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PubMed2000

Education purchasers' views of nursing as an all graduate profession.

The issue of whether nursing should be an all graduate profession is one of the most important questions currently facing the nursing profession. The literature indicates that there are differing views on this issue but that there is little research on the performance of graduate nurses in practice. Purchasers of education have played an increasingly significant part in nurse education since the advent of Working Paper 10 (WP10) (DOH 1989). Purchasers hold the resources for nurse education and can now decide whether to commission for diploma or degree level student nurses, therefore they will have a major influence on the outcome of this debate. The aim of this paper is to discuss the views of the purchasers of education about this issue. A purposeful sample of 34 key stakeholders involved in commissioning and contracting for education was selected and asked for their views on whether nursing will or should become an all graduate profession. Key areas that were focused upon were the problems that might emerge from an all graduate nursing profession, the advantages of graduate level nurses within the NHS, what graduateness is and what it might mean for nursing. The results indicated that purchasers were convinced of the importance of nursing graduates but only as part of the workforce. Alternative ways of increasing the percentage of graduates rather than in pre-registration education were preferred with pathways of education linked to continuing professional development. Significantly, the participants were able to articulate the attributes of a degree level education for clinical practice including leadership, assertiveness, and reflective, critical skills.

Delivery of Health Care↗
PubMed2001

A case study in using VET qualifications to rejuvenate learning and change in a complex and disparate rural area health service.

The Boggabri Health Service is typical of many rural and remote public health facilities. Twenty-four staff, only a third of whom work full-time, service the needs of a population of 1601. Change from a focus on acute care to a model of wellness through redevelopment as a Multi Purpose Service is providing staff with a unique opportunity for continuing professional development, particularly in regard to aged care standards, their core business. Use of flexible delivery and self-directed learning has transformed this facility from ignorance about the value of undertaking vocational education and training (VET) to 80% enrollment in certificate and diploma qualifications, ever a six month period from January 2001. Some twenty-five facilities comprise the New England Area Health Service, of which Boggabri is but one. The learning innovation demonstrated at Boggabri is being duplicated across other facilities. Interest in VET qualifications from staff at all levels is a remarkable renaissance.

Catchment Area, Health↗
PubMed2006

A population-based study of Swedish gynecologists' experiences of working in abortion care.

BACKGROUND: Legal abortion is a recurrent part of gynecologists' work. The aim of the study was to describe Swedish gynecologists' clinical and emotional experiences when working in abortion care. Further aims were to elucidate their perception of women's motives for having an abortion as well as looking for possible demographic and gender differences. METHODS: A questionnaire comprising both structured and semi-structured questions was sent to a random sample of 269 Swedish gynecologists. The response rate was 85%. RESULTS: The female gynecologists were younger (27-59 years) and more numerous than the males (33-66 years). Almost all believed that gynecologists should be involved in abortion care, and half were opposed to the privilege of refusing to work with termination of pregnancy. The gynecologists supported the shift from surgical to medical abortions but not to their being managed in primary healthcare. A few gynecologists (n = 42) had considered changing their job because of termination of pregnancy being part of their work. Misgivings occurred sometimes in connection with surgical and late abortions (n = 60 and n = 108 respectively). Few gynecologists (n = 33) had felt inadequate when encountering abortion patients and more than half thought that working with termination of pregnancy was a positive experience. The gynecologists believed that continuing professional development and ongoing guidance of termination of pregnancy matters were important. CONCLUSIONS: In general, Swedish gynecologists have no doubts about taking part in and performing termination of pregnancy. Their clinical and emotional experience, as expressed in this study, as well as their perception of women's motives for abortions, indicate that they have gained deep insights and developed their professionalism in their work with termination of pregnancy.

Abortion, Induced↗
PubMed2001

Referrals and relationships: in-practice referrals meetings in a general practice.

BACKGROUND: GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. OBJECTIVES: This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. METHODS: The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. RESULTS: Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted the complexity of decision making in general practice and the likely impact of historical background and a variety of internal and external pressures on this self-directive educational intervention. The practice members described the individual and group learning needs identified as a result of the meetings. CONCLUSION: The findings of this study raise important questions for developing practice-based learning. The outcomes of self-directive interventions in practices will be influenced by internal and external events both past and present. Such outcomes may be qualitative and difficult to measure. They are likely to differ from outcomes seen when interventions are applied to groups of doctors who are not all members of the same practice.

Family Practice↗
PubMed2005

Nurse practitioner and practice nurses' use of research information in clinical decision making: findings from an exploratory study.

BACKGROUND: There is a lack of evidence regarding the kinds of decisions made by primary care nurses and the information sources they use in clinical decision making. OBJECTIVE: To describe the decisions made by nurses working in general practice and the sources of information they use to underpin those decisions. METHODS: Qualitative methods (interviews, observation, documentary analysis) were used to collect data on the clinical decision making and information seeking behaviour of a purposive sample of 29 practice nurses and four nurse practitioners from general practices in the North of England. Data were collected November 2001-September 2002. RESULTS: A seven-fold typology captured the types of decisions the nurses made on a daily basis concerning assessment, diagnosis, intervention, referral, communication, service delivery and organization (SDO) and information seeking. Faced with clinical uncertainty, the majority of the nurses in the study relied on personal experience, or obtained advice and information from GP or other colleagues. These 'human sources' of information were overwhelmingly preferred to text or on-line resources. Despite encounters with evidence-based resources through continuing professional development, the nurses rarely used them to seek answers to routine clinical questions. CONCLUSION: The decisions of the nurses in the study were mainly concerned with undifferentiated diagnosis and treatment, in the context of acute conditions and chronic disease management. 'Human sources' of information were preferred to any other; however, we do not know whether information obtained from colleagues is based on research.

Adult↗
PubMed2002

Good medical practice: guidance for occupational physicians.

Following a catalogue of serious, highly publicized medical misdemeanours, the General Medical Council (GMC) has introduced plans for a new system of medical licensing in the UK called 'revalidation'. Under this, the onus will fall on individual doctors, including occupational physicians, to demonstrate their continuing fitness to practice. Doctors will need to show that they meet basic minimum standards in terms of the care they provide, their own continuing professional development, and other aspects of professional life like probity and ethical behaviour. As part of the process, the Faculty of Occupational Medicine, Royal College of Physicians, has produced its own guidance on good medical practice for occupational physicians, following an extensive consultation exercise. This paper summarizes the background to the initiative, the development process and the standards that have been recommended to aid professional accountability.

Clinical Competence↗
PubMed2005

The Occupational Medicine agenda: routes and standards of specialization in Occupational Medicine in Europe.

BACKGROUND: This paper reports on the nature of specialist training in occupational medicine (OM) in Europe from a survey of representatives from the Occupational Medicine section of the European Union of Medical Specialists/Union Européenne des Médecins Spécialistes (UEMS). AIMS: To analyse current differences existing in the education and training requirements to become a specialist in OM in UEMS countries. METHODS: Cross-sectional survey of representatives from 14 European countries. RESULTS: While undergraduate training duration varied slightly, there is marked variation in postgraduate training for OM in UEMS countries. The countries surveyed outlined concerns for the funding of training, continuing professional development, research requirements and recruitment to the specialty. CONCLUSION: There is a marked variation in postgraduate training in OM throughout UEMS countries. The variation between postgraduate training programmes is not consistent with UEMS charter requirements and because of national regulation purposes presents a barrier to the movement of migrant professionals within Europe. This study serves as a focus for further research into training routes and standards of specialization in OM in Europe.

Cross-Cultural Comparison↗
PubMed1997

Who contributes to the public health function?

BACKGROUND: This paper describes the current nature and distribution of staff making an active contribution to the public health function in Health Authorities in England, so as to assess the extent to which the public health function is truly multidisciplinary and to begin to consider the National Health Service public health capability. METHODS: A pre-piloted questionnaire was administered by Regional Directors of Public Health (RDsPH) to their respective District Directors of Public Health (DDsPH) in all Health Authorities in England over the period June 1995-April 1996. The questionnaire asked for details of all staff in Health Authorities contributing to the public health function as defined by the DDsPH. This provided distributions of: Public Health Physicians; Consultants in Dental Public Health (CsDPH); Trainees in Public Health Medicine (PHM); Epidemiologists; Research Officers; Nurses; Medical Advisers; Pharmacists; Directors of Health Promotion; Others (job titles specific to public health) in Health Authorities in England. RESULTS: Staff contributing to the public health function were distributed as follows: Public Health Physicians (32 per cent); Research or Information Officers and Epidemiologists (16 per cent); Trainees in Public Health Medicine (16 per cent); Nurses (8 per cent); Pharmacists (6 per cent); Medical Advisers (5 per cent); Directors of Health Promotion (4 per cent); Consultants in Dental Public Health (3 per cent); Others (job titles specific to public health) (11 per cent). CONCLUSION: The public health function is multidisciplinary, but the skill mix within Health Authorities is variable. The contribution of all disciplines to Health Authority public health functions needs recognition, not least in the provision of training, accreditation schemes and continuing professional development for all staff so as to secure an effective public health function at local levels to deliver the health agenda.

Clinical Competence↗
PubMed2006

Nature of human error: implications for surgical practice.

BACKGROUND: As the attitude to adverse events has changed from the defensive "blame and shame culture" to an open and transparent healthcare delivery system, it is timely to examine the nature of human errors and their impact on the quality of surgical health care. METHODS: The approach of the review is generic rather than specific, and the account is based on the published psychologic and medical literature on the subject. CONCLUSIONS: Rather than detailing the various "surgical errors," the concept of error categories within the surgical setting committed by surgeons as front-line operators is discussed. The important components of safe surgical practice identified include organizational structure with strategic control of healthcare delivery, teamwork and leadership, evidence-based practice, proficiency, continued professional development of all staff, availability of wireless health information technology, and well-embedded incident reporting and adverse events disclosure systems. In our quest for the safest possible surgical health care, there is a need for prospective observational multidisciplinary (surgeons and human factors specialists) studies as distinct for retrospective reports of adverse events. There is also need for research to establish the ideal system architecture for anonymous reporting of near miss and no harm events in surgical practice.

Delivery of Health Care↗
PubMed2000

Is the practice of psychological therapists evidence-based?

An interview-based survey of evidence-based practice (EBP) and the research, continuing professional development (CPD) and audit activity that support it was conducted in the North East of England amongst a representative sample of NHS clinical psychologists and counsellors (n = 30). It profiled their participation in EBP activities over the past year and their intentions for the next year. The findings suggest that the sample had used guidelines and protocols on 56 per cent of occasions, had on average drawn on research, CPD and audit approximately half of the time, but had been only minimally influenced by research, CPD or audit. It is concluded that EBP has occurred in all defined areas and that the conditions for an increased degree of EBP are promising.

Adult↗
PubMed2005

The use of digital 'virtual slides' in the quality assessment of haematological morphology: results of a pilot exercise involving UK NEQAS(H) participants.

We report the results of a pilot study assessing the use of digital 'virtual slides' in haematological quality assessment. Conducted together with the UK National External Quality Assessment Scheme for General Haematology, the study involved 166 separate participants, using the format of a typical assessment exercise. The results revealed substantial concordance of observations made using digital slides with those reported in previous glass slide surveys that used identical cases. Participant feedback strongly supported the use of electronic slides in teaching and assessment roles. Our results suggest roles for this new electronic resource in external quality assessment (EQA), education and continuing professional development.

Attitude of Health Personnel↗
PubMed2005

Digital imaging of haematological morphology.

Microscopic images of haematological cells are now routinely photographed using digital cameras. Advances in technology mean that the quality of such digital images can now approach that viewed through a microscope. At the same time there is an emerging appreciation that such images can be used in many roles: digital images are now being used to construct digital 'virtual slides', or are being employed together with cell recognition systems for morphological screening. Additionally, an Internet-based viewing systems allow access to on-line annotation, as well as real-time data gathering and feedback. The process of viewing digital images differs from the viewing of glass slides through a microscope; however, such images can provide diagnostic equivalence, and have an emerging role in areas such as education, quality control and continuing professional development. This review explores some of the present strengths, weaknesses and future applications of digital imaging in haematology.

Blood Cells↗
PubMed1992

Medical humanities in nursing: thought provoking?

Medical humanities is an innovative way of learning. Discussing literary texts of nursing practice has been used to help students analyse attitudes, values and ethics; it has also been used to help practitioners review and reflect on their own experience and philosophy of nursing. In nursing education, it has been used to explore difficult issues in a safe environment. The value of this approach in nursing education and practice is that it can encourage reflection, promote self-awareness and stimulate debate on difficult issues: for example, death and dying, power and institutionalization (of patients and staff) and pain. This paper gives a detailed worked example of how a literary text can be used in this way, the aim being to provide a resource which readers can then use with a group of students or colleagues. Finally, the authors explore the question of where medical humanities might have a place in the curriculum: as a lecture/tutorial in a course (e.g. Ethics), as a module in the curriculum, as a method of teaching nursing subjects (e.g. communication skills), as a discussion group (outside the curriculum), as a study guide, using literary texts alongside nursing text books. Any of these strategies can be a powerful vehicle for preserving the 'human factor' in both nursing education and continuing professional development.

Attitude↗
PubMed2004

Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial.

BACKGROUND: Important barriers to the wider implementation of shared decision making (SDM) and risk communication in practice remain. The attitudes of professionals undergoing training in these approaches may inform how to overcome these barriers, but there are few such data yet available. AIM: To identify the attitudes of professionals during participation in a large practice-based intervention study with substantial individual exposure to SDM and risk communication, and to assess their confidence with these approaches and reported frequency of implementing them. SETTING AND PARTICIPANTS: Twenty general practitioners (GPs) who had been in practice between 1 and 10 years, and participated in an explanatory trial lasting 6 months. The trial interventions comprised training in SDM skills and the use of risk communication materials. The doctors consulted with up to 48 patients each (mean = 40, half of them audio-taped) for the study. METHODS: Questionnaire assessments before and after each training stage. RESULTS: The GPs indicated positive attitudes towards involving patients and towards the training interventions. They indicated that the risk information packs were applicable but had used them only occasionally with patients outside the trial. No statistically significant changes were associated with the specific interventions in terms of doctors' confidence in discussing risk information after the risk communication intervention, or attitudes to patient involvement after the SDM intervention. Most attitudes and confidence ratings showed positive changes during the course of the trial as a cohort effect. Such positive changes were associated with female doctors more than male doctors, but not with MRCGP (postgraduate vocational) qualification. Time constraints remained important throughout the study in not implementing the approach more frequently. CONCLUSIONS: Professionals appear receptive to patient involvement, and willing to acquire the relevant skills. SDM and risk communication training did not appear to contribute differentially to this. Practical barriers such as time constraints should probably be addressed with greater priority than the precise content of training or continuing professional development initiatives if 'involvement' is to become a commoner experience for patients in primary care.

Attitude of Health Personnel↗
PubMed2005

Making sense of focus groups.

CONTEXT: This paper provides an overview of the contribution of medical education research which has employed focus group methodology to evaluate both undergraduate education and continuing professional development. PRACTICALITIES AND PROBLEMS: It also examines current debates about the ethics and practicalities involved in conducting focus group research. It gives guidance as to how to go about designing and planning focus group studies, highlighting common misconceptions and pitfalls, emphasising that most problems stem from researchers ignoring the central assumptions which underpin the qualitative research endeavour. PRESENTING AND DEVELOPING FOCUS GROUP RESEARCH: Particular attention is paid to analysis and presentation of focus group work and the uses to which such information is put. Finally, it speculates about the future of focus group research in general and research in medical education in particular.

Biomedical Research↗
PubMed2006

To be and to have a critical friend in medical teaching.

BACKGROUND: In order to stimulate reflection and continuous professional development, a model of critical friends evaluating each other was introduced in medical education. OBJECTIVE: To investigate whether the critical friend concept can serve as a pragmatic model for evaluation of medical teachers and as a fruitful tool for enhancing self-knowledge and professional development among medical educators. METHODS: Three pairs of critical friends were formed, consisting of experienced medical teachers (n = 6) at the Karolinska Institutet. Each teacher was assigned to give 1 lecture and 1 seminar in his or her specific research or clinical field. The critical friend evaluated the performance in class, acting as an observer using a pre-formed protocol. The evaluation was communicated to the teacher during a 45-minute session within 48 hours after the teaching session. Each of the 6 teachers was criticised and gave criticism within the pair configurance. The outcome of the process was evaluated by an experimenter, not participating in the process, who performed a semistructured interview with each of the 6 teachers. RESULTS: Each teacher had a different way of reflecting on teaching after the project than before and made changes in his or her way of teaching. We also noted that being a critical friend may be even more effective than having one. The majority of the feedback provided was positive and valuable. CONCLUSION: To be and to have a critical friend is worth the extra workload. Therefore, the critical friend concept should be made part of regular teaching practice.

Clinical Competence↗
PubMed2006

Nurses' perceptions of multidisciplinary team work in acute health-care.

Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one's own role but also the role of other professionals. The aim of this study was to explore nurses' perceptions of multidisciplinary teamwork in acute health-care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health-care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team-playing skills is an integral part of continued professional development.

Aged↗
PubMed1994

The profession of medicine.

It seems timely to define the purpose of medicine and examine the concept of a profession. This paper does so in the wider context of health, values in society, and the need to involve patients and the public as a whole. The author looks closely at what doctors do and concludes that making the diagnosis is a key element. The consultation is the building block for resource allocation. In addition to the diagnosis it sets out the prognosis and possible treatment and emphasises the importance of communicating these to the patient. Looking at the kind of doctor we need raises such issues as ethical standards, continuing professional development, team working, clinical standards, quality, outcomes, and research and development. Throughout, the role of education is seen as crucial. Leadership and vision are required by senior members of the profession if the opportunities presented are to be developed further.

Education, Medical↗