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Incidence of critical events in professional practice: a statewide survey of psychotherapy providers.

The goal was to tabulate the incidences of clients' suicide, attack by a client, and sexual contact with clients in an Alaskan sample of masters and doctoral-level psychotherapy providers (excluding psychiatrists) and to assess which, if any, demographic or professional characteristics were associated with each critical event. Results from 151 respondents (response rate 43.5%) indicated that 42.7% of providers had experienced at least one client's suicide, 28% had been physically attacked by a client, 4% reported having had sexual contact with a then current client, and 6% reported sexual contact with a former client. Areas for research are outlined, specifically the importance of using methods other than surveys and exploring variables other than standard demographic data.

Adult↗

Two models of mistake-making in professional practice: moving out of the closet.

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients.

Attitude of Health Personnel↗

[Female dentists. Style of their professional practice].

In many Western countries during the past decades there has been a strong increase in the number of women dentists. This review on current literature shows that women dentists differ from their male colleagues in their way of practising the profession. More so than men they prefer to work in a group practice or in some kind of partnership. Women dentists also appear to have relatively smaller practices than their male colleagues and on average they practise fewer hours per week. However, it is important to notice that for women dentists motherhood is an important restricting factor with regard to practising their profession, often resulting in career break and diminishing professional productivity. Because of the strong increase in the percentage of women dentists, it is important for future policies to recognise their specific issues and concerns, as well as the consequences for dentistry of their way of practising. Thus, planning of manpower and infrastructure of dentistry can be done in a more adequate way.

Dental Care↗

Stress in the professional practice of oncology nurses.

Oncology nurses have been identified as a group at risk for stress. This project aimed at identifying stress-generating situations. There was an attempt at identifying stressful situations through the application of a stress evaluation scale (Stressor Scale for Pediatric Oncology Nursing) (Hinds et al, Cancer Nurs. 1990;13:354-360). In the opinion of 35 oncology nurses, 88.57% of whom were women and 73% of whom had more than 24 months of experience, 38 out of the 50 analyzed statements involving work situations were considered stressful in some way. Fifty-four percent of the statements disclosed a medium or high stressor capacity, and 22% were seen as extremely high stressors. These situations were included in the categories "work organization," "relationships among staff members," and "care restrictions." It is reiterated that the set of activities developed by oncology nurses is stressful, and that there is a need for institutional intervention, due to the narrow relation between work environment and care results.

Adaptation, Psychological↗

An exploration of student midwives' language to describe non-formal learning in professional practice.

The essence of non-formal learning in midwifery practice has not been previously explored. This paper provides an in-depth analysis of the language of a sample of student midwives' descriptions of their practice learning in a range of clinical settings. The students submitted audio-diaries as part of a national study (Pope, R., Graham. L., Finnerty. G., Magnusson, C. 2003. An investigation of the preparation and assessment for midwifery practice within a range of settings. Project Report. University of Surrey). Participants detailed their learning activities and support obtained whilst working with their named mentors for approximately 10 days or shifts. The rich audio-diary data have been analysed using Discourse Analysis. A typology of non-formal learning (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136) has been used to provide a framework for the analysis. Non-formal learning is defined as any learning which does not take place within a formally organised learning programme (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136). Findings indicate that fear and ambiguity hindered students' learning. Recommendations include the protection of time by mentors within the clinical curriculum to guide and supervise students in both formal and non-formal elements of midwifery practice. This paper will explore the implications of the findings for practice-based education.

Attitude of Health Personnel↗

The spirit of healing: how to develop a spiritually based personal and professional practice.

The idea of healing must be considered within the context of a holistic approach to nursing practice. The authors put forth the premise that a Spirit of Healing enters into the nurse-client relationship or into any care-giving situation. This spirit is defined as a universal energy source that is accessed through imagery, therapeutic touch, Reiki, and other related interventions. Case studies are provided as illustrations, and the authors include self-help exercises and related definitions to enhance understanding and practice. The authors explore energetic techniques to treat and prevent burnout for nurses, identify specific ways to practice nursing from a holistic perspective, and consider the possibility of transforming nursing into a change agent that will redefine the healthcare system.

Attitude of Health Personnel↗

Pyramids to success: laying the foundation for professional practice.

Communication plays a vital role in an increasingly complex healthcare environment. Quality patient outcomes and successful collaboration depend upon the healthcare provider's ability to communicate needs. A self-directed work team at a large southeastern hospital used a quality improvement process to design a new series of workshops to enhance staff communication skills. The redesigned programming reduced duplication of education content and built upon a conceptual foundation that cultivates professional development. The workshops feature content such as self-awareness, personal effectiveness, and leadership of others.

Academic Medical Centers↗

Alternative services, professional practice, and community mental health.

Innovative services staffed by nonprofessionals have become a significant means of meeting a variety of community mental health needs. Most such services have elements in common, and have adopted non-traditional approaches to meeting mental health needs. As viable community mental health resources, alternative services are examined from several perspectives, including their origins, their characteristics and attractiveness to the consumer, and their relationships to mental health professionals.

Allied Health Personnel↗

Infectious disease in dental practice--professional opportunities and obligations.

This article presents one author's view of the dentist's obligations to patients, to the community, to the profession, and to the principles of ethics in a highly troubling time of serious infectious diseases. It essentially is an optimistic view that, while the epidemic of AIDS will continue and tuberculosis may become a graver problem in certain health care settings, the dental profession possesses the education, ethical insights, and technical training needed to meet with grace and authority the challenges of practice in this era of infectious disease.

Acquired Immunodeficiency Syndrome↗

Collaboration of nursing and child life: a palette of professional practice.

This evidence-based practice (EBP) article begins with a case study background. Case studies can be used to illustrate the unfolding of the nursing process, from assessment to reassessment, for particular patient care situations. The evidence-based process, and its importance for successful clinical outcomes, is explicated after the case study presentation. This is an example of how EBP is an integral part of what we do as healthcare professionals: When we are faced with clinical dilemmas, evidence-based tools are there to guide us to solutions. In this example, Child Life and Nursing worked collaboratively to identify key clinical issues. They consulted with clinical experts within the hospital, and they used scientific rationale to select therapeutic interventions to support a patient and her family through several crisis situations. The EBP tools, seeking clinical expertise and applying research-based interventions, resulted in successful outcomes for a complex patient care situation.

Child↗

Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition.

OBJECTIVE: This article describes one medical center's experience in using research to plan for nursing staff integration after hospital acquisition. BACKGROUND: Resistance to new policies, procedures, and standards; passive acceptance of new leadership; limited support for management plans; and failure to integrate with new nursing units are common staff reactions after acquisitions. Little has been written regarding which key staff variables to assess after acquisitions and how to use this data to plan for change. Structural contingency and attribution theory were used to guide leadership staff's assessment of acquired staff attributes to determine their congruence with concepts valued by the acquiring organization. METHODS: Qualitative and quantitative data were collected using a survey method. All 141 registered nurses and licensed practical nurses of the acquired medical center received a mailed survey. Sixty-six completed surveys were returned through the U.S. mail. No identifying information was placed on the survey to assure anonymity. RESULTS: The survey results described nurses perceptions of the advantages, concerns, and suggestions for a smooth transition after acquisition. In addition, the results clarified that nurses in the newly acquired hospital preferred a shared governance structure (congruent with the acquiring medical center's values) and the nurses perceived professional nursing autonomy was similar to that of nurses who worked at the acquiring medical center. CONCLUSIONS: By sharing the findings, both staffs were sensitized to the similarities among the staff as well as to their differences. Transition strategies were planned to capitalize on this knowledge. This process may be useful for other nurse executives to replicate as they guide their organizations through similar transitions.

Adult↗

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes.

BACKGROUND: Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology. OBJECTIVES: To assess the effects of telemedicine as an alternative to face-to-face patient care. SEARCH STRATEGY: We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), Cinahl (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data. We hand searched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also hand searched conference proceedings and contacted experts in countries identified as having an interest in telemedicine. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the technological aspects of the interventions appear to have been reliable, and to have been well accepted by patients. REVIEWER'S CONCLUSIONS: Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies.

Communication↗

Implementation of a professional practice model for nursing in a rural hospital.

Growing concern about rural hospitals and the health of rural citizens highlight the need for high quality, progressive nursing care. To address this concern, several program changes to improve patient and organizational outcomes were made in one rural hospital; implementation success varied. Hospital culture and changes occurring within the health care environment affected the change process.

Continuity of Patient Care↗

[Understanding the idea of nursing for use in professional practice].

This study is about the comprehension analysis of female students at graduation courses in Nursing on the meaning of Nursing as a female profession, in the light of their reasons why they have chosen it. Qualitative method and social representation have been used for data analysis. The results showed that Nursing is a profession of love for the fellowman and it is a way to get closer to God, but it is also a challenge and a struggle for a better profession.

Altruism↗

Implications of nursing role expansion for professional practice.

The topic of nursing role expansion has caused much heated debate in the nursing press in recent years. The contemporary relevance of the debate is heightened by the current recruitment and retention crisis in nursing, and continued pressures to reduce junior doctors' hours and workload. This article re-examines the 'expanded role debate' by putting current concerns in an historical framework. The perceived benefits of role expansion are discussed, and balanced against continued concerns expressed by practitioners regarding possible detrimental effects on care delivery. The potential erosion of 'caring' as the heart of nursing practice is acknowledged, and challenges are made to the belief that nursing has the 'monopoly on caring'. The issue of 'nursing time', perhaps the major barrier to continued role expansion, is also explored. The future division of labour within healthcare delivery is seen as pivotal to this aspect of the debate, and a pragmatic vision for the future is offered. Finally, the issue of the paucity of the evidence base underpinning role expansion is considered and a plea is made for future developments to be soundly underpinned by research.

Evidence-Based Medicine↗

Using essential oils in professional practice.

As the use of aromatherapy within a health care setting has grown so rapidly in recent years, and will continue to do so, the need for suitable training has become apparent. No health service can afford the risk of having staff who are inadequately trained in the practice of aromatherapy using essential oils incorrectly on those in a state of ill-health, especially if the essential oils used are not to a standard suitable for therapeutic use. Training to an acceptable level in aromatic therapy is essential for safety and effectiveness. Knowledge of the nature and make-up of essential oils, their effect on the body and the emotions, and how, when, and where to apply them is imperative in order for them to be beneficial to a patient's health. Contraindications to certain oils, patients, or treatment have also to be thoroughly understood, and the dosage employed is related to some extent to the standard of training undertaken.

Aromatherapy↗

Violence, zero tolerance and the subversion of professional practice.

Assaults on health care staff have been a fact of life since the earliest years of organised health services, but it is only in recent years that governments have begun to acknowledge the problem. Assaults not only inflict physical and emotional injury, but undermine morale, create a climate of fear, and subvert the quality of care. They are also costly in terms of lost labour, compensation, and legal and procedural expenses. The response to violence in health care settings has thus far ranged from what might be called the 'Ostrich position', in which it is simply ignored, to training in self-defence, the deployment of security staff in clinical areas, conflict resolution training and, more recently, the policy of 'zero tolerance'. This paper examines the rationale for zero tolerance policies, drawing on their origins and applications in the United States and Britain. It suggests that zero tolerance is an ineffective response to violence in health care settings, and its adoption by authorities in Australia should be rejected. It is further argued, that resource allocation and marginalisation are identifiable and modifiable factors contributing to violence in our health care systems.

Australia↗