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Tracing the evolution of a professional practice model of nursing care is the focus of this article. Many conditions over the past 10 years have required changes in the way nurses plan and deliver patient care. The way in which proactive strategies were developed and implemented in a large community hospital demonstrates how nurse administrators can build upon current systems.
This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.
OBJECTIVE: To assess influenza vaccination status and influenza vaccination practices of family physicians in Quebec. DESIGN: Mail survey of a random sample of 1000 family physicians. SETTING: Family practices in the province of Quebec. PARTICIPANTS: Of 1000 Quebec family physicians sent questionnaires, 550 responded. After excluding physicians who worked only in institutions, had no patients older than 65 years, or did clinical work less than 20% of the time, 379 respondents were eligible for the study. MAIN OUTCOME MEASURES: Vaccination status of family physicians in 1996 and professional practices based on six clinical and administrative activities pertaining to influenza vaccination. RESULTS: Prevalence of vaccination was 35.5% (95% confidence interval 30.8% to 40.4%) among responding physicians and was higher among those 60 years and older, those with a chronic condition, and those perceiving high peer pressure to get vaccinated. Most respondents frequently assessed the current influenza vaccination status of their patients, risk factors for influenza-related complications, and contraindications to the vaccine. They also frequently provided education about influenza and its vaccine, recommended vaccination, and administered the vaccine. Only a few reported assessing prior influenza vaccinations or recording vaccination status regularly. Finally, vaccinated physicians recommended the vaccine more frequently to their patients than unvaccinated physicians did. CONCLUSION: Promotion programs focusing on peer influence could increase vaccination of family physicians. This could in turn improve vaccination coverage of elderly patients.
BACKGROUND: Outreach visits have been identified as an intervention that may improve the practice of health care professionals, in particular prescribing. This type of 'face to face' visit has been referred to as university-based educational detailing, public interest detailing, and academic detailing. OBJECTIVES: To assess the effects of outreach visits on improving health professional practice or patient outcomes. SEARCH STRATEGY: We searched MEDLINE up to March 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles. SELECTION CRITERIA: Randomised trials of outreach visits (defined as a personal visit by a trained person to a health care provider in his or her own setting). The participants were health care professionals. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Eighteen studies were included involving more than 1896 physicians. All of the outreach visit interventions consisted of several components, including written materials and conferences. Reminders or audit and feedback complemented some visits. In 13 studies, the targeted behaviours were prescribing practices. In three studies, the behaviours were preventive services, including counselling for smoking cessation. In two studies, the outreach visits were directed toward improving the general management of common problems encountered in general practice, including asthma, diabetes, otitis media, hypertension, anxiety, and acute bronchitis. All studies examined physician behaviour and in three studies other health professionals such as nurses, nursing home attendants or health care workers were targeted. Positive effects on practice were observed in all studies. Only one study measured a patient outcome. Few studies examined the cost effectiveness of outreach. REVIEWER'S CONCLUSIONS: Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Further research is needed to assess the effects of outreach visits for other aspects of practice and to identify key characteristics of outreach visits that are important to its success. The cost-effectiveness of outreach visits is not well evaluated.
Professional practice models (PPMs) are innovative approaches for improving health care delivery. Implementation of these new practice models needs to be well planned and supported to ensure their success in producing desired outcomes. This article describes two programs used to implement a PPM in a health care organization, focusing mainly on a program design intended to support the implementation of a new PPM on a medical-surgical hospital unit. The program blends the concepts of the organization's PPM with the leadership concepts from the AACN's Clinical Nurse Leader role to help nurses further develop their professional behaviors and clinical leadership skills.
Professional practice models provide decentralized approaches to nursing practice. The components of such a model should include a primary nursing delivery system, decentralized decision making, salary compensation, self-scheduling and quality circles. This article describes two of the key components of the model--salaried compensation and self-scheduling--on a unit in one agency.
Although only a moderately severe general nursing shortage exists at this time, the shortage of critical care nurses remains severe. Innovative administrators across the country are trying new professional practice models aimed at maximizing autonomy and freeing nurses from mundane tasks with the hopes of retaining experienced clinicians. We implemented a professional practice model in which unlicensed assistive personnel were trained to assist registered nurses in patient care. Monies saved by increasing nurse-patient ratios were distributed to staff nurses. Acuity-based staffing was maintained and professional practice encouraged through self-scheduling and elimination of hierarchical relationships. Satisfaction among nurses working in the program increased in terms of coworkers and supervision. Patient satisfaction with the quality of care provided did not change during the course of the program. Data from interviews demonstrated that staff were satisfied with the quality of care provided by the assistants, but the changes in the staffing ratios coupled with the increased responsibility for overseeing the assistants caused stress in the nurses. We conclude that a professional practice model in which critical care assistants are added to the work force is a viable option, but creative methods of addressing the stress of increased workload are needed.
Standards of care and professional performance are the backbone of dermatology nursing practice as well as the basis for professional growth and development. The goal of developing Dermatology Nursing Standards of Clinical Nursing Practice is to gain formal recognition for the practice of dermatology nursing.
We evaluate the potential relevance of virtue ethics to the training and practice of professional psychologists, and we contrast them with principle ethics. Typically, principles are used to facilitate the selection of socially and historically acceptable answers to the question "What shall I do?" when confronted by ethical dilemmas. Virtue ethics, however, generally focus on the question "Who shall I be?" Strengths and weaknesses of each approach are presented. The impact of each is discussed with respect to informed consent and the therapeutic construct "genuineness." We conclude that virtue ethics are an essential component of responsible ethical training and practice.
The extent to which physiotherapists and occupational therapists endorse a humanistic, holistic approach to health care was addressed in a survey of attitudes of practicing occupational therapists (N = 378) and physiotherapists (N = 558). A 22-item questionnaire including aspects of therapist's knowledge and techniques, holistic approach, client characteristics, client/therapist relationship, and approaches to professional practice was employed. The findings indicate that the professional practices reflecting the new public health model prevailed. This model emphasizes client/therapist interaction, the client's own ability to change and improve, and holistic attitudes towards health care, along with the therapist's knowledge and skills. However, comparative analyses of the two therapy groups reveal that although both groups support a humanistic approach to client care, occupational therapists promote the client's resources and coping skills to a greater extent, place more emphasis on the client in terms of the client's capacity for recovery and coping abilities, were more involved with the social, personal, and psychological problems of the client, and place less emphasis on treatment methods and techniques than physiotherapists. Demographic variables including gender, age, and workplace setting (public/private) were found to be significantly related to views of professional practice. Recommendations for the training of therapists and the implications for practitioners are made and suggestions for further research are given.
This work addressed the professional practice in healthcare in the context of social policies in a municipality of São Paulo State, Brazil. It aimed at determining the influences of such policies on professional practices and on the observance of ethical principles and legal precepts established by the Unified Health System. Healthcare professionals responsible for the elaboration of health policies in the municipal district and for coordination of health institutions were interviewed. A fatalistic perception of the health system and a mechanicist vision of facts influenced by the liberal conception was verified. Thus, alternatives for solution of problems are looked at individually, not always in terms of law or ethics.
There has been recent increasing interest in reflective practice within physiotherapy education as a method for reducing the 'theory-practice gap' and as a means of articulating, exposing and developing knowledge embedded in practice. Several contrasting theories have been developed to explain the role, place, purpose and definition of reflection in learning and teaching; however, much of the research to date has relied on theoretical debate rather than high quality empirical evidence. The aim of this paper was therefore, to report how a group of United Kingdom (UK) based physiotherapy Professional Practice Coordinators (n = 33) with their unique insight into the concept from both the academic and clinical perspective viewed and interpreted the use of reflective practice within their physiotherapy curriculum. Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire. Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies. The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.
BACKGROUND: Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not consistently been found to be effective. OBJECTIVES: To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group's register and pending file up to January 2004. SELECTION CRITERIA: Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. For each comparison we calculated the risk difference (RD) and risk ratio (RR), adjusted for baseline compliance when possible, for dichotomous outcomes and the percentage and the percent change relative to the control group average after the intervention, adjusted for baseline performance when possible, for continuous outcomes. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: the type of intervention (audit and feedback alone, audit and feedback with educational meetings, or multifaceted interventions that included audit and feedback), the intensity of the audit and feedback, the complexity of the targeted behaviour, the seriousness of the outcome, baseline compliance and study quality. MAIN RESULTS: Thirty new studies were added to this update, and a total of 118 studies are included. In the primary analysis 88 comparisons from 72 studies were included that compared any intervention in which audit and feedback is a component compared to no intervention. For dichotomous outcomes the adjusted risk difference of compliance with desired practice varied from - 0.16 (a 16 % absolute decrease in compliance) to 0.70 (a 70% increase in compliance) (median = 0.05, inter-quartile range = 0.03 to 0.11) and the adjusted risk ratio varied from 0.71 to 18.3 (median = 1.08, inter-quartile range = 0.99 to 1.30). For continuous outcomes the adjusted percent change relative to control varied from -0.10 (a 10 % absolute decrease in compliance) to 0.68 (a 68% increase in compliance) (median = 0.16, inter-quartile range = 0.05 to 0.37). Low baseline compliance with recommended practice and higher intensity of audit and feedback were associated with larger adjusted risk ratios (greater effectiveness) across studies. AUTHORS' CONCLUSIONS: Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The relative effectiveness of audit and feedback is likely to be greater when baseline adherence to recommended practice is low and when feedback is delivered more intensively.
With the ever-increasing availability and accessibility of the Internet, students are able to access a multitude of resources in support of their studies. However, this has also led to an increase in their ability to cheat through plagiarising text and claiming it as their own. Increased pressures of balancing work and study have contributed to this rise. Not only confined to the student population, some academics are also guilty of engaging in this practice providing a less than favourable role model for their students. Of increasing concern is the links of this practice to professionalism or indeed in this case unprofessionalism. Both pre- and post-registration nursing students who plagiarise risk bringing the reputation of the profession into disrepute. There are a number of methods that may be used to detect plagiarism but often the penalties are menial and inconsistently applied. Overall it is essential that academic institutions foster a culture of honesty and integrity amongst its academic community. A culture that clearly emphasises that plagiarism in any form is unacceptable.
BACKGROUND: The Chief Medical Officer has presented a report proposing a change in general practitioners' education towards a 'Practice Professional Development Plan', which, in principle, is based around formal needs assessment, practice-based learning in areas identified by those involved, and with the potential for multi-professional learning. This aims to replace the present system of a financial allowance earned by attending a certain amount of educational activity. AIM: To study the opinions of a group of general practitioners attending a course that included workshops that introduced and considered this educational initiative. METHOD: Semi-structured interviews four weeks after the course. RESULTS: Educational benefits were clearly seen, while issues such as funding and time will present difficulties in implementation. CONCLUSIONS: This proposal was seen as an improvement to the existing postgraduate educational allowance system. To maintain enthusiasm, successful introduction will depend on the issues of support and resources.
The reorganization of healthcare systems has largely focused on the redesign of clinical management structures with little emphasis on the systems that are essential to support professional practice and quality of care. This article describes the unique process of designing a framework that clearly articulates the essential elements of professional practice. The framework was crucial in clarifying account-abilities and role relationships between the clinical management and professional practice structures in the design and implementation of a major reorganization at Toronto East General Hospital, a 400-bed community teaching hospital in Toronto, Canada.
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