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PubMedDate not supplied

The scope of professional practice in specialist practice.

The Scope of Professional Practice (UKCC, 1994a) now offers nurses, midwives and health visitors new opportunities to develop their clinical role. Role expansion is at the centre of debate in the health service. In the spirit of Scope, trusts and regional health authorities have been experimenting with new roles that combine medical and nursing practice in order to promote a holistic approach to health care. Education, experience and the appropriate clinical competency are the foundations for role expansion and the development of professional practice. However, some of the new roles and innovative practices have also been targeted at reducing junior doctors' hours (Read and Graves, 1994). New roles must be evaluated before they are allowed to develop and there is an urgent need for national evaluation of the initiatives underpinning Scope. This article examines the changing role of practitioners in specialist practice. The ethical, professional and legal issues surrounding these changes will also be considered.

Clinical Competence↗
PubMed1996

Valuing authority/responsibility relationships. The essence of professional practice.

Central to the practice of professional nursing are the elements of accountability, autonomy, direct communication, and authority. The value that nursing work groups place on authority affects their level of acceptance of responsibility and accountability for clinical decision making. The authors examined the value that nurse managers and staff nurses on primary nursing and total patient care units place on authority/responsibility relationships. Results indicated that nurse managers and staff nurses on primary nursing units valued accountability, authority, and autonomy more than the nurse managers and staff nurses on total patient care units, a finding consistent with the professional practice model of primary nursing.

Attitude of Health Personnel↗
PubMedDate not supplied

Nursing leadership and autonomous professional practice of registered nurses.

Autonomous professional practice continues to be elusive for registered nurses. Autonomous professional practice implies that nurses would be free to determine the procedures for carrying out their nursing work. In other works, they would be able to make independent decisions about their own nursing practice. This article reports research that describes the nature of nursing leadership that supports autonomous professional practice of registered nurses.

Attitude of Health Personnel↗
PubMed2000

[Evaluation of professional practices].

Concepts and methods in professional practices evaluation are often confused. After a description of the classical conceptual framework, we present these methods in an approach in which practice is the principal result to be measured. Thus it makes it possible to apply the traditional epidemiological concepts to the evaluation of the professional practices with their three traditional fields: 1) In the descriptive approach, cross-sectional practice studies allow an observation and description of the usual behaviors, possibly compared to references. The methodological constraints are the same as which of descriptive epidemiological studies; 2) In the analytical approach, factors associated with practice - simple or conformed to criteria - are evidenced on a representative sample; 3) In the evaluative approach of practices improvement, the objectives are the assessment of formative, organizational or structural interventions, aiming at modifying practices. Three types of studies are to be used: quasi experimental in which clinical audit is the reference method in the field of medical care. The six main steps of clinical audit are described; experimental, based on the community randomized trial scheme, which have the advantage to provide results that can be immediately generalized; observational in which no control on the implementation of intervention is done. "Here and else" and "before and after" studies are used. To be effective for evaluation of professional practice, theses methods must come within the scope of a favorable institutional context.

Epidemiologic Methods↗
PubMedDate not supplied

Rebuilding a professional practice model. The return of role-based practice accountability.

There is no patient care without clinical practice. To improve the quality of health care, organizations must build a finely tuned and resilient clinical enterprise, one founded on clear role accountability and decision authority within the team. The author views scope of practice and professional standards as the foundation for practice accountability and decision authority. A case is made that an interdisciplinary, professional practice model is an appropriate delivery model in today's health care environment; a model that places the professional role in its rightful place as decision maker and supports the role's inherent accountability to evaluate and monitor practice performance. The importance of measuring professional practice performance is seen as a key link toward better understanding ways to reduce error and ensure patient safety.

Decision Making, Organizational↗
PubMed1992

The Nursing Practice Personnel Data Set. Implications for professional practice systems.

Existing data about nursing practice personnel has been found to be fragmented, incomplete, and non-uniform. These shortcomings can severely hamper administrative decision making related to professional practice systems in general, and differentiated pay and practice models in particular. The Nursing Personnel Practice Data Set (NPPDS) is designed to remedy these deficiencies by providing available, accessible, reliable, and comparable data about nursing personnel. The authors describe elements of the NPPDS and discuss implementation aims.

Career Mobility↗
PubMed2000

Examination for professional practice in psychology subtest scores of professional and traditional clinical psychology program graduates.

Professional school clinical psychology graduates not only exhibit inferior performance on the research subtest of the Examination for Professional Practice in Psychology (EPPP; D. I. Templer & M. E. Tomeo, 1998), but they also perform less well on the four more professionally oriented subtests: diagnosis, intervention, professional/ethical/legal issues, and application to social systems. Graduates of free-standing professional schools exhibited performances inferior to those of graduates of non-free-standing professional schools on the diagnosis, intervention, and professional/ethical/legal subtests.

Curriculum↗
PubMedDate not supplied

Decentralized unit orientation: a model for professional practice.

Facilitating use of professional practice models is a goal of nursing administrators and educators. A plan for decentralized unit orientation designed to foster use of nursing process and nursing standards was developed within the division of surgical nursing. Conceptual frameworks, topic selection, behavioral objectives, content outline, teaching strategies, operationalization of the plan, and methods to evaluate learning are described in this article. Staff development educators can use the information to assist unit managers in developing a decentralized unit orientation plan that emphasizes professional practice.

Curriculum↗
PubMed2006

Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice?

This paper reports on the findings of a study that aimed to explore how relevant initial training is in relation to evidence-based practice, and explore the perceptions of recently qualified practitioners about their confidence to engage in evidence-based practice. A cross-sectional postal survey was used to ascertain the views of nurses, social workers, occupational therapists and physiotherapists who had been qualified no longer than two years prior to the survey, and had qualified at one of three London Universities. Fifty questionnaires were sent out to each professional group (a sample of 200 overall) and there was a 43% response rate achieved. The results show a clear discrepancy between what are generally positive attitudes towards evidence-based practice and the value of research evidence and the infrequency with which they actually do make use of research resources and engage in evidence-based practice. A number of constraints to engagement in accessing and utilising evidence were identified.

Attitude of Health Personnel↗
PubMedDate not supplied

Bridging the "theory-practice gap" in renal nursing: establishing a renal professional practice model. Experiences of the Adam Linton Dialysis Unit.

The renal program (RP) at the London Health Sciences Centre (LHSC) chose to implement a professional practice model (PPM). This paper examines the implementation and maintenance issues of the renal professional practice model (RPPM) at the Adam Linton Dialysis Unit (ALU), one unit of several dialysis units affiliated with the LHSC RP. The discussion includes primary nursing as the care delivery system for the RPPM. Attention is paid to experiences post program transfer--when the renal programs from St. Joseph's Health Centre and LHSC merged. The final focus of this paper is on the practical experiences of nurses at the ALU while using this model. Included are: Systems in place to support the success of this model. How leadership and staff contributed to the model's success. How this model might have improved patient outcomes. How this model could enhance both patient and staff satisfaction.

Clinical Nursing Research↗
PubMed2004

Development and psychometric evaluation of the Professional Practice Environment (PPE) scale.

PURPOSE: To describe the Professional Practice Environment (PPE) scale, its conceptual development and psychometric evaluation, and its uses in measuring eight characteristics of the professional practice environment in an acute care setting. DESIGN AND METHODS: The 38-item PPE Scale was validated on a sample of 849 professional practice staff at the Massachusetts General Hospital in Boston. Psychometric analysis included: item analysis, principal components analysis (PCA) with varimax rotation and Kaiser normalization, and internal consistency reliability using Cronbach's alpha coefficient. FINDINGS: Eight components were shown, confirming the original conceptually derived model's structure and accounting for 61% of explained variance. Cronbach's alpha coefficients for the eight PPE subscales ranged from .78 to .88. CONCLUSIONS: Findings showed the 38-item PPE Scale was reliable and valid for use in health outcomes research to examine the professional practice environment of staff working in acute care settings.

Acute Disease↗
PubMed2001

Practicing professional psychology.

The practice of professional psychology generally has consisted of assessment and intervention. This article describes the functioning of one practitioner's activities. For assessment, the model described emphasizes point predictions and actuarial approaches whenever those are available. The discussion includes descriptions of specialization and expansion of practice areas, as well as the need for involvement in advocacy activities and professional associations.

Humans↗
PubMed2004

The changing professional practice of physician assistants: 1992 to 2000.

BACKGROUND: Substantial changes in professional practice for physician assistants (PAs) occurred between 1992 and 2000. This paper describes a new professional practice index for the PA profession for 2000 that reflects current practice environments more accurately than did an index developed to reflect practice environments in 1992. In addition, the paper examines the relationships among the profession, its professional environment, and physicians, as well as the relationship between the PA profession and access to care for underserved populations. RESULTS: Comparisons of the 1992 professional practice index for the PA profession and indices for 2000 indicate that, collectively, the scope of practice of PAs increased significantly across the United States over the 8-year period. Variation of the index scores narrowed over the same period, suggesting that the 1990s were a period of convergence of professional practice across the 50 states. During this period the numbers of practicing PAs nearly doubled between 1992 and 2000, and in 2000 there were 5.8 practicing PAs per 100 physicians in active patient care in the United States. The professional practice index for the profession is positively correlated with the numbers of PAs per capita across the 50 states for both 1992 and 2000. CONCLUSION: Enabling legislation for PAs has been enacted in all 50 states and the District of Columbia over a 3-decade period. A period of consolidation and convergence of statutes and policies over the 1990s suggests that American medicine has endorsed the role of PAs. In spite of these findings, almost one third of states continue to have limited or restricted statutes for PA practice, mostly in the area of reimbursement.

Health Services Accessibility↗
PubMedDate not supplied

Elements of a nursing professional practice model.

The authors define a professional practice model (PPM) as a system (structure, process, and values) that supports registered nurse control over the delivery of nursing care and the environment in which care is delivered. A PPM has five subsystems: values, professional relationships, a patient care delivery model, a management approach, and compensation and rewards. Analysis of five PPMs described in the literature showed that the professional values addressed most often are nurse autonomy, nurse accountability, professional development, and emphasis on high-quality care. Teamwork, collaboration, and consultation consistently appeared as approaches to enhance professional relationships. Primary nursing and case management are the care delivery systems most often used in the models. Decentralizing decision making, expanding the scope and type of unit nurse manager responsibilities, and instituting structural changes to support professional practice were common activities in the management subsystem. Compensation and reward systems generally recognized professional achievement and contribution toward organizational goals. Recommendations for implementing and evaluating PPMs are offered.

Humans↗
PubMed2003

Describing the essential elements of a professional practice structure.

The proliferation of program management coupled with the Introduction of the Regulated Health Professions Act, prompted many healthcare organizations in Ontario to introduce professional practice models. In addition, the Magnet Hospitals research (Kramer and Schmalenberg 1988) identified the existence of a professional practice model as a key element for recruitment and retention of professional staff. Professional practice models were introduced to address issues of accountability, identity and overlapping scopes of practice as experienced by healthcare professionals and organizations across the continuum of care. The authors of this paper describe exploratory work done through the Professional Practice Network of Ontario to identify the essential elements of the "ideal" professional practice structure, key areas of challenge and strategies for adapting these elements into an organization. The paper presents a list of 16 essential elements of an ideal professional practice structure with a further discussion on four key areas consistently identified as areas of challenge. This paper is intended to report, not the findings of a formal research study, but rather the result of facilitated dialogue among professional practice leaders in Ontario. The information will be of interest to healthcare organizations across the continuum of care and to professional associations and academic institutions, as we all address the challenges of creating a quality work environment that supports and fosters excellence in professional practice.

Communication↗