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At least 325 records · Page 18Linked to original sources
PubMed1996

[Goal attaining scale. Reliability and practical experiences in 397 psychiatric treatment courses. 2: Practical experiences with a simplified version of Goal Attainment Scaling in clinical practice and intermediate length rehabilitational treatment].

Goal attainment scaling (GAS) measures outcome dependent on the degree, to which patients attain, what was thought to be their potential. Can this method be simplified by giving up to detail in advance, what would be "much more" and "much less" than the expected outcome? In 339 psychiatric treatment courses of inpatients, GAS was compared with a traditional clining rating. The patients did least agree to goals, their therapists wrote down concerning "social contacts" and "coping". The simplified form of GAS turned out to be more vulnerable to wrong prognoses. The influence of the vocational experience of those, who constructed the scales was tested as well. Despite methodological shortcomings GAS has evident therapeutic qualities: how else can we evaluate, how much of their potential our patients realize?

Adaptation, Psychological↗
PubMedDate not supplied

Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions.

BACKGROUND: Advance directives (ADs) are widely regarded as the best available mechanism to ensure that patients' wishes about medical treatment at the end of life are respected. However, observational studies suggest that these discussions often fail to meet their stated goals. OBJECTIVES: To explore best practices by describing what physicians who are considered expert in the area of end of-life bioethics or medical communication do when discussing ADs with their patients and to explore the ways in which best practices of the expert group might differ in content or style from normative practice derived from primary care physicians' discussions of ADs with their patients collected as part of an earlier study. DESIGN: Nonexperimental, descriptive study of audiotaped discussions. SETTING: Outpatient primary care practices in the United States. PARTICIPANTS: Eighteen internists who have published articles in the areas of bioethics or communication and 48 of their patients. Fifty-six academic internists and 56 of their established patients in 5 practice sites in 2 locations-Durham, NC, and Pittsburgh, Pa. Eligible patients were at least 65 years old or suffered from serious medical illness and had not previously discussed ADs with their physician. Expert clinicians had discretion regarding patient selection, while the internists chose patients according to a predetermined protocol. MEASUREMENTS: Coders applied the Roter Interaction Analysis System (RIAS) to audiotapes of the medical visits to describe communication dynamics. In addition, the audiotapes were scored on 21 items reflecting physician performance in specific skills related to AD discussions. RESULTS: Experts spent close to twice as much time (14.7 vs 8.1 minutes, P<.001) and were less verbally dominant (P<.05) than other physicians during AD discussions. When length of visit was controlled statistically, the expert physicians gave less information about treatment procedures and biomedical issues (P<.05) and asked fewer related questions (P<. 05) but tended toward more psychosocial and lifestyle discussion and questions. Experts engaged in more partnership building (P<.05) with their patients. Patients of the expert physicians engaged in more psychosocial and lifestyle discussion (P<.001), and more positive talk (P<.05) than patients of community physicians. Expert physicians scored higher on the 21 items reflecting AD-specific skills (P<.001). CONCLUSIONS: Best practices as reflected in the performance of expert physicians reflect differences in measures of communication style and in specific AD-related proficiencies. Physician training in ADs must be broad enough to include both of these domains. Arch Intern Med. 2000;160:3477-3485.

Adult↗
PubMed2005

Radiation oncology practice accreditation: the American College of Radiation Oncology, Practice Accreditation Program, guidelines and standards.

The American College of Radiation Oncology Practice Accreditation Program (ACRO PAP) is a process by which a medical practice is evaluated through an in depth external review to ascertain whether or not key components of the practice comply with existing regulations, rules, laws, practice guidelines and professional practice standards. In radiation oncology, like other fields, it is driven by the need or desire to demonstrate an identified level of patient care. The accreditation process adopted by the American College of Radiation Oncology (ACRO) is based on the parameters of quality care assessment outlined by the National Academy of Science's Institute of Medicine. Those practices that meet these criteria are eligible for recognition and accreditation by ACRO.

Accreditation↗
PubMed2003

Practice makes perfect: the critical role of mixed practice in the acquisition of ECG interpretation skills.

PURPOSE: To examine the effect of instructional format on medical students' learning of ECG diagnosis. METHOD: Two experiments employed different learning and practice methods. In the first, students were randomly allocated to one of two instructional approaches, one organized around features (e.g., QRS voltage) and the other around diagnostic categories (e.g., bundle branch blocks), followed by a practice phase. In the second experiment, the instruction was standardized, and students were randomly allocated to one of two practice phases, either "contrastive" where examples from various categories are mixed together, or "non-contrastive" where all the examples in a single category are practiced in a single block. RESULTS: In the first experiment, there was no significant differences in students' diagnostic accuracy on novel ECG examples. In the second experiment, students exposed to the contrastive approach in the practice phase had superior diagnostic accuracy (46%) compared to 30% accuracy for the non-contrastive session, p < 0.05). CONCLUSION: These experiments highlight two important features in the design of instructional materials. First, learning around the features of the problem (analogous to problem-based learning) may have no advantages over learning the category. Second, the design and organization of deliberate practice can result in significant learning gain.

Canada↗
PubMed1998

Are practice nurses an unexplored resource in the identification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995.

Changes in the health promotional work undertaken in primary care, including the work needed to meet the 'Health of the Nation' alcohol targets, have led to a rapid expansion of the number of practice nurses in England and Wales. However, there has been little evaluation of this role. This study provides data, for the first time at a national level, about practice nurses' work in identifying and managing patients drinking above recommended sensible guidelines. Data were collected by postal questionnaire from all nurses in a 50% random sample of 1852 practices (drawn from a general practitioner (GP) national study, undertaken at the same time). 43% of nurses responded from 62% of the targeted practices. Respondents reported identifying a mean of 3.1 patients per month who were drinking above recommended sensible guidelines. These patients tended to be male, above 40 years of age and in contact with the nurse for the first time about this problem. Most patients were categorized as having a potential alcohol problem; few were classified as currently dependent. Very little intervention work was undertaken by nurses except for referral to the GP. If real progress is to be made in meeting the 'Health of the Nation' targets on population alcohol consumption, then primary care work in identifying alcohol misusing patients needs to be developed as a matter of urgency. The patients identified by practice nurses are those patients relevant to the 'Health of the Nation' alcohol targets. More emphasis needs to be placed on the valuable contribution practice nurses can make, particularly through the use of screening instruments and brief interventions.

Adult↗
PubMed2003

Nursing roles and levels of practice: a framework for differentiating between elementary, specialist and advancing nursing practice.

The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles. Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles. Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices. Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred. The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear.

Job Description↗
PubMed2003

Evidence-based practice in mental health: practical weaknesses meet political strengths.

UNLABELLED: RATIONALE, AIMS, AND OBJECTIVES: Evidence-based medicine (EBM) has given rise to evidence-based practice (EBP) in the field of mental health. EBP too is predicated on an evidence hierarchy and has the goal of using the "best evidence" (usually randomized controlled trials) to improve practice. EBP is increasingly influential in mental health care in the U.S. Growing numbers of researchers and public officials endorse its claims and pursue its benefits. The rationale for this paper is to examine the potential of EBP for the field of mental health-and public mental health care specifically. Is it likely to contribute to improved lives for mentally ill people? If so, how? METHODS: This qualitative study relies on archival, and to a much lesser extent, informant interview data. Informants were mostly public mental health officials because they are in a position to implement EBP on a large scale and their policies are a matter of public record. Interviews were semi-structured, held in person and on the telephone, and lasted one to two hours. Archival research included the substantial literature on EBM and EBP plus studies and articles on the practice and policy of U.S. public mental health care. RESULTS: The results of this study were that there exists an extensive, coherent literature critical of EBM and of EBP specifically. Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc. CONCLUSIONS: This paper concludes that EBP is growing more influential in public mental health care in the U.S. Its practical strengths, i.e., its improvement of mental health practice, may turn out to be less than its strengths as a public idea in the formulation and dissemination of mental health policy.

Biomedical Research↗
PubMed2000

Action research to improve the pre-registration midwifery curriculum Part. 3: Can fitness for practice be guaranteed? The challenges of designing and implementing an effective assessment in practice scheme.

OBJECTIVE: To design and implement a robust assessment scheme to more effectively identify student midwives' fitness for midwifery practice. DESIGN: Five inter-related action research cycles. Methods included: documentary analysis, interviews, observation, questionnaires, focus groups. SETTING: A large university in England. PARTICIPANTS: Student midwives, practising midwives and midwife teachers, childbearing women, course planning team and EME project team collaborators. FINDINGS: Whilst there was evidence that the majority of students are fit for midwifery practice by the end of the course, assessment schemes were found to be unreliable. In particular there was the potential for 'borderline' students to register as midwives if assessors were inadequately prepared for their responsibilities; assessment documentation was not 'user' friendly; evidence of competence was inadequately recorded or there was a lack of systematic monitoring by university teachers and examiners of the assessment in practice scheme. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The gap between curriculum aspirations and actual implementation needs to close. The assessment matrix, developed as part of the national evaluation study, could usefully be used as a framework when designing assessment schemes. The difficulties for midwife assessors in each locality need to be identified and solutions incorporated into workable but robust strategies. University midwife teachers/lectures have a responsibility to work in partnership with assessors and students to monitor assessment in practice schemes and, where local circumstances and confidence in reliability permit, grade and award credits for practice-based assessment of student capability.

Clinical Competence↗
PubMedDate not supplied

Establishing a practice-based research network of advanced practice registered nurses in southern New England.

BACKGROUND: Biomedical research focuses on highly controlled clinical trials in academic health centers, where the emphasis is on disease treatment and rehabilitation. The results, therefore, are not readily applicable to patient populations that primary care clinicians encounter in their community practices, where the focus is on health promotion and disease prevention. Although the number of practice-based research networks (PBRNs) is growing in primary care, these networks are governed by the physicians who created them and address research questions reflective of physicians' practices and perspectives. Other primary care clinicians, such as advanced practice registered nurses (APRNs), who routinely provide care for underserved and minority populations lack a forum for studying their practice problems and processes. A PBRN of APRNs in primary care provides a means for this research. SUMMARY: The Advanced Practice Registered Nurses' Research Network in southern New England is the first PBRN established for APRNs. This article describes the development of the network.

Evidence-Based Medicine↗
PubMed1997

Pseudoissues in practice evaluation: impediments to responsible practice.

This article reviews often-cited barriers to the implementation of practice evaluation activities and suggests that they are pseudoissues. Five pseudoissues in evaluation are reviewed: (1) time constraints, (2) single-system design issues, (3) gender and ethnic bias, (4) complexity of practice, and (5) incompatibility between the science of evaluation and the art of helping. These pseudoissues result from two misconceptions: First, these issues are sometimes viewed as affecting only the evaluation component of practice, but they pervade all of practice. Second, the confusion about the purpose of single-system designs leads to unwarranted concerns about design and methodology. The article argues that the incorporation of evaluation activities in practice helps practitioners become more aware of and sensitive to legitimate barriers to effective practice and paves the way for overcoming these barriers.

Adolescent↗
PubMedDate not supplied

Genetic practice, education, and research: an overview for advanced practice nurses.

PURPOSE/OBJECTIVES: The purpose of this article is to describe how the new genomic era will affect advanced practice registered nurses (APRNs) patient care, education, and research. BACKGROUND/RATIONALE: Given the exponential growth of genetic information and that 9 of the top 10 leading causes of mortality have genetic components (www.cdc.gov), it is imperative to educate advanced practice nurses about this salient topic. DESCRIPTION OF THE PROCESS: Because few APRNs in practice or academia have had formal education on genetics, the first step of nursings' own gene discovery is recognizing that there is an ongoing need to understand state of the science genetic information to gain clinical and educational utility. OUTCOMES: By recognizing APRNs need to know genetics, APRNs will clamor within their workplace for continuing education about this dynamic information. It is critical knowledge for APRNs to classify risk based on family history, target individualized patient prevention and education, modify pharmacologic interventions, and refer when genetic testing is necessary. INTERPRETATION/CONCLUSION: This article stresses the timely relevance of applying genetics and genomics to practice, teaching, and research. IMPLICATIONS FOR NURSING PRACTICE: APRNs need to maintain a place at the genetic table with all healthcare providers by developing strategies to expand this nursing knowledge to their practice, teaching, and research. Nurses need to be cognizant of the keen genetic value of family histories, how risk classification will individualize prevention recommendations, and the exciting role of pharmacogenetics, given many APRNs' prescriptive authority. Our core professional belief that each human is highly unique has probably never been more accurate than with the future in genetic and genomic nursing.

Genetic Testing↗