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PubMed1993

[Risks of failure of uncontrolled adoption of foreign children].

Four cases of failed adoptions of children from abroad are reported. Risk factors included advanced age of the adopting parents or adoptee and insufficient commitment on the part of the adopting parents who organized the adoption on their own without undergoing counselling. Prevention of adoption failures would require counselling by competent professionals and support groups (e.g., adopting parent groups, competent physicians) and mandatory review of adoption requests by an appropriate commission.

Acculturation↗
PubMedDate not supplied

The role of peer assessment and peer review in nursing.

With the implementation of clinical governance and professional self-regulation, substantial responsibility is devolved on to clinical nurses. Central to these two concepts is accountability for practice. We are accountable for our professional competence and knowledge to various parties such as the professional statutory body, the employer, society as well as ourselves. Although self-assessment provides each individual with a medium for ascertaining his/her own level of performance and, therefore, identifying his/her learning needs, peer review and peer assessment provide healthy means for obtaining feedback and external perceptions. They also bring with them several other benefits and meet other recommended professional requirements. Peer review is an intrinsic component of clinical governance, and it can be initiated and implemented at one-to-one, departmental or organizational level.

Clinical Competence↗
PubMed2005

[Defining and assessing competence of healthcare professionals. A survey of 148 organizations].

INTRODUCTION: To study how competence is described and perceived by organizations of healthcare professionals in France and propose approaches toward implementing a policy to monitor and assess competence throughout medical professionals' careers. METHODS: After a literature search, we sent 160 letters to organizations representing 16 healthcare professions (listed in the French healthcare code) describing our objectives and proposing interviews. Semi-structured interviews (45-90 minutes) were conducted. The principle questions asked were: What is your organization's definition of competence? What are the principal elements that define competence in healthcare activities? How can a system for assessing competence be implemented? Which methods for such a system are most appropriate, based on experience in other countries? Who are the players in the field of competence? How can organizations participate in monitoring competence? RESULTS: 265 people representing 148 French organizations were interviewed. Analysis of the interviews showed that the principal points mentioned included: need for recognition; lack of training on new developments; need to anticipate changes; need for better health security in the healthcare system. There was a general consensus on the basic elements of competence, the responsibility of public institutions and professional organizations, and the need to work together. DISCUSSION: We suggest that competence in health care should be defined as follows: "professional competence is based on an initial diploma, participation in effective continuing medical education, a minimum amount of professional activity, and a regular peer review process". Healthcare professionals in France would like to have a better system that allows them to exchange more information on the principal issues in health care.

Clinical Competence↗
PubMed2003

OSCE! Variations on a theme by Harden.

BACKGROUND: In 1979, Harden described the first objective structured clinical examination (OSCE). Harden's OSCE dramatically changed the assessment of professional competence because it used actors and choreographed scenarios to evaluate the performance of professional behaviours. ANALYSIS: Because of the intense focus on performance, OSCEs have had a powerful influence on doctor training and practice. However, the immediate psychometric characteristics of OSCEs rather than their performance effects have been the subject of most research. CONCLUSION: The time has come to undertake a sophisticated sociological investigation of how OSCEs affect medical practice, including the ways in which they shape doctor interaction with patients, families and other health professionals.

Clinical Competence↗
PubMed2005

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery.

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.

Aged↗
PubMed1993

From competent novice to competent expert: a discussion of competence in the light of the post registration and practice project (PREPP).

The nursing profession in the UK, is today faced with major changes in the light of the Post Registration and Practice Project (PREPP) (UKCC 1990). This paper raises questions about how the maintenance of professional competence as detailed in PREPP can be assured. Through a discussion of professional porfolios and continuing education, the subjectivity of guaranteeing a practitioner's competence at tri-annual re-registration is raised. With reference to Benner's (1984) work, the paper suggests that there may be some similarities on the 'novice to expert' continuum that relate directly to the UKCC's proposals. However, the inherent deficiencies with such a mandatory approach to professional development are discussed and questions posed about the extent of nurses' continuing education needs being met. In view of the controversy that still surrounds who will finance the changes, and what format the portfolios will adopt, practitioners are at risk of conforming to the changes but being denied the opportunity of ensuring that they possess the necessary skills and framework, that are essential in ensuring the maintenance of clinical competence. The paper suggests that a concerted effort will be required by both educators and service personnel to ensure that the PREPP proposals are successful.

Certification↗
PubMed1995

Reflecting on reflection: a personal encounter.

This paper reports a retrospective study of a Senior Lecturer in Nursing Studies experience of supervising a student teacher who, as part of her teaching placement experience, utilised 'Critically Reflective Analysis of an Educational Event' as a means to assess her teaching in the practice setting. The Senior Lecturer and student nurse teacher used an external 'advisor' to facilitate their meta-reflection on the theoretical perspectives that informed the process in which they were engaged. The paper raises the following questions for consideration--What is the link between ability to reflect and quality of practice? Is it possible to utilise reflective tutorials as a means of assessing professional competence whilst at the same time encouraging personal and professional development? Is the ability to reflect on practice dependent on the context? Should we assume that all practitioners have the necessary skills to supervise students in practice and what preparation and support is needed? The paper demonstrates that by introducing 'Critically Reflective Analysis of an Education Event' into the student teachers' curriculum the role of both supervisor and student teacher was challenged and changed. The paper also demonstrates that reflective tutorials are not wholly a retrospective business. They are creative, or recreative of a teaching experience, as well as to some extent representing it. Finally, even if one cannot speak in Kuhnian parlance, of a conceptual revolution, it would seem legitimate to say, in Schon's terms, that the contextual frame in which professional problems are addressed has undergone significant change.

Education, Nursing, Baccalaureate↗
PubMed2002

[Nursing training from the perspective of education-- reflections and challenges for the future].

The present article proposes to show a reflection in the nurse's formation on the point of view of educators, philosophers and contemporary researchers. Moacir Gadotti, Edgar Morin e Philippe Perrenoud's theories and reflections were used, as well as the four pillars of the contemporary education, presented in the Delors Account. The adoption of tools like learning to know, learning to do, learning to be and learning to live together as well as the competences abording, are indispensable devices in the formation of professionals in the modern world. It is believed that in incorporating these new dimensions to the nurse's formation, it will be possible to untie the notts that are to be overcome in the conformation of critic nursing professionals, competent and agents of social transformation.

Education, Nursing↗
PubMed1998

[Problems in expert assessment in child custody cases according to sections 1666, 1666a BGB in the controversy between control and assistance].

The restriction of parental rights includes not only legal but also therapeutic aspects. The therapeutic aspects refer first to the child's disorder and then to its resulting needs. Furthermore a restriction of parental rights could be necessary for therapeutic reasons when the parents' reaction to reality is insufficient, usually caused by parental psychiatric disorders. The expert's counsel should facilitate the communication with disturbed parents thus engendering an improved reality-insight by the parents. Successful helping strategies can thus be made workable. The expert, the judge and the local authority social services should mutually respect specifically defined role-functions. The communication barriers between parents and helpers can only this way be partially resolved. The expert's evidence requires a high professional competence and responsibility and goes over and above the professional contribution from family therapy.

Adolescent↗
PubMed1998

Professional standards: linking care, competence, and quality.

Professional standards are key to the success of nurses as health care evolves, new roles are created, and new practice settings established. They are the infrastructure beneath the development of institutional standards of care, competency-based education programs, and quality assurance programs. Using them to link these key components provides for consistency across practice settings and among practicing nurses within integrated delivery systems. They also serve as the foundation for consensus building for partnerships and interdisciplinary initiatives.

American Nurses' Association↗
PubMed2003

[Quality improvement of medical diagnostic laboratories].

Service quality in medical laboratories is influenced by a number of variables. Medical laboratories have long recognized the need for total quality management that incorporates the continuous improvement of all stages, such as the pre-analytical, analytical and post-analytical phases, of the diagnostic process, in addition to the traditional internal and external quality control of analytical procedures. Based on national and international experience, continuous improvement of quality and its external assessment are of high priority in order to guarantee a reliable, effective and cost-effective diagnostic service. Certification of health care services, according to ISO 9001 standards in Hungarian hospitals, is not sufficient to prove professional competence of medical laboratories, which called for a system of laboratory accreditation. Accreditation is an external professional audit by which an independent accreditation body gives formal recognition that the medical laboratory is competent to provide high quality services that are compliant with rigorous professional standards of best practice. The primary aim of accreditation is the improvement of the quality of diagnostic services by voluntary participation, professional peer review, continuous training and education and compliance with professional standards. In vitro medical laboratories have pioneered quality control and quality assurance in health care. Based on these strengths and traditions, the introduction of the accreditation program of medical laboratories in Hungary is one of the key professional and ethical responsibilities of diagnostic professions, in order to improve the quality, efficiency and effectiveness of laboratory services during the course of Hungary's accession to the European Union.

Accreditation↗
PubMed2005

Perinatal care regionalization and acceptability by professionals in France.

BACKGROUND: For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals'expectations and objections to perinatal regionalisation and to compare them from a professional group to another one. METHODS: Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals'interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals' competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of 'private practice'professionals, legal consequences. RESULTS: The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and "private practice" professionals) compared with neonatologists, or by "private" professionals (professionals working in private clinics and "private practice" professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning. CONCLUSION: By identifying clearly professionals 'objections and expectations, this study should facilitate improvement in the organization of studied perinatal networks.

Attitude of Health Personnel↗
PubMed1991

A comparison of self-reported health education competencies among selected school health educators in the United States and Taiwan, R.O.C.

Results from a preliminary, cross-national study examining perceived competence of school health educators in Taiwan, R.O.C., and in Florida are reported. The study used the Self-Assessment for the Health Educator instrument, developed by the National Task Force on the Preparation and Practice of Health Educators, Inc., which specifies 79 skills in seven competency areas. School health educators from Taiwan and Florida rated their own perceived competence regarding each skill, and assessed the perceived usefulness of each skill in health education practice. Responses from the two groups were similar on six of seven competency areas regarding usefulness of the items. Yet, teachers from Taiwan expressed greater perceived competence than the Florida teachers in five of seven areas. However, within both groups, teachers rated perceived usefulness higher than their own perceived level of competence. Inservice training, amount of formal training, and years of professional experience affected levels of perceived confidence in both groups. Initial results suggest the self-assessment instrument may prove useful as a tool for examining professional competence in other countries, but more extensive research is needed to determine the instrument's applicability in cross-national comparisons.

Adult↗
PubMed2005

[Oncological care according Alfred Schütz].

The study was realized among oncological nurses in their daily work routine and aimed to understand these professionals' subjective action, starting from their relation with patients, adopting a phenomenological reference framework based on the ideas of Alfred Schütz. The question: what does working in oncological care mean to you? Please describe, was used to collect statements, which were analyzed and clarified the typical action of a nurse caregiver in this daily routine. The study revealed that oncological care implies dealing with humans in a fragile situation; requires a relationship of affectivity; is care delivery that entails the genesis of professional burnout. Care delivery in oncology is highly complex, requiring a professional competence that goes beyond the technical-scientific sphere. Nursing professionals need to seek strategies which enable them to face the fatigue they are submitted to in their work.

Humans↗
PubMed1980

Prescribing psychotropic drugs: whose responsibility?

Through the use of a questionnaire it has been ascertained that a significant number of second-year graduate school social work students at the Columbia University School of Social Work are called upon to monitor and dispense psychotrophic drugs in various placements where they receive their practical clinical training. In some instances they may even fill out prescription blanks that are signed by psychiatrists who do not have the time to see the patients personally. This situation not only represents the abdication of medical responsibility, frequently leaving non-medical personnel with functions beyond their training and professional competence, but also raises important ethical and legal problems. Non-medical professionals in mental health settings should receive appropriate instruction in the essentials of psychopharmacology. Such training should not be left to chance as apparently is the case now. Non-medically trained members of the mental health team, if properly instructed, could cooperate more effectively with the psychiatrists who must in any event retain primary responsibility for pharmacotherapy.

Clinical Competence↗
PubMed2001

A change of the physicians' understanding of the encounter parallels competence development.

Patients today complain that physicians do not listen. There is a need to improve the professional competence in the patient encounter. According to theory, competence is a result of how people perceive their work. Observation and reflection can improve the competence. The aim of this study was to investigate if physicians can develop a more patient-centred consultation style by an experienced-based specialist course and how such a development is related to the physicians understanding of the task. The physicians video recorded consultations and reflected on these. The video consultations were analysed with a time study and Pendleton et al.'s consultation schedule [Pendleton D, Schoefield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.]. Before-after questions were answered. The study indicates that seven out of 10 physicians participating in the course had developed a patient-centred attitude and acted according to it. The time study gave ambiguous results. This study implicates that it is possible to initiate competence development by influencing the understanding of the encounter.

Adult↗
PubMed2003

A study of collaboration inpatient treatment between the community psychiatric health services and a psychiatric hospital in Norway.

The aim of this study was to examine factors that may have an influence on the collaboration between the health-care professionals in a psychiatric hospital and two communities' psychiatric health service departments. Interviews were conducted with three psychiatric nurses, one medical practitioner, one health and social manager and one cultural worker; thus a total of nine informants. The transcribed interview texts were analysed by means of qualitative content analysis. The main results showed that the community psychiatric nurses felt a need for more systematic interdisciplinary collaboration. The existing collaboration was characterized by ad hoc meetings. In addition, the need for information about their colleagues' professional competence was reported. The respondents called for a more regular forum for professional guidance and coordination in relation to particular client cases in order to improve the quality of psychiatric care. There was also a need for collaboration within community health care and a link to psychiatric hospital care in order to better evaluate the outcomes of care provided. In conclusion, the lack of continuity in the collaboration between health-care professionals may affect the quality of community health services because continuity is a vital component of care.

Adult↗
PubMed2002

The process of translating women's health care competencies into educational objectives.

"Women's Health Care Competencies for Medical Students" lists the competencies undifferentiated medical students should be able to demonstrate before graduation. The Association of Professors of Gynecology and Obstetrics (APGO) was among the groups asked to convert specified competencies into educational objectives. Working individually, APGO's Undergraduate Medical Education Committee members used APGO's Medical Student Educational Objectives, Seventh Edition, to construct objectives appropriate to preassigned competencies. Referring to the work of Miller, members determined the level of professional competence medical students should reach for each objective. Members also selected evaluation tools appropriate for the skill and its competency level from the Toolbox of Assessment Methods created by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties. The group collectively revised the work of its members using a standard format to generate the final product.

Clinical Competence↗