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PubMed2006

Formal mentoring programmes for medical students and doctors--a review of the Medline literature.

Mentoring programmes have been implemented as a specific career-advancement tool in the training and further education of various groups in the medical profession. The main focus of our investigation was to examine what types of structured mentoring programmes exist for doctors as well as for medical students, what short- and long-term goals these projects pursue, and whether statements can be made on the effectiveness and efficiency of these programmes. A literature-search strategy was applied to Medline for 1966-2002 using the keyword combinations: (a) mentor* [AND] program* [AND] medical students, and (b) mentor* [AND] program* [AND] physicians. Although a total of 162 publications were identified, only 16 papers (nine for medical students and seven for doctors) met the selected methodological criteria. The majority of the programmes lack a concrete structure as well as a short- and long-term evaluation. Main goals are to increase professional competence in research and in further specialization and to build up a professional network for the mentees; no statements are to be found on the advantages for the mentors. Programme evaluation is for the most part presented descriptively in terms of great interest and high level of satisfaction. No publication contains statements on the effectiveness or the efficiency of the programme. Although the results of mentoring are promising, more formal programmes with clear setup goals and a short- and long-term evaluation of the individual successes of the participants as well as the cost-benefit analysis are needed.

Education, Medical, Continuing↗
PubMed2002

Perspectives on practicing procedures on the newly dead.

UNLABELLED: Invasive procedures are commonly practiced and taught on newly deceased patients (the newly dead) in emergency and critical care settings. Justified by the claim of necessity for professional competence to provide lifesaving care, these procedures, commonly hidden from public and professional scrutiny, are frequently performed on the newly dead without consent from family or interested parties. OBJECTIVE: To describe older adults' beliefs about practicing and teaching lifesaving procedures on the newly dead and their belief about the requirement for consent for these procedures. METHODS: An exploratory, descriptive design used a seven-item Likert-type instrument with open-ended questions to gather data from a convenience sample of 100 adults in two metropolitan cities. RESULTS: The typical respondent was 74.5 years old (mean; range of 55-95 years), female (71%), and married (44.8%) or widowed (36.5%). Most respondents were high school graduates (94%), and 63% had some level of college education. The majority of the sample was white (75%), they were predominately Protestant (40%), and 72% reported their health as good to excellent. Most study participants believed that practicing or teaching lifesaving skills on a newly dead body is acceptable (54%), and that provision for consent is necessary (80%). Planning to donate organs and preferring an autopsy were associated with agreeing that using the newly dead body for skill practice was acceptable; preferring cremation was related to believing that consent for skill practice on the newly dead was not necessary. CONCLUSIONS: The participants in this study value the use of the newly dead to practice and teach lifesaving skills, and believe that consent for this practice is necessary.

Aged↗
PubMedDate not supplied

Development of educator competencies and the professional review process.

As staff development educators prepare themselves and their organizations for forthcoming healthcare challenges, educators influence the practice of staff development through the use of competencies. Because competencies and peer review are expectations for staff, educator competencies and educator professional review should be essential for those who train staff. Based upon the American Nurses Association Standards of Practice, National Nursing Staff Development Organization research, and Patricia Benner's work, competencies for educators reflect practice levels from novice to expert and challenge educators to attain levels of excellence in practice. Use of educator competencies includes the professional review process components of peer input, self-evaluation, and portfolio development. Portfolio development provides documentation of educator accomplishments for the organization. This approach to educator competencies serves as a strategy to position educators to meet healthcare demands and demonstrates leadership in the profession. The staff development educators at a large Midwestern health system have refined this process during the past 2 years, and their unique approach to educator competencies and professional review can benefit both individual educators and healthcare organizations now and in the future.

Education, Nursing, Continuing↗
PubMed2000

Education and training towards competency for cardiac rehabilitation nurses in the United Kingdom.

The development of cardiac rehabilitation in the UK, the evolution of the nursing role as a speciality, and the nursing role within the multidisciplinary team are briefly outlined. The potential impact of different professional backgrounds on the effectiveness of patient care is discussed, with particular reference to the differences between acute cardiac care and rehabilitation. Issues of professional competency are discussed, and core competencies for cardiac rehabilitation as specified by various professional associations are described. Current opportunities for preparation for practice in this field in the UK are outlined. Conclusions point towards the need for clearly specified competencies and an accredited programme of education and training to meet proposed standards for the management and rehabilitation of coronary heart disease (CHD) in the UK.

Clinical Competence↗
PubMed2005

Persistent family concerns in long-term care settings: meaning and management.

PURPOSE: The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives. DESIGN AND METHODS: Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes. RESULTS: Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families. IMPLICATIONS: The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.

Adult↗
PubMed2006

Genetics education in the nursing profession: literature review.

AIM: This paper reports a literature review exploring genetics education for nursing professionals. The aim was to contribute to the debate about the future direction of such education. BACKGROUND: Advances in genetics science and technology have profound implications for health care and the growing importance and relevance of genetics for everyday nursing practice is increasingly recognized. METHOD: A search was conducted in February 2005 using the CINAHL and Google Scholar databases and the keywords nurse, midwife, health visitor, education and genetics. Papers were included if they were published in English between 1994 and 2005 and included empirical data about genetics education in nursing. In addition, attempts were made to access the grey literature, with requests for information on research, for example, to members of the Association of Genetic Nurses and Counsellors and searches of relevant websites. FINDINGS: Agreement on the relevance of genetics for nursing practice is extensive. Empirical evidence of the learning needs of practitioners highlights widespread deficits in knowledge and skills, and low confidence levels. Provision of nursing education in genetics is patchy and insubstantial across a number of countries, further hampered by lack of strategic development. Significant progress has been made in the identification of learning outcomes for nurses. Research on the delivery of genetics education is limited, but the role of skills-based training, use of clinical scenarios, and importance of assessment have all been identified as factors that can promote learning. CONCLUSION: Whilst areas of good performance were revealed, many studies identified gaps in professional competence and/or education. New initiatives are underway to support genetics education and its integration into professional practice, but further research is needed on the most effective forms of educational delivery, and an international collaborative approach to this should be considered.

Clinical Competence↗
PubMedDate not supplied

RN students' ratings and opinions related to the importance of certain clinical teacher behaviors.

Clinical teachers make a necessary and valuable contribution to clinical nursing courses with non-RN learners. This contribution is often not considered necessary in degree nursing programs with an RN student population. This study describes the perceptions of RN students and the importance they attach to certain clinical teacher behaviors. Fifty-six participants in a distance education baccalaureate nursing program completed a questionnaire, including a rating scale and open-ended questions. Based on the mean values, items were ranked in importance. Sample quotes were provided to elaborate on the highest and lowest-ranked items. Participants rated the four categories in descending order of importance: Evaluation, Professional Competence, Interpersonal Relationships, and Teaching Ability. The top items gave the profile of a teacher who is approachable, fair, open, honest, and who creates mutual respect. The findings support a clinical teacher for RN learners. The data also reflect similarities and differences with findings of studies with non-RN student participants. The findings of this study provide information, not available in the literature, regarding clinical teacher behaviors of significance to RN students.

Adult↗
PubMed2002

An action research project to evaluate the clinical practice facilitator role for junior nurses in an acute hospital setting.

It has been well documented that newly qualified nurses require support in developing confidence and professional competence. Although preceptorship models have gone some way in addressing this need, innovative and flexible models of facilitation and development are also required to respond to local demands. In the project reported here a number of supernumerary clinical practice facilitators (CPFs) were appointed to support both healthcare assistants and newly qualified registered nurses to enhance their competence and clinical skills. It was anticipated that they might also encourage awareness of other professional issues, such as evidence-based practice, as well as having a positive influence on the clinical learning environment and staff morale. This article describes how an action research approach was used to establish the CPF role in a variety of clinical areas across a large inner-city National Health Service Trust. It outlines the evaluation undertaken and the further contribution that such roles could provide.

Clinical Competence↗
PubMed1999

[Institutional handling of sexual abuse: experiences, evaluations, and desires of nonabusing parents of sexually abused children].

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

Adolescent↗
PubMed1991

Unionization: boon or bane?

Again, you only get a union if you deserve one, and you get the union you deserve. Collective bargaining in a professional milieu indicates an unhealthy environment, is incredibly cumbersome, and--perhaps most concerning--is phenomenally expensive, as measured in terms of fiscal resources, human resources, and energies. Moreover, time lost in collective bargaining reduces institutional flexibility and responsiveness. But more important, the collective bargaining process imposes an additional administrative layer and extra legal and contract implementation fees and adds mistrust into a professional setting that requires total trust along with professional competence. Thus, resources are diverted that could be better devoted to excellent patient care and professional salaries. The process of maintaining a union-free environment is well worth the effort. In the end, administration, nursing personnel, and, most important, patient care are positively impacted by an open, flexible environment. In short, within a healthy union-free environment, everyone wins!

Humans↗
PubMed2004

Relationship between malpractice claims and medical care quality.

The purpose of this paper was to examine the relationship between medical malpractice claims and medical care quality in Taiwan. The Delphi technique with an expert panel was used to determine the relationship between malpractice and medical quality. A total of 371 medical malpractice claims were analyzed. Main measures included the rate and strength of malpractice cases associated with quality and the identification of the quality factors influencing the occurrence of malpractice. Results showed that malpractice claims were associated with internal medicine cases, surgery cases, pediatric cases, obstetricc and gynecological cases, physicians' professional competence, nonacceptable outcomes, complications, and poor communication. Concludes that medical malpractice cases could be avoided by increasing physicians' professional knowledge, practical skills, and communication.

Clinical Competence↗
PubMed2003

[Health care access and receptivity to users in a unit in Porto Alegre, Rio Grande do Sul, Brazil].

This study focuses on users' views of factors influencing quality of care at a health care unit in the city of Porto Alegre, relating to access and receptivity. The data were collected using a semi-structured interview and participatory observation and treated using thematic analysis. The results compare ease and difficulties in geographic, economic, and functional access. Organization of services and professional competency were determinant factors in ease of reception, leading to user satisfaction. Poor reception and unsatisfactory professional performance were identified as difficulties. The study concluded that there is a need to increase the professional staff, train them in receiving users, implement a complementary modality for dental care, open the facility earlier for scheduling appointments, and prioritize care for residents of the catchment area.

Brazil↗
PubMed1993

[Work satisfaction of psychiatric nurses].

A demanding clientele, the social stigma of working in a psychiatric institution and a lack of professional support are factors that discourage psychiatric nurses from staying in their profession. Because of this, there is the potential risk of decreasing nursing's contribution to psychiatric treatment and rehabilitation--thereby compromising the quality of health care. In light of this, a research study was carried out to look at job satisfaction of psychiatric nurses in four Quebec hospitals. The study aimed to identify the direct repercussions on nurses caring for hospitalized psychiatric patients. The results of the study indicate that both staff nurses and nurse managers alike suffer a marked sense of job dissatisfaction. The key element is the apparent prioritization of administrative functions above clinical functions. The study recommended that necessary adjustments be made to create a favorable milieu that stimulates rehabilitation. The authors propose to enhance professional competence by making less bureaucratic demands on nurses; increasing the value of direct patient care; increasing professional supervision; providing more inservice education, and diminishing the hierarchial structure--thereby favoring clinical nursing practice.

Data Collection↗
PubMed2006

Evidence-based medicine: discrepancy between perceived competence and actual performance among graduating medical students.

Since at the time of graduation from medical school physicians are expected to demonstrate adequate professional competence including mastery of critical appraisal skills, we conducted a preliminary, cross-sectional, web-based study to examine the extent to which fourth year medical students in the US are competent in core areas of evidence-based medicine (EBM). Using self-assessment instruments, subjects (n = 150) were asked to demonstrate their ability to understand the practical meaning of key methodological and data analysis constructs as they relate to patient care, to rate their perceived competence in core areas of EBM and to disclose their attitudes toward critical appraisal of the literature and EBM. The mean score in our cohort was 55% suggesting that students may have knowledge gaps that interfere with their ability to critically appraise the medical literature. There was an apparent chasm between subjects' perceived competence and their actual performance on the assessment instrument. These findings, if corroborated in larger studies, (1) suggest that better education in EBM is needed so as to avoid the possibility that patient care may inadvertently be jeopardized; and (2) cast doubt on the use of self-assessed knowledge as a proxy for actual skills with respect to EBM and medical decision-making.

Attitude↗
PubMed2004

The rules of the game: interprofessional collaboration on the intensive care unit team.

BACKGROUND: The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. METHODS: Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. RESULTS: Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. CONCLUSION: Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team.

Adult↗
PubMed2004

Meeting the Accreditation Council for Graduate Medical Education competencies using established residency training program assessment tools.

BACKGROUND: Most existing residency evaluation tools were constructed to evaluate the Accreditation Council for Graduate Medical Education (ACGME) competencies. METHODS: Before ACGME's six competency based assessment requirements for resident performance were developed, we created a residency evaluation tool with 5 domains important to successful surgical resident performance. Reliability was determined after 6 months of use. Factor analysis assessed whether the evaluation tool was a construct-valid measure of the ACGME competencies. RESULTS: Three hundred forty-three evaluations for 36 surgical residents were tested. The original evaluation tool was highly reliable with an overall reliability of 0.97. Factor analysis defined 4 new combinations of questions analogous to 4 of the ACGME competencies: professionalism (reliability 0.95), patient care (reliability 0.93), medical knowledge (reliability 0.92), and communication (reliability 0.92). The new competency clusters were correlated with each other to a moderate degree. CONCLUSIONS: Our locally developed tool demonstrated high reliability and construct validity for 4 of 6 ACGME competencies. The correlation between factors suggests overlap between competencies.

Accreditation↗
PubMed2006

Will opposites attract? Similarities and differences in students' perceptions of the stereotype profiles of other health and social care professional groups.

The extent to which health and social care (HSC) students hold stereotypical views of other HSC professional groups is of great potential importance to team working in health care. This paper explores students' perceptions of different HSC professional groups at the beginning of their university programmes. Findings are presented from an analysis of baseline data collected as part of the New Generation Project longitudinal cohort study which is assessing the impact of interprofessional education over time on a range of variables including stereotyping. Questionnaires were administered to a cohort of over 1200 students from 10 different HSC professional groups entering their first year of university. Stereotypes were measured using a tool adapted from Barnes et al. (2000) designed to elicit stereotype ratings on a range of nine characteristics. The findings confirm that students arrive at university with an established and consistent set of stereotypes about other health and social care professional groups. Stereotypical profiles were compiled for each professional group indicating the distinctive characteristics of the groups as well as the similarities and differences between groups.Midwives, social workers and nurses were rated most highly on interpersonal skills and on being a team player whilst doctors were rated most highly on academic ability. Doctors, midwives and social workers were perceived as having the strongest leadership role, whilst doctors were also rated most highly on decision making. All professions were rated highly on confidence and professional competence and, with the exception of social workers, on practical skills. A comparison of profiles for each professional group reveals that, for example, pharmacists and doctors were perceived as having very similar characteristics as were social workers, midwives and nurses. However, the profiles of nurses and doctors were perceived to be very different. The implications of these similarities and differences are discussed in terms of their potential impact on interprofessional interactions, role boundaries and team working.

Health Personnel↗