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PubMed2006

High tech cheating.

The use of technology has enhanced the convenience, flexibility, and efficiency of both preparatory and continuing education. Unfortunately, academic dishonesty, including plagiarism, has shown a positive correlation with the increased use of technology in education. A review of the literature related to unintended outcomes of the use of technology in nursing education and continuing education was conducted to determine the ethical implications for the nursing profession. Although nursing research dealing with academic and professional misconduct is sparse, evidence suggests that academic dishonesty is a predictor of workplace dishonesty. Given this correlation between unethical classroom behavior and unethical clinical behavior, efforts to staunch academic dishonesty may help allay professional misconduct. A combination of high tech and low tech methods may be used to minimize unethical behaviors among students and practicing professional nurses in order to maintain the integrity of the profession.

Attitude of Health Personnel↗
PubMed2006

Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice?

This paper reports on the findings of a study that aimed to explore how relevant initial training is in relation to evidence-based practice, and explore the perceptions of recently qualified practitioners about their confidence to engage in evidence-based practice. A cross-sectional postal survey was used to ascertain the views of nurses, social workers, occupational therapists and physiotherapists who had been qualified no longer than two years prior to the survey, and had qualified at one of three London Universities. Fifty questionnaires were sent out to each professional group (a sample of 200 overall) and there was a 43% response rate achieved. The results show a clear discrepancy between what are generally positive attitudes towards evidence-based practice and the value of research evidence and the infrequency with which they actually do make use of research resources and engage in evidence-based practice. A number of constraints to engagement in accessing and utilising evidence were identified.

Attitude of Health Personnel↗
PubMedDate not supplied

Practice what you teach: a case study of ethical conduct in the academic setting.

Nursing faculty teach ethics and ethical behavior in undergraduate and graduate curriculum. In this article, a case study is presented that illustrates a breach of ethical behavior and conduct in the academic setting by both faculty and students. The decision-making process used to resolve this dilemma by the chair, the associate dean, and a faculty member relied on a dialectic approach that looked at philosophical underpinnings, historical background of nursing ethics, and university- and schoolwide policies and procedures. The conversations facilitated the ethical resolution to the dilemma raised in the case study as well as the recognition of additional issues for consideration. The authors uncovered compelling questions that included, "What is meant by ethical conduct in the classroom?," "How do we teach it?," and "How do we practice it?" The purpose of this article is to begin the dialogue in search of answers to these questions.

Attitude of Health Personnel↗
PubMed2005

The geographical distribution of specialists in public health in the United Kingdom: is capacity related to need?

OBJECTIVES: Recent organizational changes reflect the need to be more responsive to local populations and have included fostering a closer structural relationship between primary care and public health. In light of this, we explore the distribution of the specialist public health workforce and the relationship with population deprivation and need. STUDY DESIGN: Questionnaire survey to all directors of public health working in primary care trusts (PCTs) and strategic health authorities (SHAs) in England to determine the number of specialists in public health working in either PCTs or SHAs. All identified specialists were given the opportunity to self-define in a further questionnaire survey. Whole-time-equivalent staffing, per head of population, was analysed against socio-economic deprivation, measured by the DETR 2000 Index of Multiple Deprivation. The analysis was conducted at the SHA level. RESULTS: The survey was undertaken whilst public health in the UK was undergoing immense change. This presented specific challenges in identifying specialists in public health working within PCTs and SHAs. Seven hundred and eighty-three specialists working in PCTs and SHAs were identified. On average, in England, there are 1.69 specialists in public health per 100,000 population, with some variability at SHA level (range = 0.8-2.89). Findings indicate an overall positive association between capacity at SHA level and socio-economic need, although some discrepancies between need and provision are apparent. CONCLUSIONS: The general positive association between capacity and deprivation should offer some reassurance to policy makers, researchers and patients alike. However, further efforts are needed to redistribute specialists in some areas to address organizational capacity and equity issues.

England↗
PubMed2005

Conflicts in how interpreters manage their roles in provider-patient interactions.

Interpreters face challenges because of the various role expectations that others have placed on them and then adopt specific strategies to manage these conflicts. This study examines the conflicts in medical interpreters' role performances, the sources of these conflicts, and interpreters' strategies for resolving conflicts. It is based on in-depth interviews with 26 medical interpreters from 17 languages in the Midwestern area of the USA. The results showed that interpreters experienced four sources of conflicts in their role performances: (a) others' communicative practices, (b) changes in participant dynamics, (c) institutional constraints, and (d) unrealistic role expectations. To resolve conflicts, interpreters justified their roles by identifying the source and location of an assignment, (re)defining the relationships and identities of the provider and the patient, and adopting specific communicative strategies. This study highlights the importance of speaker and contextual factors on interpreters' communicative strategies and management of role conflicts.

Communication Barriers↗
PubMed2002

Family caregiver training is needed to improve outcomes for older adults using home care technologies.

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.

Aged↗
PubMed2002

Professional involvement is associated with increased job satisfaction among dietitians.

This study explored a relationship between professional involvement and job satisfaction among dietitians. A random sample of 2,600 employed registered dietitians (RDs) received a 55-item questionnaire including a standardized measure of job satisfaction. The response rate was 67.3%; 50.8% were useable (n = 1,321). Ninety-two percent of RDs reported job satisfaction. The mean score was 68.8 +/- .28 (possible range: 18-90), with scores over 54 indicating job satisfaction. A positive relationship was found between job satisfaction and markers of professional involvement. Additionally, six characteristics related to professional involvement were: having had a mentor, being a mentor, self-assessed high professional involvement, full-time employment, high annual income, and increased hours worked per week. There was also a positive relationship between markers of professional involvement and employer support. We conclude that, overall, RDs are satisfied with their jobs and that greater professional involvement is related to greater job satisfaction.

Adult↗
PubMed2000

Important qualities in physiatrists: perceptions of rehabilitation team members and patients.

OBJECTIVE: To determine the personal qualities important in physiatrists as described by patients and rehabilitation team members. DESIGN: An oral survey. SETTING: Adult rehabilitation service at a teaching rehabilitation institution affiliated with an academic medical center. PARTICIPANTS: Convenience sample of 171 people including inpatients, rehabilitation nurses, occupational and physical therapists, and resident and full-time attending physicians. INTERVENTIONS: Two questions to elicit the personal qualities that were considered important in a physical medicine and rehabilitation physician. MAIN OUTCOME MEASURES: Subjects' responses grouped as personal qualities (personality), working qualities (professionalism), competence, caring, and collegiality. RESULTS: Caring and competence qualities were the most important to patients. Collegiality and caring were valued most by the rehabilitation staff. Personal qualities and competence were of relatively greater importance to the physiatrists. CONCLUSIONS: There was significant variability in the relative. value assigned to each of the five groups of traits among the respondents. Knowledge of the desires and expectations of the people involved in the rehabilitation process may benefit rehabilitation patients, physicians, and staff.

Adult↗
PubMed2003

Appropriateness in programs for continuous quality improvement in clinical laboratories.

BACKGROUND: External reviews and the accreditation of medical laboratories involve more than the mere assessment of conformance with standards for organisational processes. The new approaches to quality improvement suggest that, rather than using inspection to correct unusual errors, there should be more emphasis on improving the processes of health care to ensure that desired outcomes are produced. Appropriateness plays a key role in programs for quality improvement. METHODS: Appropriateness in laboratory medicine can be assessed, and improved, through the governance of the entire testing process. This begins with test selection, proceeds through valuable pre-, intra- and post-analytical procedures, and concludes by assuring the correct interpretation and utilization of laboratory information. RESULTS: The International Standard, specifically developed for medical laboratories (ISO 15189) recognizes the value of appropriate interpretation and advisory services, although it does not specify requirements for assessing appropriateness, requesting tests and interpreting results. The effectiveness of clinical laboratories can be assessed by using surrogate markers, which indicate physicians' satisfaction, and clinical audits. Effectiveness is also enhanced by stressing the importance of the technical and professional competence of evaluators. CONCLUSIONS: Inappropriate laboratory utilization unjustifiably increases health care costs, can harm patients and perpetuates the vision of laboratory testing as a commodity. Improvement in laboratory appropriateness can be achieved by seeking a better relationship with physicians and by stressing the role of laboratory specialists in providing clinical advice for the selection of laboratory tests, and the interpretation and utilization of their results, thus leading to more satisfactory clinical outcomes.

Clinical Laboratory Techniques↗
PubMed2003

Interprofessional care co-ordinators: the benefits and tensions associated with a new role in UK acute health care.

While more flexible models of service delivery are being introduced in UK health and social care, little is known about the impact of new roles, particularly support worker roles, on the work of existing practitioners. This action research study aimed to explore the impact of one such new role, that of interprofessional care co-ordinators (IPCCs). The general (internal) medical service of a UK hospital uses IPCCs to provide support to the interprofessional team and, in doing so, promote efficiency of acute bed use. Using a range of methods, mainly qualitative, this action research study sought to explore the characteristics and impact of the role on interprofessional team working. While the role's flexibility, autonomy and informality contributed to success in meeting its intended objectives, these characteristics also caused some tensions with interprofessional colleagues. These benefits and tensions mirror wider issues associated with the current modernisation agenda in UK health care.

Acute Disease↗
PubMed1989

Quality assurance in cytology: New York State Proficiency Testing Program.

The New York State Proficiency Testing Program in Cytology is a three-part program consisting of an annual inspection, biennial proficiency tests, and ongoing education programs. Clinical laboratory consultants inspect laboratories' internal quality control and compliance with regulatory standards. In the proficiency test, cytotechnologists screen test slides and cytopathologists make final diagnostic interpretations. The program promotes professional competence through continuing educational courses and remedial training. Data from a 1988 study that examined test results from the July 1, 1986 to June 30, 1988 test period show that 93.9% of test participants agreed with the correct reference answer.

Cell Biology↗
PubMed1999

Elderly patients' perceptions of care in the emergency department.

OBJECTIVE: Patients' perceptions and satisfaction are areas of growing concern in health care research, but little has been reported from the perspective of elderly persons. The purpose of this study was to describe elderly patients' perceptions of care in the emergency department. METHODS: A qualitative, descriptive study design was used. Twelve elderly people were interviewed following a treatment episode in 1 of 3 emergency departments in the western United States and data were submitted to content analysis according to qualitative, interpretive methodology. FINDINGS: The following 5 themes emerged from the analysis: "needs for information," "observations of waiting time," "perceptions of professional competency and caring service," "concerns about process and facility design," and "personal tolerance." DISCUSSION: Findings support some aspects of existing literature and offer additional information regarding care of elderly persons in the emergency department. Results also support the need for more research in the area of the actual experience of elderly patients in the emergency department.

Aged↗