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Origins and benefits of dental hygiene practice in Europe.

Origins and benefits of the practice of dental hygiene were investigated in order to provide guidelines to countries where initiatives are being taken to introduce the profession. In Europe, so far the profession has been introduced in the Czech Republic, Denmark, Great Britain, Finland, Italy, Latvia, Lithuania, the Netherlands, Norway, Portugal, Sweden, Switzerland and Spain. Programmes in Ireland, Poland, and Romania are not presented in this article. Information for this study was obtained using questionnaires and followed up by e-mail correspondence with additional experts, supporting studies and reference literature. All experts consulted are involved in the professional and educational organisation of dental hygiene in their countries. Results show that dentists and dental hygienists who had been inspired by the delivery of preventive care in the US, initiated the European dental hygiene movement. In some countries, opposition of organised dentistry had to be overcome. In countries where the population has limited access to qualified dental hygiene care, such as in Austria, Belgium, Germany and France, a high prevalence of untreated periodontal disease has been reported. There, the lucrative practice of delegating dental hygiene tasks to dental assistants without qualifying education has slowed efforts to implement the profession and resulted in negative health and vocational outcomes. This leads to the conclusion that an implementation of legislation governing the practice and the educational process of dental hygiene in the EU and beyond would contribute to an equitable standard of health care as well as to equal opportunities in education and employment.

Dental Care↗

The effects of gender disparities on dental hygiene education and practice in Europe.

In Europe, over 96.5% of dental hygienists are women. The objective of this report was to examine the impact of gender role stereotyping on the image of the dental hygiene profession and on disparities in educational attainment and work regulations within Europe. Data pertaining to regulated or non-regulated dental hygiene practice in 22 European countries were analysed according to possible gender impact on access to education and on the structure of the delivery of care. It was examined whether there is a correlation between national differences found in the dental hygiene profession and gender related disparities found in other work-related areas. Results show that the gender bias in the dental hygiene profession has an effect on equal access to education, and on equal occupational opportunities for dental hygienists within the European Union (EU) and beyond. In northern Europe, higher educational attainment in the field of dental hygiene, more extensive professional responsibilities and greater opportunities for self-employment in autonomous practice tend to correlate with greater equality in the work force. In eastern Europe, lower educational and professional opportunities in dental hygiene correlate with greater gender disparities found in other work-related areas. In some western European countries, the profession has not been implemented because of the political impact of organised dentistry, which expects financial loss from autonomous dental hygiene practice. In order to fulfil mandates of the EU, initiatives must be taken to remove the gender bias in the delivery of preventive care and to promote equal access to educational attainment and to professional development in the whole of Europe for those who choose to do so.

Career Mobility↗

Conceptions of authority within contemporary social work practice in managed mental health care organizations.

This article examines how social workers may use their authority to create managed mental health care organizations that support the principles and values of professional social work practice. By exploring research and theoretical contributions from a multidisciplinary perspective, the author suggests ways that social workers may incorporate empowerment strategies into their organizational practices to create more socially responsible and humane mental health organizations.

Humanism↗

A national survey of dental technicians: career development, professional status and job satisfaction.

OBJECTIVE: To investigate the career development, perception of status within the dental team, and level of job satisfaction of dental technicians in the United Kingdom. DESIGN: Cross-sectional postal questionnaire survey of 1,650 dental technicians registered with the Dental Technicians Association. Replies were received from 996 (60%). RESULTS: Eighty two per cent respondents had a qualification in dental technology and 21% also had an advanced level qualification. Almost two thirds of the respondents had undertaken no verifiable continuing professional development in the previous year. Only 27% of respondents expected to develop their career over the next five years. Less than 50% of the respondents felt adequately valued as individuals and as a professional group in the dental team. Job satisfaction was significantly related to age, attendance at one or more courses in the last year, working shorter hours, feeling valued in the dental team, and future career plans. CONCLUSIONS: Plans for the registration and role expansion of dental technicians provide opportunities for career development which have yet to be realised. The low levels of continuing professional development currently undertaken indicate the need for a review of the provision and funding of training at a strategic level. Whilst levels of job satisfaction are satisfactory, many dental technicians feel insufficiently valued in the dental team.

Attitude of Health Personnel↗

Moral and ethical dilemmas in critically ill newborns: a 20-year follow-up survey of Massachusetts pediatricians.

OBJECTIVE: To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates. STUDY DESIGN: A long-term follow-up survey of American Academy of Pediatrics Massachusetts membership, maintaining the 1987 instrument, was initiated. RESULTS: A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians' attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making. CONCLUSION: This study indicates stability and consensus in pediatricians' attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy.

Adult↗

Empowerment and care management: swimming against the tide.

This paper is concerned with the policy and practice of care management, that is, the system for assessing care needs and arranging services to meet them, developed under the legislative framework of National Health Service (NHS) and Community Care Act 1990. The paper takes as its starting point the contrast between the rhetoric of service user empowerment in professional training, particularly of social workers, with the disempowering realities that arise in practice. It examines some of the sources of this conflict, looking in particular at contradictions inherent within the development of care management as a policy, conflicts contained within the legislation and associated guidance and contradictions evident at the level of practice. It argues that organizational processes and procedures consequent upon care management as it is evolving in practice are decreasing the possibilities for empowering practice and reinforcing the power of care managers at the expense of service users. It suggests that the power of the care manager is based on increased administrative and managerial responsibility, counterbalanced by diminishing professional autonomy and discretion. Some possibilities for future development if empowerment is to survive as a meaningful concept within care management are outlined. The paper concludes that there are serious limitations on the scope for empowerment within care management and that the real hope for empowerment lies in the encouragement and support of user-led initiatives in service planning, evaluation and provision.

Journal Article↗

The concept of the specialist community nurse.

This paper seeks to stimulate discussion on the concept of the specialist community nurse and to investigate the effectiveness or limitations of the role. The main arguments presented are that, although the role of the specialist community nurse will be exposed to constraints from both the medical and managerial culture and tensions within the profession regarding perceptions of professionalization may militate against progress towards specialist status, the concept is a worthy goal and can be underpinned by phenomenological concepts of professionalism.

Attitude of Health Personnel↗

A phenomenological investigation into the role of the clinical nurse specialist.

This research study adopts a phenomenological approach to investigate how a group of clinical nurse specialists think and experience their role. It reviews the literature on the clinical nurse specialist from 1943, when Frances Reiter first coined the phrase "nurse clinician', to the present time, when individuals are committed to a range of initiatives aimed at improving the quality of the British National Health Service and patient care. The study investigates and analyses their views and conveys the personal meaning of clinical nurse specialists' "lived experience' in the role. Findings of the study suggest that clinical nurse specialists are experienced practitioners who strive to be in positions in which they influence patient care and utilize advanced knowledge, expertise and leadership skills in a multidisciplinary environment. The literature proposes that for the role to be recognized and accepted individuals need to be educated at an advanced level, demonstrate practice based in research and have a firm base as a specialist in nursing. The findings clearly suggest that while the role of the clinical nurse specialist can be influenced in a positive manner by the organization and guided by the individual, it is important to acknowledge that the role is in a transitional phase. Finally, the research suggests the importance of establishing a clear role definition in a creative and supportive environment allowing for autonomy, professional growth and the development of individuals as clinically competent nurse specialists.

Adult↗

Professionalization of nursing: development, difficulties and solutions.

This paper re-examines the claim of the profession of nursing to professional status. The criteria for professional recognition are used to determine whether nursing is indeed a profession, and the author could substantiate the professional status of nursing in certain countries. The problems encountered in the process of professionalization were explored and, in conclusion, a few solutions to the problems encountered were offered from the author's own paradigm.

Education, Nursing↗

The use of a customized training needs analysis tool for nurse practitioner development.

The role and professional boundaries of the nurse practitioner (NP) in the UK have not yet been unequivocally defined. This confusion has served to limit the expansion of the NP in both the acute and primary care sectors, despite a mounting body of evidence that attests to their value. This lack of coherence has necessarily impacted upon the educational provision currently available for NP development, with a range of courses of variable nature and standards being provided. The lack of nationally agreed educational criteria and the importance of taking account of local needs, together suggest that a formal training needs analysis might be valuable in systematizing and unifying the present position. Such a survey would have the function of informing both the definition and regional training requirements of NPs, provided the data were obtained through the use of a reliable assessment instrument. To this end a total population survey of all nurses employed in general practice within a large regional health authority was undertaken, using a psychometrically valid and reliable training needs analysis questionnaire. The information obtained provided a preliminary definition of the NP role and a clear index of the content and level of prospective educational provision. In addition, the survey offered an estimate of the numbers of potential participants on NP courses, by FHSA and preferred educational institution. In this way, the use of a scientifically constructed and specifically customized training needs analysis tool may have the potential to inform precise educational commissioning, thereby rationalizing resources and enhancing the quality of both training and ultimate care provision.

Adult↗

Back to the bedpans: the debates over preregistration nursing education in England.

AIMS OF THE PAPER: This paper aims to examine the recent debates in both the general and professional press over the future of preregistration education in England, in the light of the sociological literature on the professions, and the nature of nursing knowledge. The literature on the Project 2000 reforms, although by now well worn, will also be discussed briefly. BACKGROUND/RATIONALE: The bulk of nursing education in England moved into higher education in the 1990s. Unlike other higher education in England, it is not funded by the Department for Education and Employment, but commissioned by the National Health Service (NHS), to which it is expected to be highly responsive. DESIGN/METHODS: This paper is based on a brief literature survey, plus policy documents and media reports. FINDINGS/CONCLUSION: It will be argued that the process of professionalization is not a straightforward one, and has its potential for reversals of fortune, and that nursing occupies a marginal place in higher education in England.

Education, Nursing, Baccalaureate↗

Creating a framework for clinical nursing practice to advance in the West Midlands region.

The West Midlands Regional Health Authority identified a lack of opportunities for nurses to develop advanced clinical practice through a recognized programme at Postgraduate diploma/Masters degree level. Education for clinical practice must be equally grounded in theory and practice. Advanced clinical practice requires more than just skills acquisition, it has a much wider remit incorporating elements of clinical expertise and higher level decision making, research awareness, teaching and role modelling, informing policy making and leading in the provision of patient care within individual Trusts. This initiative has encouraged universities, trusts and provider units to work together to identify and prepare students and staff for their changes in role, and to review existing boundaries for practice which will enable new approaches to team work and the provision of holistic patient care.

Career Mobility↗

Nursing in the community--impact of context on the practice agenda.

The agenda for health care detailed in recent policy statements has a strong community and primary health care focus. The impact of the community, and specifically the patient's home, as a location for practising and learning to practise nursing, is an issue which has received limited exploration. Recent research suggests that the context influences the practice agenda in a number of ways. Highlighting the impact of working in the community context is timely in order that education providers, policy makers and managers are fully aware of the impact of moving care 'closer to home'.

Adaptation, Psychological↗

Interprofessional relations: case studies of working relationships between Registered Nurses and general practitioners in rural Australia.

Interprofessional working relationships of nurses and doctors have been discussed in the literature but are less frequently the subject of research. A review of international research on nurse-doctor professional relationships conducted over 30 years (1966-99) shows that the relationship is of interest predominantly to nurses. From a series of interviews with nurses and doctors, as part of a case study of four rural health services, harmonious working relationships between nurses and doctors were examined. Further analysis reveals many aspects of nurse-doctor relationships that are traditional and common across many contexts. There are, however, some aspects that are specific to the rural nature of the working context and relate well to contemporary advances in nursing knowledge and confidence.

Attitude of Health Personnel↗