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PubMedDate not supplied

Are we being forced into isolation?

Do you ever feel a sense of being locked in? Has it been more than a year since you went out for lunch? Are e-mails your main source of keeping in touch with friends and colleagues? What are the issues for our self-inflicted isolation? What am I hearing and seeing? Case managers are saying they do not have time to meet with manufacturers or home care providers, and then the home care providers are upset that no one cares about what they have to offer.

Assertiveness↗
PubMedDate not supplied

Mediation in health care: a collaborative journey.

In health care, the patient is the recipient of a service, another person provides that service, a third party attempts to standardize and regulate the service, and a fourth party creates invoices and expects a fifth party to pay for the service. One misstep in this game of dominoes and the ripple effect can cause adversity and conflict. In these situations there often is no wrong or right, only perceptions of situations, with perceived meanings and motives. Individuals' emotions and vision are often clouded in this web of perceptions, and mean-spirited words may be exchanged. Once individuals have acted irrationally, they feel compelled to justify their actions, hence the escalation of conflict, each party vilifying the other and painting them as the enemy. These types of conflict abound in health care, consuming time, energy, and money. They divert attention from heath care's main focus-the patient-and affect everyone's ability to make wise and level-headed decisions.

Case Management↗
PubMedDate not supplied

The jury shall decide!

Those familiar with the code of professional conduct, set forth by the Commission for Case Manager Certification (CCMC), know of the expectations for case managers' behaviors. Professionals making application for certification must sign a statement committing to case management practice consistent with the law and the ethical requirements for their primary profession. The case manager's role and function have been repeatedly studied, based on input from the field and review of the literature. The outcomes are consistent with these foundations: advocate for the patient/client and act in the patient's best interest. Increasingly, case managers are becoming the focus of a lawsuit when it appears that they have done other than advocate for the individual or act in the individual's best interest. The three cases and information presented here are all public information; however, they have been disguised for publication purposes. Should one or all of these cases proceed to court, the jury shall decide if the case manager's actions were consistent with the standard of care. Reflect on your own practice as you consider each actual case.

Adult↗
PubMed2005

Excellence in evidence-based practice: organizational and unit exemplars.

The University of Iowa Hospitals and Clinics is a recognized leader in evidence-based practice. Creating organizational excellence in evidence-based practice takes leadership and a committed effort at all levels. Building the capacity, culture, and vision at the organizational and unit levels is needed to promote use of evidence in practice. Practical approaches that have been effective in promoting development of an evidence-based practice program and project are outlined. An exemplar describing development and adoption of an evidence-based project to improve sedation management led to improvements in patient care processes and outcomes.

Algorithms↗
PubMed2005

Interdisciplinary collaboration: the heart and soul of health care.

In a health care system in which patient complexity, outcome indicators, and informed families are representative of current reality, an interdisciplinary approach to care is crucial to successful navigation of a patient's experience in the ICU. To guide practitioners toward favorable patient progression, a thorough understanding of interdisciplinary collaboration is necessary. This article focuses on definitions of, benefits of, and barriers to interdisciplinary collaboration and provides practical solutions for implementation.

Attitude of Health Personnel↗
PubMed2004

"A double-edged sword"? The professionalisation of counselling in the United Kingdom.

Drawing on interviews with practitioners involved in voluntary-sector counselling in Scotland, this paper explores contradictions associated with the professionalisation of counselling in the UK. Five meanings of the term "professional" are identified. Those in support of professionalisation aim to bring these different meanings into close alignment, whereas those with reservations point to tensions between at least some of these meanings and core values of counselling. In conclusion the paper reflects on the possibility that counselling might contribute to a reshaping of what it means to be a profession.

Attitude of Health Personnel↗
PubMed2005

Leadership and priority setting: the perspective of hospital CEOs.

The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.

Attitude of Health Personnel↗
PubMed2004

Empowerment, skills, and values: a comparative study of nurses and social workers.

This article focuses on social workers and nurses who complement each other's work in providing health care services to their patients. The professional literature suggests that understanding the professional differences between social workers and nurses may lead to more collaboration between these groups. This study empirically compares empowerment, skills, and values of social workers (n = 213) and nurses (n = 152). Nurses reported higher scores in all empowerment and value variables. Nurses also claimed to use more therapeutic and communication skills, and social workers reported the use of more social action skills. The differences in empowerment, skills and values between social workers and nurses are discussed in light of their different professional roles and work environments.

Adult↗
PubMed2005

A phenomenographic study of registered nurses' understanding of their role in student learning--an Australian perspective.

BACKGROUND: Students may be 'buddied' with registered nurses during their clinical experience since the designated clinical facilitator cannot be available for each student at all times. Little is known about the way registered nurses understand this informal role. OBJECTIVES: The rationale for this study was to gain an insight of the variation of understanding registered nurses have of their role with students, and explored the qualitatively different ways registered nurses perceive their role with students on clinical experience and the implications of this understanding for student learning. DESIGN: A phenomenographic approach was used to identify the variation of understanding and meaning of the role of the registered nurse with students on clinical practice from the perspective of the registered nurse. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena. SETTINGS AND PARTICIPANTS: A purposive sample of 30 registered nurses from 15 public and private hospitals in central and south eastern Queensland, Australia. METHODS: Individual semi-structured interviews from a final sample of 28 interviews were analysed to identify Categories of Description. RESULTS: Eight variations of understanding registered nurses have of their informal role with students were identified. The registered nurses' understanding varies from a focus that is 'student-centred', to 'completion of workload-centred', to 'registered nurse control', to a preference for no contact with students. As a consequence some students may have positive learning experiences while others will have limited learning opportunities. CONCLUSIONS: The research highlights the varied ways registered nurses understand their role with students that may promote or impede the quality of student learning and development to meet professional competency standards. Formal recognition of the complexity of the registered nurse role by health care agencies and tertiary education providers is essential to ensure registered nurses have adequate preparation for their role with students.

Attitude of Health Personnel↗
PubMed2006

Nursing and public participation in health: an ethnographic study of a patient council.

BACKGROUND: Conceptualisations of the nurse-patient relationship tend to view nursing as embodying an empowering approach to patients, one that places the service user perspective at the centre of decision-making. However, the relationship of nursing to public participation in health service planning and development has been under examined. AIMS: The aim is to explore the relationship of the nursing profession to public participation as enacted through a UK-based patient and public council, located in an acute hospital. The council was developed by nursing staff and aimed to achieve service user participation in strategic level health care decision-making. The views and experiences of participants and the applicability of the 'nurse-patient partnership' construct to public participation are considered. METHODS: The study employed integrative ethnography, involving multiple field methods: non-participant observation of council meetings, i.e. fourteen 3 h meetings (n=42 h); in-depth interviews with councillors (n=17) and with key hospital staff (n=18). A documentary review and mapping of the actions of the council was undertaken. RESULTS: A nurse-patient partnership was not initially intrinsic to the operation of the council or embedded in the perspectives of the nurse or patient participants. Professional vulnerability and the organisational context constrained the nursing response. Councillors and nursing staff moved to create a shared set of understandings in order to progress change in service organisation and delivery. Nurses' repositioning vis-à-vis the credibility of user experiences and status was central to the effective progression of the council. CONCLUSIONS: Partnership in public participation requires a shift by nurses' towards acceptance of members of the public functioning as informed, critical and powerful agents in health care decision-making. Equipping nurses with the skills to communicate with patient representatives in a position of interactional equality is likely to be a pre-requisite for successful engagement by nursing with public participation.

Anthropology, Cultural↗
PubMed2005

Members of research ethics committees accepted a modification of the randomized consent design.

BACKGROUND AND OBJECTIVE: The use of randomized consent designs has been subject of methodologic and ethical controversy. In most Western countries, research ethics committees make the decision as to whether a randomized consent design can be applied. The purpose of the study is to assess to what extent a randomized consent design and a modification of this design is accepted by research ethics committees, in terms of ethics, health law, and methodology. METHODS: A postal survey was conducted among members of research ethics committees in the United Kingdom, and in The Netherlands, with professional competence in ethics, (health) law, methodology, or clinical practice. RESULTS: In both the UK and in The Netherlands, the modified randomized consent design appears to be statistically significantly more acceptable than the randomized consent design, with respect to ethical and judicial aspects. The overall rejection rate of the randomized consent design was 66% in the UK and 59% in The Netherlands. However, the modified randomized consent design was rejected by 47 and 41% in the two countries, respectively. CONCLUSION: the modified randomized consent design appears to be more acceptable than the randomized consent design. To increase consistency in the way research ethics committees handle study protocols, a discussion about the use of randomized consent designs appears necessary.

Ethics Committees, Research↗
PubMedDate not supplied

Content of childbirth-related fear in Swedish women and men--analysis of an open-ended question.

The content of childbirth-related fear as described by 308 women and 194 men was analyzed and compared in relation to intensity of fear. The content of fear was similarly described by women and men and concerned the following main categories: the labor and delivery process, the health and life of the baby, the health and life of the woman, own capabilities and reactions, the partner's capabilities and reactions, and the professionals' competence and behavior. Among women, the labor and delivery process was the most frequently reported among the 6 categories of fears, whereas the health and life of the baby was the most frequent among the men. Fears related to own capabilities and reactions were described significantly more often by women with intense fear than by women with mild to moderate fear. The greatest difference between men with intense versus mild to moderate fear was a more frequent expression of concern for the health and life of the woman. Both women and men had fears related to not being treated with respect and not receiving sufficient medical care. This finding suggests that part of the problem with childbirth-related fear is located within the health care system itself.

Adult↗
PubMed2006

Pain control and chaplaincy in Australia.

This paper summarizes the experiences of 327 Australian health care chaplains with regard to their involvement in issues concerning pain control within the health care context. The findings indicate that approximately 60% of surveyed chaplains had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning pain, and that approximately 36% of chaplains had assisted clinical staff with issues concerning patient pain. Differences of involvement between volunteer and staff chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to pain control. Some implications of this study with respect to chaplaincy utility and training are noted.

Australia↗
PubMed2005

An investigation into adult nursing students' experience of the relevance and application of behavioural sciences (biology, psychology and sociology) across two different curricula.

Curriculum development for nurse education is constantly changing to reflect the sociopolitical context and medical advancement. Throughout this process the contribution of the behavioural sciences to each curriculum has been widely debated. Nurse educators encourage students to acquire and develop academic knowledge to underpin their practical skills and professional competencies. However with new political agendas science content within the new curricula is being marginalised, [United Kingdom Central Council for Nursing Midwifery and Health Visiting, 1999. Fitness for Practice. London, UKCC]. This qualitative study investigated adult branch nursing students' experiences of the behavioural sciences while studying two different curricula: one a new integrated delivery of the sciences, the other involving discrete science modules. The study utilised focus group interviews at two distinct phases of their courses: 12-18 and 24-30 months. Each interview was tape recorded, transcribed verbatim and inductive thematic analysis [Hayes, N., 1997. Doing Qualitative Analysis in Psychology. Psychology Press Erlbaum Taylor & Francis Ltd.] was applied. This article reports the findings and discusses the relevance of the sciences to students and their patient care, and how the sciences underpin their view of health and illness.

Adult↗
PubMed2005

Liberating the potential: the role of non-nurses in adding value to nurse education.

In this paper, I have attempted to explore the role of non-nurse lecturers in adding value to nurse education programmes. In measuring "added-value" in higher education, I have embraced a more comprehensive approach including investigating the views of "Experts"; including the nurse and non-nurse lecturers themselves, and various United Kingdom stakeholders such as the Government, the Nursing and Midwifery Council and the Quality Assurance Agency. The students' views are also taken into account, when considering both the content of the programmes and how they are delivered. The complexity of "objective measurement" is considered, and the requirements of a "good" teaching experience. The potential areas for adding value include: health and social care policy priorities which encourage partnership working, the blurring of professional boundaries, and inter-professional working. Professional-specific changes embracing extended and enhanced roles and the concepts of specialist and assistant practitioners. Other areas include the Higher Education agendas including transferable skills and adult and student-centred learning. I conclude by discussing the latest policy changes and suggest that the role of the non-nurse lecturer needs more exploration to provide the best value for all.

Attitude of Health Personnel↗
PubMed2005

Nurses', midwives' and health visitors' perceptions of the impact of higher education on professional practice.

AIM: This study examines the perceptions of qualified nurses, midwives and health visitors of the impact of higher education on professional practice. METHODOLOGY: This is a qualitative study using a phenomenological approach. A non-probability convenience sample of 12 qualified nurses, midwives and health visitors who had enrolled upon a Master of Science programme in Professional Practice at a United Kingdom Higher Education Institution in the East Midlands were interviewed using semi-structured interviews, which were audio-taped and analysed using Colaizzi (1978) [Colaizzi, P., 1978. Psychological research as a phenomenologist views it. In: Valle, R., King, M., (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, pp. 48-71] approach. Approval to undertake this study was received from the University's Research Ethics Committee. RESULTS: Four themes emerged from the interview data. These were personal and professional motivation, workplace constraints, valuing "hands-on" nursing and client contact, and challenging and questioning practice. From the respondents' perspective, there was a strong view that higher education has a positive effect in practice, but a significant number of factors including time and support seemed to inhibit the possible benefits in practice. These are discussed in relation to the findings from similar studies. CONCLUSION: This study has highlighted the need for further research to explore the impact of higher education on client care and service delivery.

Adaptation, Psychological↗