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PubMed2006

The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.

In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually developing themselves; proper student selection and the creation of a culture of student/faculty partnerships in education and in building an international reputation and credibility by cooperating with reputable international universities and organizations.

Bahrain↗
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↗
PubMed2001

Ethical issues in limb transplants.

On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self-evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost-benefit, or patient autonomy.

Body Image↗
PubMed2001

Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?

Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy.

Confidentiality↗
PubMed2005

Survey of paediatric case management practices in Australia for children and young people with acquired brain injury (ABI).

AIM: To investigate the characteristics of paediatric acquired brain injury (ABI) case managers and their organizations in Australia, and to determine the ways in which case managers deliver their service, maintain professional development and evaluate outcomes. METHODS: Postal survey of 57 known paediatric ABI case managers working at 24 separate organizations in Australia. RESULTS: Out of 40 questionnaires returned (70%), the majority of respondents had been providing case management for over 5 years (55%). Co-ordination of services was ranked the most important component of case management, with services most frequently delivered by telephone. Evaluation of case management outcomes was reported by only 52% of the case managers. Whilst the majority of case managers had received some form of training (83%), this varied widely from informal in-house training, to workshops run by insurance companies and government agencies. DISCUSSION: This survey provides information about current case management practices for children with ABI in Australia. Detailing what case managers do is a first step towards developing controlled research designs which are required to demonstrate whether case management is effective in terms of clinical outcomes and cost-benefit.

Adolescent↗
PubMed1978

Nurse--teacher behaviours in the clinical field: apparent effect on nursing students' learning.

One primary source of feedback on the effectiveness of their teaching, which instructors may easily overlook, comprises of students' reactions. The purpose of this study is to identify students' perceptions of teacher behaviours, which either facilitate or hinder students' learning in the clinical field, and to determine if there is a difference in the perceptions of 1st and 2nd year students. This study is exploratory and descriptive in nature. Firstly, some research studies regarding effective clinical teaching in nursing are reviewed, followed by a discussion of the research design. The tool used for collecting data is a modified form of the critical incident technique. A description of illustrative incidents is requested within five divisions: professional competency, relationship, personal attributes, teaching methods, and evaluation of practice. A system for analysis and coding of data is then discussed. Finally, the finding of this study is presented. It would seem ot the investigator that students in 1st year are particularly sensitive to how the teacher makes them feel, whereas students in the 2nd year would seem to be more concerned with the teacher's competency in teaching. The teacher behaviours reported as helpful or hindering to students' learning, as identified by the students, are outlined.

Clinical Competence↗
PubMed1989

An evaluation of a communication skills course for health visitor students.

This paper presents part of the findings of an extensive empirical evaluation of a communication skills training programme for health visitor students. The programme was designed to develop the health visitors' ability to communicate with clients. A wide range of interpersonal skills were addressed and the training format involved skill analysis, roleplay practice and video-recorded feedback. The method of evaluation included an appraisal of the health visitors' social behaviour in a roleplay of a home-visit to a pregnant client. Data were collected, both before and following training, in an attempt to assess changes in trainee behaviour. The analysis took the form of a detailed frequency measurement of behavioural elements of health visitor performance, and a global rating of social competence by independent judges. Results of the analyses indicated that 14 out of the 20 behavioural variables changed in the desired direction. Thus, for example, following training the health visitors used significantly more open questions and verbal encouragers, and significantly fewer multiple questions and interruptions when communicating with the client. They were also rated significantly higher on the rating scale for social competence following training. These findings would seem to suggest that the training programme had a considerable degree of success. The findings are discussed in terms of the implications for development of health visitors' social skills, the need for more sophisticated measures of social behaviour and for the formulation of a model of competent professional practice in this area.

Communication↗
PubMed1992

Continuing professional education for qualified nurses: a review of the literature.

Reviewed literature identifies the importance of continuing professional education and professional development for nurses subsequent to initial registration (including enrolled nurses). However, there is a lack of empirically based work analysing nurses' perceptions of their continuing professional education needs and the perceived outcomes of continuing professional education in terms of changes in knowledge accretion, attitudes, skills, job satisfaction, staff retention and career development. It is suggested that this lack of empirical work needs to be addressed if the proposed plans of the United Kingdom Council for Nursing, Midwifery and Health Visiting (UKCC) to introduce mandatory continuing professional education are to have maximum benefits for clients, nurses and the service.

Attitude of Health Personnel↗
PubMed2004

Nursing ethics and conceptualizations of nursing: profession, practice and work.

BACKGROUND: Nursing has been understood as a calling, vocation, profession, and most recently, a practice. Each of these conceptualizations has associated with it an ethics that has emphasized particular aspects of nursing reflecting the social position of nursing in a given historical period. The ethics associated with current understandings of nursing as a profession and a practice are, we believe, no longer adequate to address the social realities and moral challenges of health care work. AIM: The aim of this paper is to discuss the limitations of the ethics associated with profession and practice and to show why the concept of work can contribute to a nursing ethics. DISCUSSION: The characteristics that have socially defined professionals, among them the possession of a unique body of knowledge, provision of an altruistic service to society, and autonomy in the sense of control over their work and work conditions, only partially reflect the realities of contemporary health care work. This is true even for physicians, an exemplar of a professional group. The ethics associated with the professions has tended to limit what counts as a moral concern and who is authorized to label them as such. More recently, the idea of a practice has been used to argue for an ethics in which professional activities of a certain kind and understood in a specific way are inherently moral. However, this approach is limited for similar reasons. Because morality cannot be separated from the social organization of health care, we argue that considering nursing primarily as work, in contrast to a profession or a practice, offers the possibility of an ethics that more completely reflects the complexity of contemporary health care. CONCLUSION: Beyond the obvious conclusion that nursing is work, conceptualizing nursing as work points to changing social realities that are raising significant ethical issues. As a concept, work inherently conveys value, connects intellectual and manual labour, and recognizes social divisions of labour. At the moment an ethics of work is merely an idea, but we believe that such an ethics would lead nurses to ask different questions and propose different answers to the moral challenges of the present and near future.

Codes of Ethics↗
PubMed2004

Towards a Chinese definition of nursing.

BACKGROUND: A theory of nursing derived from nurses' experience can reflect indigenous practice values, which in turn can act as a fertile source of ideas and inventiveness in developing a relevant knowledge base to inform practice. However, systematic study of how Chinese nurses articulate nursing in their everyday practice is lacking. AIM: The aim of this paper is to describe how Chinese nurses conceptualize the practice of nursing; and to arrive at a definition of nursing based on this common understanding. METHOD: A systematic inquiry using a modified version of Van Kaam's controlled explication was designed. In the prescientific phase, 254 written accounts of nurses' views on nursing as lived in their everyday practice were collected in eight Chinese cities. In the scientific phase, concept analysis based on Aristotle's notion of four causes was adopted to capture the richness of the phrases that explain the multi-dimensionality of Chinese nurses' concepts of nursing. This was followed by a survey of 1782 nurses to verify the findings. The most commonly held views were summarized and a Chinese definition of nursing was drafted. FINDINGS: Nursing in the Chinese sense means to understand the dynamic health status of a person, to verify health concerns dialectically, and to consider interventions with the goal of assisting the person to master the appropriate health knowledge and skills for the attainment of optimal well-being. The survey findings show that nursing has developed into a professional caring practice in China today. The definition has some similarities with those of Western nurses, but the underpinning epistemic concerns are grounded in the philosophy of traditional Chinese medicine and Eastern ideologies. CONCLUSION: The findings provide Chinese nurses with a definition of nursing articulated in their own language. The identification of qing, li, zhi, and xin as its epistemic concerns, and the articulation of the process of nursing as 'dialectical verification', provides a perspective for understanding nursing based on Eastern philosophies. The findings can enhance nurses' engagement in a cross-cultural dialogue to promote better understanding of nursing as it is practised in different parts of the world.

Adult↗
PubMed2004

Sense of coherence among unemployed nurses.

AIMS: This paper reports a study assessing Finnish unemployed nurses' sense of coherence and the factors relating to it. BACKGROUND: During the 1990s, due to the widespread economic downturn in Finland, the nursing profession suffered from a high level of unemployment. Previous research has clearly indicated that unemployment is detrimental to health. It creates stress by disturbing a person's sense of identity and self-esteem and by disrupting social networks. In Finland, many studies have been conducted on the impact of unemployment, but have not examined the sense of coherence of unemployed nurses. METHODS: Data were collected in one Employment and Economic Development Centre area in Finland in 1998. Structured questionnaires were used to collect data among Finnish unemployed nurses (n = 183), and included the General Health Questionnaire, measuring nurses' mental health; socio-demographic questions; and the 13-item version of the Sense of Coherence scale based on Antonovsky's salutogenic model to measure sense of coherence. RESULTS: Although the majority of unemployed nurses had a strong sense of coherence, many felt that during their period of unemployed they did not feel at ease, did not know what to do and had a sense of being unfairly treated. Daily household chores, on the whole, were perceived as meaningful. Income and the state of mental health were positively correlated with nurses' sense of coherence: the better the family income and state of mental health, the stronger was their sense of coherence. Because of the low response rate (less than 50%), the results might be skewed by those whose higher sense of coherence made them more motivated to complete the questionnaires. CONCLUSIONS: Many of the nurses reported low sense of coherence and poor general health. Special interventions should be designed to improve their sense of coherence and high motivation level, and to maintain their professional competence when they return to work. This kind of support may prevent further out-migration and nursing shortages from Finland and other industrialized countries.

Adaptation, Psychological↗
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

Evaluation of the concept of supervision related to public health nurses in Norway.

AIM: The aim of the study is to clarify the concept of supervision by means of concept analysis, in order to evaluate the concept's application to the practise of public health nurses. BACKGROUND: According to the World Health Organization, a change in strategies for improving public health is necessary. This change demands new strategies. There exists little research concerning intervention strategies in public health. The concept of supervision is well used, but neither well-defined nor well described, either within the nursing discipline or across disciplinary boundaries. METHODS: The method is a review of literature. Twenty scientific papers covering the years 1996-2001 are analysed, using a concept-analysis methodology. FINDINGS: Supervision can be defined as a formal, pedagogical, relational enabling process, related to professional competence. Relationship and dialogue are central aspects. Supervision is based on theory and humanistic values, has a normative, formative and restorative function. The supervisor's competence is of great importance. Supervision has unclear boundaries with concepts such as psychotherapy, consultation and counselling. CONCLUSION: The concept of supervision as described in the selected papers is applicable to public health nurses' supervision of clients, with adaptation caused by the contextual variation of the relationship. Related to clients, supervision can be defined as a formal, pedagogical, relational enabling process with the purpose to strengthen resources, enhance assertiveness and improve independence and coping. It is necessary that registered public health nurses have the competence to supervise.

Humans↗
PubMed1980

Preclinical teachers and preclinical students.

A survey in 1974 in Manchester University medical school of the preclinical teachers showed that they thought that the motives of students in studying medicine were not what they should have been. Medically qualified and non-medically qualified teachers agreed about the importance of nine suggested motives, but there were highly significant differences between the two groups about the motives they felt to be present in students. The non-medically qualified were very much more likely to see students as concerned with the financial and social rewards of medicine, and more likely to doubt students' desires to be professionally competeant or to help individuals. Some anecdotal evidence possibly throws light on these findings, which may have serious implications for teaching as non-medically qualified staff make up an increasing proportion of preclinical teachers.

Attitude of Health Personnel↗
PubMed2005

Before the white coat: perceptions of professional lapses in the pre-clerkship.

BACKGROUND: It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations. METHODS: We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory. RESULTS: Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, validating our previous clerkship-based framework. However, they also reported numerous lapses committed by fellow students and many instances of lack of accountability to students, which were not reported by clerks. Many of their reports involved non-health care professionals. CONCLUSIONS: The willingness of pre-clerkship students to report on fellow students was associated with a tendency to blame their colleagues, at the expense of a more reflective analysis, and their views on professionalism appeared to be generic rather than medicine-specific. We should reinforce students' appreciation of these generic values and add on medicine-specific values as the students progress, in order to better cultivate professionalism without entitlement.

Attitude of Health Personnel↗
PubMed2005

Using a standardised patient assessment to measure professional attributes.

INTRODUCTION: Professionalism is an important topic in medical education today. While much work has focused on defining professionalism and teaching medical students the appropriate interpersonal behaviours, relatively little research has looked at meaningful ways of assessing the relevant attributes. METHOD: The Educational Commission for Foreign Medical Graduates (ECFMG) clinical skills assessment (CSA) uses standardised patients (SPs) to evaluate the readiness of graduates of international medical schools to enter accredited graduate training programmes in the USA. Doctor interpersonal skills, including professional qualities such as rapport, are evaluated as part of the CSA. Attentiveness, attitude and empathy, all facets of professional behaviour, are specifically targeted as part of the assessment. RESULTS: To date, over 35 000 candidates have been assessed, encompassing more than 370 000 individual SP encounters. Based on a 1-year cohort of examinees, the reliability of the individual professionalism-related component scores ranged from 0.61 to 0.70. Doctors who had graduated from medical school more recently, or were younger, generally obtained higher ratings. Professional qualities were only marginally related to measures of basic science and clinical science proficiency. Female candidates were rated significantly higher than male candidates on all dimensions. CONCLUSIONS: While some professional behaviours are probably best measured using formats such as surveys, self-assessment and critical incident techniques, certain aspects of the domain can be reliably and validly measured in SP examinations.

Attitude of Health Personnel↗
PubMed2005

Proto-professionalism: how professionalisation occurs across the continuum of medical education.

INTRODUCTION: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training. THESIS AND DISCUSSION: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis, or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement. CONCLUSION: Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.

Curriculum↗