be effective when introduced to rural health centres of a developing country with multiracial health care professionals. .

Attitude of Health Personnel↗

Public health physicians' knowledge of core skills and current policy: clinical audit by questionnaire.

BACKGROUND: The aim of this study was to facilitate the assessment of the knowledge of general public health physicians on a range of topics relating to everyday areas of work and core skills, and to encourage learning in the process, by means of an educational clinical audit exercise. METHODS: A group of experts in different aspects of public health were asked to contribute multiple-choice questions. These were developed into a questionnaire that could be marked by computer. The questionnaire was circulated to all members of the Faculty registered for Continuing Professional Development (CPD) and to specialist registrar members, but participation was voluntary. The experts marked answers according to a marking scheme against model answers agreed. RESULTS: A total of 499 public health doctors returned answer sheets. There was no 'pass mark' as this was a learning exercise, not an examination. However, although the negative marking system meant that the possible range of scores was -100 per cent to 100 per cent, no one had a negative score. The median uncorrected result was 44 out of 80. Questions on communicable disease and critical appraisal had the highest scores, and one on Primary Care Trusts the lowest. Participants thought the most interesting questions were those on epidemiology and evidence-based medicine, whereas the most unpopular was on Personal Medical Services pilots. Most comments were favourable to the approach but several commented that the whole exercise was too general and questions outside their current area of specialization were irrelevant. CONCLUSION: The general public health physicians who took part in this audit appeared to be mainly competent in their knowledge of core skills and up to date with current health policy issues. However, the audit raises a debate about what 'core' knowledge is required in the post-training period. The place of UK-wide CPD initiatives over national or regional, or local approaches needs consideration, as do potential regional or national variations in CPD. This will receive further impetus because of revalidation and the need to demonstrate valid CPD activities in public health medicine.

Attitude of Health Personnel↗

South Cheshire Local Multi-disciplinary Evidence Centre: an evaluation.

The South Cheshire Local Multidisciplinary Evidence Centre (LMEC) was a two-year project commenced in March 1998 and completed in April 2000. The project aimed to develop an information service to enable all primary and community care staff in South Cheshire to access high-quality evidence and thus to improve patient care. The LMEC gave access from the workplace to both physical and electronic resources to support clinical governance and lifelong learning, with a strong emphasis on evidence-based material. Automation of the library catalogue enabled its inclusion on the website. The project developed enquiry and document delivery services and provided training on using the LMEC and on critical appraisal. An evaluation carried out at the end of the project showed that over 120 primary and community care staff had used the LMEC and were positive about the service. As Clinical Governance, the NHSnet, and plans for continuing professional development are implemented, the LMEC is one model for a Local Health Information Service outlined in the NHS IT strategy.

Education, Medical, Continuing↗

Development of a competency based training programme to support multidisciplinary working in a combined biochemistry/haematology laboratory.

The aim of this study was to develop a competency based training programme to support multidisciplinary working in a combined biochemistry and haematology laboratory. The training programme was developed to document that staff were trained in the full range of laboratory tests that they were expected to perform. This programme subsequently formed the basis for the annual performance review of all staff. All staff successfully completed the first phase of the programme. This allowed laboratory staff to work unsupervised at night as part of a partial shift system. All staff are now working towards achieving a level of competence equivalent to the training level required for state registration by the Council for Professions Supplementary to Medicine. External evaluation of the training programme has included accreditation by the Council for Professions Supplementary to Medicine and reinspection by Clinical Pathology Accreditation (UK) Ltd. The development of a competency based training system has facilitated the introduction of multidisciplinary working in the laboratory. In addition, it enables the documentation of all staff to ensure that they are fully trained and are keeping up to date, because the continuing professional development programme in use in our laboratory has been linked to this training scheme. This approach to documentation of training facilitated a recent reinspection by Clinical Pathology Accreditation (UK) Ltd.

Biochemistry↗

Pedagogical implications of approaches to study in distance learning: developing models through qualitative and quantitative analysis.

The need for flexibility in the delivery of nurse education has been identified by various initiatives including: widening the entry gate; continuous professional development; and the specialist practitioner. Access to degree level programmes is creating the need to acquire academic credit through flexible learning. The aim of this study was to further develop relationships between the need for guidance, materials design and learning styles and strategies and how these impact upon the construction of meaning. The study is based on interviews of 20 female community nurses purposively selected from the 96 respondents who had previously completed a survey questionnaire. The interviews were underpinned by theories relating to learning styles and approaches to study. Of particular concern was how these variables are mediated by student context, personal factors and materials design, to influence the need for support and guidance. The interview transcripts were first analysed using open and axial coding. Three approaches to study emerged from the data - systematic waders, speedy-focusers and global dippers - which were linked to other concepts and categories. Categories were then assigned numerical codes and subjected to logistical regression analysis. The attributes of the three approaches to study, arising from both qualitative and quantitative analysis, are explained in detail. The pedagogical implications of the three approaches to study are explained by their predicted relationships to other variables, such as support and guidance, organization of study, materials design and role of the tutor. The global dipper approach is discussed in more detail due to its association with a variety of predictor variables, not associated with the other two approaches to study. A feedback model is then developed to explore the impact of guidance on the global dipper approach. The paper makes recommendations for guidance to students using different approaches to study in distance learning.

Adult↗