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PubMed2006

Reviewing the potential for critical appraisal training to cater for professional practice.

Critical appraisal training aims to encourage evidence-based decision-making and ultimately improve health outcomes for patients. Such training must arguably be participatory, multi-disciplinary and problem-based if it is to equip health professionals for problem solving within a modern health service. To explore whether critical appraisal training has the potential to achieve its aims we systematically reviewed reports of critical appraisal training. We identified 58 critical appraisal training programmes, identified through two recently published systematic reviews. Of these, only 15 were identified as multi-disciplinary. Similarly, whilst many of the 58 interventions included some level of participation this was often limited in scope. Around a third of the identified training programmes were problem-based. Only a very small number of the 58 interventions might be described as facilitating cross-disciplinary participatory working. These were by no means all problem-based. We recommend that providers of medical training consider how they might encourage the use of problem-based, mixed, participatory training to encourage evidence-based patient-centered care. More research is also needed to understand how mixed and participatory problem-based learning might influence working practice.

Decision Making↗
PubMed2004

[Professional practice and gender in primary care].

In this paper we analyse the relations between sex of patients and professionals, social class and health insurance scheme, with the type of medical practice and level of satisfaction with care received by the patients. Following recent literature it can be said that medical practices based on the psychosocial paradigm obtain better results in terms of health and satisfaction. In the primary health care sector, there is evidence that women doctors follow a communication pattern grounded on the psychosocial model. In parallel, women patients frequently show their preferences for women doctors when their complaints are related to psychosocial issues. Sex and social class of patients and professionals are not consistently related to the level of satisfaction reached, although to date there is still a lack of research to support this point. It is necessary to incorporate in our research these analytical categories. Not only in data collection but also in the analysis. It would not be possible to fully understand the complexity of clinical activities without considering that gender and class shape our individual and social identity and therefore condition the diverse forms of interaction in patient-doctor relations.

Female↗
PubMed1994

Professional practice patterns of U.S. psychiatrists.

OBJECTIVE: The authors develop a classification of psychiatric practice based on primary and secondary work settings. METHOD: Data from the 1988-1989 APA Professional Activities Survey were used to characterize seven practice groups: public psychiatrists, public psychiatrists with private secondary work settings, private psychiatric/general hospital psychiatrists, private office practice psychiatrists, private office practice psychiatrists with secondary private psychiatric/general hospital work settings, private office practice psychiatrists with secondary settings other than private hospitals, and psychiatrists in private organized outpatient settings. Psychiatrists primarily in government administrative agencies, medical schools, or nursing homes were among those excluded. Usable data were available from 16,135 psychiatrists (82.8% of the target respondents). RESULTS: The largest groups were private psychiatric/general hospital psychiatrists (19.6%), private office practice psychiatrists with secondary settings other than private hospitals (18.9%), and private office practice psychiatrists with secondary private psychiatric/general hospital work settings (17.4%), followed by public psychiatrists with private secondary work settings (14.5%), private office practice psychiatrists (11.7%), public psychiatrists (11.4%), and psychiatrists in private organized outpatient settings (6.6%). During a typical week, the practice groups varied in the average proportion of their outpatients who received assessments, therapy and medication, therapy and no medication, and medication management. The groups also varied in the mean number of patients they treated each month with affective disorders, schizophrenia, anxiety disorders, and other disorders. CONCLUSIONS: Only about one in 10 clinical psychiatrists is engaged exclusively in office-based private practice, and approximately half of the outpatients treated by the average psychiatrist receive medication. Work setting appears to exert a powerful influence over whom psychiatrists treat and what services they provide. Because a majority of psychiatrists work in more than one setting, most psychiatrists serve a broad range of patients and provide a variety of treatments.

Age Factors↗
PubMed1999

Managing the unmanageable: risk assessment and risk management in contemporary professional practice.

AIM: This study sets out to investigate the theories and practices of risk assessment and management in the context of contemporary mental health practice. BACKGROUND: Although risk assessment and management policies are well established for those working in the field of community mental health care, there are noticeable anomalies and regional variations, in the criteria, procedures and decision-making strategies used. METHODS: Focus group taped interviews were conducted with over 100 mental health professionals in one NHS Trust. These were compared with an extensive literature review on the topic. FINDINGS: The main theme to emerge was lack of resources, which included time and staff in the context of a changing and increasing workload. Another important theme was the lack of access to centralized and accurate information about mental health service provision. CONCLUSION: It is essential that professionals, clients, their families and the public feel confident in professional judgements and practices to avoid a 'back to the asylum' lobby, for the care and treatment of seriously mentally ill individuals.

Attitude of Health Personnel↗
PubMed1996

Money: personal issues affect professional practice.

Money is a taboo subject. Clinicians have much ambivalence about money, both personally and professionally, and are often more comfortable discussing clients' issues around money than examining their own. As a result, how clinicians handle money with clients is often determined by the clinicians' personal feelings about money; however, they do not explore the meaning and origin of these feelings or determine how these feelings affect their practices. This article explores the conscious and unconscious issues surrounding money, case examples of therapists' dilemmas in handling money, and implications for practice.

Attitude of Health Personnel↗
PubMed1999

[Professional practice and theoretical orientation of women and men psychiatrists].

RESEARCH QUESTIONS: Differences between male and female psychiatrists in their careers, professional and clinical activities, and clinical orientations, in general and in contrasted settings for the practice of psychiatry. METHODS: Survey by mailed questionnaire to psychiatrists working in private practice or in institutions. RESULTS: Male and female psychiatrists share some similar characteristics (age, many interests, etc.). However, female psychiatrists differ from male psychiatrists in numerous respects: more frequently engaged in private practice, shorter work-weeks, less diversification of clinical activities, more frequent reference to a psychological model. In women occupying hierarchic positions, these differences disappear, whilst they are maintained in private practice for those using the psychological model. The differences can be interpreted in part in terms of gender-specific socialization, but their origin could mainly arise from the existence of different systems of gender-based constraints in the management of professional and personal, or family, spheres. CONCLUSIONS: Adjusting the training period and working conditions in institutions could facilitate career diversification for both male and female psychiatrists.

Adult↗
PubMed1999

Problematic or practical? Professional body occupational health guidelines.

This paper focuses upon conflict between professional and managerial values in an occupational health setting. Findings are presented which suggest that the guidelines issued by UK occupational health professional bodies (describing the duties and responsibilities of occupational health professionals), have been perceived by professionals as being impractical because they tend to focus on the theoretical role of the professional at the expense of the reality of the experienced role. The paper concludes that the problem does not actually lie with the guidelines, but with the perception of the guidelines. It is suggested that this problem can be addressed by empowering occupational health professionals to interpret and tailor the guidelines to suit their particular working environment. In addition, encouraging occupational health professionals to pro-actively market their role, will result in awareness raising amongst the managers for whom they work who often have inappropriate expectations of the occupational health professionals.

Attitude of Health Personnel↗
PubMed2001

A model-based analysis of professional practices in suicide prevention.

AIMS: The purpose of this study was to investigate what suicide prevention means in terms of practical interventions. Another purpose was to assess the feasibility of a previously developed theoretical model for analysing suicide prevention (1-3). METHODS: The data consisted of plans for action provided by professionals from five fields (n = 173) (psychologists [n = 41], clergy [n=37], nurses [n=34], social workers [n=32], and physicians [n=29]) as responses to an inquiry within the National Suicide Prevention Project in Finland. The plans were operationally described and theoretically interpreted using the model. RESULTS: The analysis indicated that practice patterns were more or less similar irrespective of the focus of suicide prevention. Neither did clear sectoral or professional profiles of practice appear. Clinical topics, individually focused interventions and curative strategies constituted the main approach. Interventions focused mainly on risk factors, the priorities being life crises, acute risk of suicide, coping of survivors, and a suicide attempt. The bulk of the strategies were aimed at developing professional interventions and skills. CONCLUSIONS: The model proved to be a feasible tool for differentiating and theoretically interpreting suicide-prevention approaches. The paradigm adopted by the sectors was versatile and comprehensive: the activities were multifocused, all aims of prevention and locations of intervention were included, and a common set of interventions--a "multimethod approach"--was applied. The adoption of the idea of risk as well as of protective factors can be interpreted as reflecting a process theory of suicide development.

Attitude of Health Personnel↗
PubMedDate not supplied

[Competency-based training for nurses: alternation between theory and practice, professionalization, and complex thought].

This study aims at eliciting a reflection on a competency-based education for nurses by understanding alternation as a necessary condition for an articulation between theory and practice, as well as at discussing some issues related to competency-based education and professionalization. We have searched to widen up our understanding of what competencies are and of an articulation between theory and practice. We have discussed the notion of professionalization and some ways of working on competencies by following different approaches and distinctive objectives, and we have reached an understanding about competencies, how to act in some situations, what leads to educational commitment, and what calls for contextualized and complex thought. Finally, we suggest alternation as a device for professional nurse education.

Brazil↗
PubMed2006

Utilizing research in professional practice.

A review of the rehabilitation, disability studies, and allied health literature suggests the presence of numerous factors that impede the utilization of research by practitioners. The purpose of this article is to describe these factors and offer potential solutions that could enable rehabilitation professionals to integrate research findings into their practice. Specifically, the authors recommend strategies to (a) contextualize research throughout pre-service curricula, (b) establish researcher-stakeholder partnerships, (c) increase the accessibility of research to practitioners, and (d) establish professional and peer support for implementing research in field practice.

Evidence-Based Medicine↗
PubMed2000

Fit for purpose: the relevance of Masters preparation for the professional practice of nursing. A 10-year follow-up study of postgraduate nursing courses in the University of Edinburgh.

Continuing education is now recognized as essential if nursing is to develop as a profession. United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) consultations are currently seeking to establish appropriate preparation for a 'higher level of practice' in the United Kingdom. The relevance of Masters level education to developing professional roles merits examination. To this end the results of a 10-year follow-up study of graduates from the Masters programme at the University of Edinburgh are reported. The sample was the entire cohorts of nurses who graduated with a Masters degree in the academic sessions from 1986 to 1996. A postal questionnaire was designed consisting of mainly closed questions to facilitate coding and analysis but also including some open questions to allow for more qualitative data to be elicited. The findings indicated clearly that the possession of an MSc degree opened up job opportunities and where promotion was not identified, the process of study at a higher level was still perceived as relevant to the work environment. This applied as much to the context of clinical practice as to that of management, education or research. The perceived enhancement of clinical practice from a generic Masters programme was considered a significant finding. Also emerging from the data was an associated sense of personal satisfaction and achievement that related to the acquisition of academic skills and the ultimate reward of Masters status. The concept of personal growth, however, emerged as a distinct entity from that of satisfaction and achievement, relating specifically to the concept of intellectual sharing, the broadening of perspectives and the development of advanced powers of reasoning.

Adult↗