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PubMed1993

The perspective of student nurses and their perceptions of professional nursing during the nurse training programme.

This study was undertaken to identify what preconceptions student nurses have of nursing when they enter the nurse training programme at university and how these views change during the course. The term 'perspective' was chosen to describe how the students view themselves, their environment, way of thinking and feeling about nursing and the opportunity to act in nursing and educational situations. The data for this ethnographic study were collected by means of participant observations, interviews and document analysis. The subjects were 41 nursing students enrolled in the nursing programme at a school of nursing in the Swedish Midlands. Four different ways of perceiving the nursing function are discerned from the descriptions of the task, status and personality traits associated with nursing. The results indicate that student nurses perceive nursing in a very traditional way and that their perceptions tend to be stable during th training period. The findings suggest that about one-third of the student develop a new perspective and a self-concept as a nurse during the course, but the traditional image of the nurse persists.

Adult↗
PubMed1998

Health care reform and the transformation of nursing in Hong Kong.

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.

Anthropology, Cultural↗
PubMed2001

Clarification of conceptualizations of empathy.

BACKGROUND: If understanding our clients needs, emotions, and circumstances is fundamental to nursing practice, and empathy is the foundation of that understanding, then a conceptualization of empathy that can be used by nurses is of utmost importance to the profession. In 1992, Morse, Anderson, Bottorff, Yonge, O'Brien, Solberg and McIlveen analysed the concept of empathy in the psychological and nursing literature, and suggested the conceptualization of empathy was incomplete. Since that time, nurse authors have continued to publish conceptualizations and research on empathy. PURPOSE: The purpose of our analysis was to describe empathy as presented in the nursing literature between 1992 and 2000. METHOD: A concept clarification methodology of concept analysis was used because of the many definitions, the rich descriptions, and the application of empathy as a research variable in the reviewed literature. FINDINGS: Five conceptualizations of empathy were revealed: empathy as human trait, empathy as a professional state, empathy as a communication process, empathy as caring, and empathy as a special relationship. CONCLUSIONS: The literature reviewed contained evidence that the concept is developing more depth and breadth. Nurse authors are approaching empathy from a variety of perspectives, time frames, measurements, and outcomes. While all are important to the development of the concept, further enrichment of the conceptual work on empathy is needed before a fully mature concept emerges that is fully useful in nursing practice, research, and education.

Communication↗
PubMed2002

Swiss nurses' knowledge related to health care reforms: an exploratory study.

BACKGROUND: This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Swiss (Canton Vaud) context, where health care reforms have been initiated, on the National (Federal) level, in 1996. OBJECTIVES: Three research questions were formulated: (a) What is the level of nurses' knowledge regarding the basic principles of LAMal (Loi fédérale sur l'assurance maladie, Federal Health Insurance Law)? (b) What is the level of nurses' knowledge concerning the principles of health care reforms in Canton Vaud (NOPS, Nouvelles Orientations de la Politique Sanitaire)? and (c) Are there knowledge differences relating to employment setting (hospital, community, and education), nurses' roles (managerial vs. staff nurses) and level of education? METHODS: The sample consisted of a total of 74 nurses. Of these, 20 were employed in the community, 30 in hospital settings and 24 worked in schools of nursing. The research tool utilized was 40-items nurses' knowledge questionnaire developed for the purpose of this study. Three knowledge subscales and a subscale of certainty were constructed. RESULTS: Overall, data showed a moderate to high mean level of knowledge (around 70% correct responses) on all knowledge scales considered. Community setting, managerial position, and a nonacademic nursing degree were all positively related to higher levels of reforms' knowledge. On the contrary, employment in a hospital setting and having a university degree had both negative impacts on achieving a high score of knowledge. Levels of certainty were significantly higher for LAMal than NOPS and for correct rather than for wrong responses.

Adult↗
PubMed2001

Nursing in the community--impact of context on the practice agenda.

The agenda for health care detailed in recent policy statements has a strong community and primary health care focus. The impact of the community, and specifically the patient's home, as a location for practising and learning to practise nursing, is an issue which has received limited exploration. Recent research suggests that the context influences the practice agenda in a number of ways. Highlighting the impact of working in the community context is timely in order that education providers, policy makers and managers are fully aware of the impact of moving care 'closer to home'.

Adaptation, Psychological↗
PubMed2004

The testing of clinical skills in dietetic students prior to entering clinical placement.

BACKGROUND: One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise (Howe, 2002). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE). METHODS: The learning experience of the student was altered to accommodate a more conceptually-driven, problem-centred, case-based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students. RESULTS: The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty-one (57%) students returned the post-OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed. CONCLUSION: The Project Team was confident with the novel approach taken in re-designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.

Clinical Competence↗
PubMed2003

A source of strength--nurses' perspectives of the perioperative dialogue.

AIM: To describe nurse anaesthetists' and theatre nurses' experiences of working with the perioperative dialogue. BACKGROUND: A new way of working in the perioperative context is the 'perioperative dialogue model', which is the meeting between the nurse and the patient before, during and after a patient's surgery. METHOD: Semi-structured interviews were conducted with 20 nurses, trained in working with the perioperative dialogue. Data were analysed according to grounded theory. FINDINGS: One core category, 'source of strength', and two main categories, 'walking together' and 'creating a caring relation', were defined. These represented factors in developing nurses' work and professional competence. The nurses became more committed to their work when they came to know the person beyond the character of the patient. CONCLUSIONS: The perioperative dialogue is a source of strength to the nurses. It is necessary that the organization supports nurses in this new way of working.

Adult↗
PubMed1998

Self and tutor evaluations in problem-based learning tutorials: is there a relationship?

It is now recognized that acquiring specific skills in self-evaluation helps students in a more general appraisal of their overall performance. Self- and peer-evaluation skills are essential prerequisites for the success of every doctor in maintaining professional competence. In the Faculty of Medicine and Health Sciences (FMHS) of the United Arab Emirates, problem-based learning (PBL) is instituted in the first year. Self-evaluation by students and tutor rating of students' performances are an integral part of the PBL tutorials. This has provided the opportunity to conduct a systematic study of the role of self-evaluation by students as distinct from the tutor evaluation of students in the PBL tutorials for five themes. The study sample included all preparatory year (first-year) students who joined the FMHS in 1994 and 1995. A total number of 64 students participated, of whom 17 (26%) were male and 47 (74%) female. Mean self-evaluation scores were high throughout the module and did not follow any trend from theme one to theme five. While self and tutor scores were similar, male student self-evaluation scores were higher than for female students on overall scores. The sharing of assessment reports between students and tutors has been perceived to be a useful tool for the students' development of the skills of analysis, differentiation and critical appraisal.

Adult↗
PubMed2001

Doctors' professional values: results from a cohort study of United Kingdom medical graduates.

OBJECTIVES: To examine young doctors' views on a number of professional issues including professional regulation, multidisciplinary teamwork, priority setting, clinical autonomy and private practice. METHOD: Postal survey of 545 doctors who graduated from United Kingdom medical schools in 1995. RESULTS: Questionnaires were returned by 95% of the cohort (515/545). On issues of professional regulation, teamwork and clinical autonomy, the majority of doctors held views consistent with current General Medical Council guidance. The majority supported the right of doctors working in the NHS to engage in private practice. Most respondents thought that public expectations of doctors, medicine and the NHS were too high, and that some form of rationing was inevitable. On many issues there was considerable variation in attitudes on the basis of sex and intended branch of medicine. CONCLUSIONS: The results highlight the heterogeneity of the profession and the influence of specialty and gender on professional values. Doctors' attitudes had also been shaped by broader social changes, especially debates surrounding regulation of the profession, rising public expectations and the need for rationing of NHS care.

Adult↗
PubMed2003

Medical students' learning needs about setting and maintaining social and sexual boundaries: a report.

BACKGROUND: Despite increasing awareness of the potentially harmful consequences of social and sexual relationships between doctors and patients, little assessment has been made of the learning needs of medical students for setting and maintaining social and sexual boundaries in the doctor-patient relationship. AIM: To assess the learning needs of students with regard to issues concerning the setting of professional boundaries. METHODS: The study used a 4-part questionnaire, designed to collect both quantitative and qualitative data from medical students in all 6 years of the medical curriculum at 1 Australian university. RESULTS: A total of 293 students participated (94.5% response rate). The majority of students were ambivalent about the relationship between social and sexual boundary violations and sexual misconduct. A total of 21% of students said that sexual contact with patients might not be inappropriate. Short answers to a series of vignettes demonstrated conservatism on the part of students when faced with dilemmas. Most (87.4%) of the student population surveyed stated that insufficient teaching time had been given to issues concerning social and sexual boundaries. CONCLUSION: If medical schools shun teaching about the violation of social and sexual boundaries in doctor-patient relationships, sexual predators will continue to graduate.

Attitude of Health Personnel↗
PubMed2002

Geographic delivery models for radiotherapy services.

The study described here was undertaken to quantify the societal cost of radiotherapy in idealized urban and rural populations and, hence, to generate a measure of impediment to access. The costs of centralized, distributed comprehensive and satellite radiotherapy delivery formats were examined by decomposing them into institutional, productivity and geographical components. Our results indicate that centralized radiotherapy imposes the greatest financial burden on the patient population in both urban and rural scenarios. The financial burden faced by patients who must travel for radiotherapy can be interpreted as one component of the overall impediment to access. With advances in remote-monitoring systems, it is possible to maintain technical quality while enhancing patient access. However, the maintenance of professional competence will remain a challenge with a distributed service-delivery format.

Catchment Area, Health↗
PubMed2003

The role of the information specialist in the systematic review process: a health information case study.

There is an increasing body of literature on the information specialist's role in supporting evidence-based health care. In particular, the information component in systematic reviews has received considerable attention in recent years. Information professionals have evolved from simply acting as 'evidence locators' and 'resource providers' to being quality literature filterers, critical appraisers, educators, disseminators, and even change managers. This paper describes ten possible roles for information professionals in the systematic review process, using a case study of a review of the health information needs of visually impaired people carried out by the Centre for Health Information Management Research (CHIMR) at the University of Sheffield. This health information review was undertaken entirely by a team of information professionals. The ten roles identified are: project leader, project manager, literature searcher, reference manager, document supplier, critical appraiser, data extractor, data synthesiser, report writer and disseminator. This review has also identified an eleventh possible role for information professionals; that of primary researcher. Finally, the implications for evidence-based health care and evidence-based health informatics are discussed.

Humans↗
PubMed2003

Embedding knowledge management in the NHS south-west: pragmatic first steps for a practical concept.

Knowledge management, like clinical governance, is a practical science. Clinical governance, with its emphasis on creating an environment where clinical quality is monitored and acted upon, is one of the foundation stones of the new National Health Service (NHS). Both knowledge management and clinical governance need to share the same criteria in order to operate. Using these two pragmatic concepts and the premise of a practical approach, this article seeks to identify the drivers for knowledge management in the NHS, highlight national initiatives and focus on the steps libraries in the south-west of England have taken to make knowledge management a reality. In so doing, the central role of the library and information service has been reinforced and embedded and librarians have been recognized for their real worth to their organizations.

Evidence-Based Medicine↗
PubMedDate not supplied

Practice development: purpose, methodology, facilitation and evaluation.

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if practice development is to be transparent, rigorous and systematic in its intentions and approaches. A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustainable change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development. Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted. Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research.

Critical Care↗
PubMed2000

Trends in American nuclear medicine training: past, present, and future.

As soon as the capability to produce radioactive atoms was achieved in the 1930s, physician-scientists gravitated as apprentices toward important research centers, such as those at Berkeley, Washington University, and Massachusetts Institute of Technology (M.I.T.)/Massachusetts General Hospital. After World War II, Oak Ridge Associated Universities (ORAU) trained many of the founders of the specialty of nuclear medicine. The initial ORAU preparatory course lasted only 3 weeks. Over the 20 years after World War II, only 100 to 200 physicians had learned radioisotopic techniques and their clinical applications from their older preceptors. The founding of the conjoint American Board of Nuclear Medicine in 1971 (cosponsored by the American Boards of Internal Medicine, Pathology, and Radiology) marked a new era in certifying the quality of graduates of a growing number of nuclear medicine residency programs. Future trends in nuclear medicine education include the following: greater availability of jobs for physicians with board certification in radiology and nuclear medicine; an increased emphasis on training in positron-emission tomography (PET); and recertification and documentation of maintenance of professional competence as certainties.

Accreditation↗
PubMed2002

Finnish women's experiences of antenatal care.

OBJECTIVE: to explore and describe women's experiences of antenatal care. DESIGN: semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method. SETTING: four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland. PARTICIPANTS: in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae. FINDINGS: a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care. IMPLICATIONS FOR PRACTICE: the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.

Adult↗