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PubMedDate not supplied

Telehealth technology in case/disease management.

Case managers can better coordinate and facilitate chronic illness care by adopting telehealth technology. This article overviews four major categories of telehealth technology based on patients' roles in self-management: surveillance, testing peripherals and messaging, decision support aids, and online support groups related to patients' subordinate, structured, collaborative, and autonomous roles, respectively. These various telehealth technologies should be selected on the basis of patients' care needs and preferences. Moreover, when they are integrated with other clinical information systems, case management practice can be better performed. However, the specific role functions and skill sets needed to be competent in telehealth environments have not yet been clearly identified. Considering role ambiguity and stress among telehealth clinicians, clarifying relevant roles is an urgent task.

Case Management↗
PubMed2006

The practice of optometry: National Board of Examiners in Optometry survey of optometric patients.

PURPOSE: A study commissioned by the National Board of Examiners in Optometry was designed to obtain information about patients seen in general practice. METHODS: Providers completed an encounter form for patients seen during a 2-day sample. Data were obtained from 11,012 patients in rural, urban, and suburban environments from a diverse population of 480 optometrists representative of profession-wide practitioners in terms of geographic distribution and practice settings. Although practitioners were randomly selected, the response rate among those who were invited to participate was only 17.7%. Optometrists who specialized and did not classify themselves as general practitioners were excluded from the study. RESULTS: The study provides insights into the most common diagnostic and therapeutic procedures performed, medications prescribed, and referrals made in general practices. Seventy-one percent of all examinations were categorized as comprehensive eye examinations, approximately 13% the result of disease, and 11% was for contact lens care. Almost 17% of all patients received a formal visual field test (Goldmann or automated). Refractive error was the most prevalent diagnosis reflective of the ocular problems found in the general population and systemic conditions were the second largest category. Although 12% of all patients were referred to an ophthalmologist for further care, other types of referrals were infrequent. Referrals to a primary care physician, laboratory, and imaging or for refractive surgery accounted for only 8% of all referrals. CONCLUSION: Ocular disease treatment was found to be an integral part of the optometrist's practice. Prescribing topical medications, both legend and "over the counter," was a primary treatment option. The most common medications prescribed were for glaucoma, with antibiotics, antiinflammatory, and antiallergy drops making up the remainder in descending order.

Adolescent↗
PubMed1999

Empowerment and the performance of health services.

Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.

Conflict, Psychological↗
PubMed2006

The glass ceiling in Irish healthcare: a nursing perspective.

PURPOSE: The purpose of this study is to describe and explore from the perspectives of top-level nurses holding the formal position of director of nursing their perceptions and interpretations of their experiences in the Irish healthcare system. DESIGN/METHODOLOGY/APPROACH: This paper presents some findings from a nation-wide study, which is qualitative in approach using grounded theory methodology. Semi-structured interviews were conducted with 50 directors of nursing representing general and psychiatric nursing. FINDINGS: The study in this paper was conducted in the context of a changing healthcare system, which emphasises the flattening of organisational pyramids. However, this study's findings indicate that, while structures might be changing, behaviours remain unaltered. In particular, the medicine nursing power base remains unchanged, while the power shift between nursing and general management continues to widen in favour of general management. RESEARCH LIMITATIONS/IMPLICATIONS: Research in this paper shows that directors of nursing who chose to participate in this study may have different perceptions of experiences from those who chose not to participate. ORIGINALITY/VALUE: In the paper the reality is neither medicine nor general management, individually or collectively, are going to share or devolve power and influence to nursing. This study's findings indicate that nursing needs to confront this power imbalance. Nursing needs to take the first steps towards shattering the glass ceiling by really examining its own behaviours, in maintaining the status quo, in the traditional balance of power.

Adult↗
PubMed2003

A subtle governance: 'soft' medical leadership in English primary care.

In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank-and-file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues' perception of threats to professional autonomy and self-regulation rather than fears of competition as the means of 'soft coercion'.

Attitude of Health Personnel↗
PubMedDate not supplied

Does advanced community/public health nursing practice have a future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.

Career Choice↗
PubMedDate not supplied

From function to competency in public health nursing, 1931 to 2003.

Explaining the content of public health nursing practice is not a new phenomenon. This historical narrative examines two documents published in the first Public Health Nursing journal, in which the National Organization for Public Health Nursing (NOPHN) described the nature of public health nursing for the profession and for those who administered programs employing public health nurses. While changes in language reflect evolution of both the nursing profession and public health practice, consistencies in purpose and the core understanding of public health nursing link these documents conceptually to the recent statement of Public Health Nurse Competencies (Quad Council, 2003).

Community Health Nursing↗
PubMed1994

The curriculum revolution: can educational reform take place without a revolution in practice?

Nursing scholars from around the world have written extensively in the past decade of the need to transform current health care systems and of the role of nursing education in achieving this goal. Proposals for change abound in the literature and are beginning to emerge in practice but not without difficulties. Having examined new curricular developments, this paper will discuss barriers to further progress. It is suggested that emphasis on reforming schools of nursing and teaching practices has tended to overlook broader institutional influences, in particular the clinical settings in which 50% of nurse education occurs. This paper will outline the major themes of the curriculum revolution, examine the ways in which educational institutions, health care settings and nursing organizations hinder the progress of curricular reform, and discuss possible solutions and their limitations.

Certification↗
PubMed1995

From psychiatric science to folk psychology: an ordinary-language model of the mind for mental health nurses.

In this paper it is argued that, if mental health nurses are to integrate the skills necessary to accomplish the diverse tasks that comprise their professional role, then what is required is a conception of mind independent of any particular paradigm in the biophysical and psychosocial sciences. This is proposed as a necessary condition of articulating the professional autonomy of mental health nurses. A four-part model of mental functioning is presented and developed, drawing on the ordinary language of folk psychology. Objections to this strategy are anticipated and answered. The utility of the model is demonstrated by deploying it to analyse emotional states and to show how subjective experience is a necessary component of mental ill-health, which is why empathic understanding is a necessary skill for mental health nurses. Finally, the major research paradigms associated with scientific approaches to the care and treatment of mental ill-health are aligned with the elements of the model to demonstrate the potential of that model for clarifying the rationale of theoretically divergent treatment approaches for the benefit of both nurses and their clients. It is emphasized that the proposed model is 'theory' only in the weak sense of being a 'systematic account' of the mental life.

Behavior Therapy↗
PubMed2005

The impact of international placements on nurses' personal and professional lives: literature review.

AIM: This paper presents a critical review of research literature on the impact of international placements on the lives and practice of nurses. BACKGROUND: Health care institutions are progressively more aware of the need to respond to diverse patient populations and cultivate leaders to enrich the nursing profession, both locally and globally. One response has been to establish international exchange programmes for nursing students to give them experience of different cultures and health care systems. METHODS: A search of the literature from 1980 to 2003 using electronic databases was undertaken using the databases CINAHL, ERIC, British Nursing Index, Web of Science, the BIDS Social Science Citation Index and Medline. The keywords used were 'international exchange experience', 'international studies', 'international education', 'international placement(s)', 'exchange programme(s)', combined with 'nurses/nursing', combined with 'evaluation', 'practice', 'education' and/or 'policy'. The papers retrieved used both qualitative and quantitative approaches and were scrutinized for recurring themes. FINDINGS: Nurses reported significant changes in their personal development, perspectives on nursing practice and critical appraisal of health care systems. They also indicated an increased appreciation and sensitivity towards cultural issues and cross-cultural care. Moreover, differences in placement programmes, such as duration, preparation and debriefing were found to have affected the reported overall international placement experience. However, the primary effects of international placements were identified as personal development and transcultural adaptation. CONCLUSION: Students should be exposed to a variety of nursing experiences within the host country. This would give them a broad spectrum for comparisons between cultures, nursing practice and health care delivery in those cultures. Therefore, educational institutions are strongly encouraged to provide opportunities for students to participate in nursing care and education in another country.

Cognition↗
PubMed2005

Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views.

AIM: The purpose of this study was to explore nurses' conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace. BACKGROUND: The use and comprehension of the term 'evidence-based practice' in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept 'evidence-based medicine'. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients. METHOD: Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. RESULTS: Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine. CONCLUSIONS: Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. RELEVANCE TO CLINICAL PRACTICE: The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients.

Attitude of Health Personnel↗
PubMed2005

Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development.

AIMS AND OBJECTIVES: The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long-term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs. BACKGROUND: Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner. DESIGN: This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development. METHODS: This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates. RESULTS: Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter-professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team. CONCLUSIONS: There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors. RELEVANCE TO CLINICAL PRACTICE: A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi-disciplinary teams. A greater level of day-to-day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.

Adaptation, Psychological↗
PubMed2007

Review of advanced nursing practice: the international literature and developing the generic features.

AIM: The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. BACKGROUND: This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. METHODS: An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. FINDINGS: The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. CONCLUSION: Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. RELEVANCE TO CLINICAL PRACTICE: Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.

Humans↗