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Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness.

PURPOSE: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback. METHODS: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. RESULTS: Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback. CONCLUSION: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlight questions for further study.

Attitude of Health Personnel↗

Emotional intelligence in mental health nurses talking about practice.

The aim of this study was to explore mental health nurses' experiences of emotional intelligence (EI) in their nursing practice by means of qualitative interviews. The interview questions where developed from the literature on EI. This study used a hermeneutic analysis. Four main themes emerged: relationship with the patient; the substance of supervision; motivation; and responsibility. It was concluded that EI stimulates the search for a deeper understanding of a professional mental health nursing identity. Emotional learning and maturation processes are central to professional competence, that is, personal growth and development. In addition, the moral character of the mental health nurse in relation to clinical practice is of importance. The findings imply multiple types of intelligence related to nursing science as well as further research possibilities within the area of EI.

Clinical Competence↗

Defining remote health.

OBJECTIVE: To develop a definition of the discipline of Remote Health. DESIGN: A broad literature search using key words and an Internet search of industry-recognised web sites were carried out. RESULTS: Fifty-five relevant citations and nine web sites were reviewed, covering Australia, Canada, New Zealand, the United Kingdom and United States. The papers offered a variety of definitions of geographical and practice-based approaches to 'remoteness', and definitions of 'remote and rural health'. CONCLUSIONS: None of the single current definitions in the literature adequately reflect all of the characteristics of Remote Health in Australia. A definition is offered: Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by geographical, professional and, often, social isolation of practitioners; a strong multidisciplinary approach; overlapping and changing roles of team members; a relatively high degree of GP substitution; and practitioners requiring public health, emergency and extended clinical skills. These skills and remote health systems, need to be suited to working in a cross-cultural context; serving small, dispersed and often highly mobile populations; serving populations with relatively high health needs; and a physical environment of climatic extremes.

Australia↗

Moral expertise: a problem in the professional ethics of professional ethicists.

Philosophers, particularly moral philosophers, are increasingly being involved in public decision-making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the 'Committee of Inquiry into Human Fertilization and Embryology' in the UK in 1982-4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential. The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision-making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.

Advisory Committees↗

Reproductive technologies in developing countries.

Are there any ethical concerns about reproductive technologies that are specific or unique to developing countries? Three ethical concerns often mentioned specifically in regard to developing countries are (1), the "overpopulation argument"; (2) the limited resources argument; and (3) the ethical problem of poorly trained practitioners offering their services to unsuspecting and uninformed infertile individuals or couples. Each argument is explored in some detail, with the conclusion that ethical problems do, in fact, exist but are not unique to developing countries. Nevertheless, the difficulties relating to reproductive technologies are likely to be greater in developing countries than in developed ones because of limited resources and a larger number of poor people residing there.

Delivery of Health Care↗

The Health Care Ethics Consultant, edited by Françoise Baylis.

The Health Care Ethics Consultant marks a stage in the development of ethics consultancy. Ethics consultancy is a manifestation of a newly secularized society in which a new discipline has developed to fill a gap created by the combination of the diminishing influence of traditional moral authorities and the growth of new problems associated with the development of new technology and changes in society and culture. The stated primary objective of the book is to focus attention on an immediate practical problem: the role and responsibilities, the education and training, and the certification and accreditation of health ethics consultants. An edited collection of articles, the book originated as a research project financed by the Social Sciences and Humanities Research Council of Canada, undertaken by a Strategic Research Network which included faculty members from Dalhousie University, McGill University, the University of Toronto, McMaster University and the University of Calgary.

Canada↗

Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian.

BACKGROUND: This paper is the first of a two-part series of articles presenting the role of the clinical librarian (CL) in the UK today. It situates the CL concept historically, and specifically reports the findings from a study in 2002 (Skinner, The Role of the Clinical Librarian in the UK. MSc Dissertation. Loughborough University: Department of Information Science). RELEVANCE: The impetus for the 2002 study was the awareness of an increase in job advertisements within the NHS for roles seeking to enhance the practice of evidence-based medicine, which included elements of clinical librarianship. Therefore the research was undertaken to establish whether this increase was coincidental, or the beginning of a new professional role for librarians. METHODS: A content analysis of CL job advertisements, examining job titles and duties was undertaken. Twenty-three advertisements were scrutinized, and these results are presented here. As a complementary investigation, a postal questionnaire was sent to a sample of practising CLs in the UK. RESULTS: Several duties can be classified as core to the role of the CL. However there is a great diversity of duties attached to this core, reflecting an absence of nationally accepted practice. CONCLUSION: Further work was necessary to assess current practice and how clinical librarianship can continue to grow at local and national levels. This is addressed in Part Two of this series.

Evidence-Based Medicine↗

Genetic research and genetic information: a health information professional's perspective on the benefits and risks.

BACKGROUND: The completion of the Human Genome Project, and recent breakthroughs in identifying the genes both directly responsible for and contributing to the severity of specific diseases and disabilities in humans offer great potential for future health care. AIM: The aim of the paper is to inform the health information community of these developments in order to foster debate over their wide-reaching implications. METHODS: The article outlines recent research in this area and explains how our growing understanding opens the way for improved diagnosis of disease, detection of possible predisposition to specific diseases, the interaction between genetics and environmental aspects such as diet, as well as enabling gene therapy and preventative actions. This new knowledge also opens the way for the use of pharmacogenetic information to enhance the efficacy of pharmaceuticals and to avoid toxic reactions. RESULTS: These advances have significant social, legal and ethical implications. Most countries have limited legislative control over the use and protection of genetic information about individuals. CONCLUSION: There is a role for health information professionals to play in promoting wider public knowledge of genetic research and its implications, in fostering public debate on key issues, and in seeking clearer policies in the health sector concerning the use of genetic information about individuals.

Genetic Counseling↗

A method for linking health and social training courses of medium length to research.

By means of a process of pragmatic and philosophical investigation set out in three stages a method has been successively developed and set to work for linking health and social training courses of medium length to research. This method consists of strategies and prescriptive models. In the first stage the training is organised and the teachers' frames of references are developed. During the second stage an intensified identification of the major subjects and professional competences is started, by means of the feedback process inherent in the strategy. On this follows the further identification of relevant fields of research--elucidated by the prescriptive models--by means of a research process. From the third stage, which comprises a solid research and developmental programme, consisting of three principal phases, the prescriptive models are directive. In the last phase these models provide the criteria for the analysis of the follow-up and results of the research link within training courses.

Competency-Based Education↗

Violation of the patient's integrity, seen by staff in long-term care.

The aim of the study was to describe the views held by staff (n = 233) in long-term care on what they regard as a violation of patient's integrity and to define the concept "integrity" in simple terms. The design of the investigation was inductive. The answers were coded into 775 items. Agreement was reached between the authors on 770 of the items when sorted into 13 categories: the unique personality, autonomous self, personal opinions, secret self, personal competence, professional self, family self, cultural self, information self, personal properties, private territory, corporal self, and ridiculing. The number of categories shows a great variation in the ordinary language definitions given by staff. It was also shown in two other ways: the difference in the level of abstraction in the items, and the fact that integrity referred to the patient, directly or indirectly. Our conclusion is that integrity by the staff reflects an ethical value and not a personal trait. If the staff have to violate the patient's integrity, because other vital values are involved, it is absolutely essential that they consider the ethical aspects of the situation carefully. Such violation demands that they preserve their respect for the patient to the greatest extent possible. It seems important in the training of different staff groups to show the complexity in the concept "integrity" and the ethical dilemmas that arise, especially in the interaction with vulnerable patients who are not able to protect and maintain their own integrity.

Adult↗

The Opticians Act 1989 and UK optometry.

The build-up to the original 1958 Opticians Act is used as an introduction to the more recent developments in UK optics that have culminated in the introduction of the Opticians Act 1989. The changes introduced as a result of the Health and Social Security Act 1984 and the Health and Medicines Act 1988 are briefly described before discussing the sectional arrangement of the new Act. This new legislation pulls together much of the law relating to optometry and dispensing optics in the UK and provides a single accessible source.

Optometry↗

Tertiary nurse practitioners.

Tertiary nurse practitioners are proposed to meet the specialized health care needs of complex patients. Societal changes, increasing numbers of medically vulnerable people and increased costs of health care demand innovative responses to health care delivery. Nurse practitioners' effectiveness in primary care settings supports their introduction into acute care settings. Nurse practitioners are involved in tertiary care in response to a need for the delivery of care to patients with specialized needs. The evolution of the tertiary nurse practitioner role pre-dated the response of educational institutions to provide appropriate preparation for practitioners in tertiary care. Curricular imperatives and policy issues that will influence professional practice of the tertiary nurse practitioner are discussed.

Curriculum↗

Revisioning nursing scholarship.

PURPOSE: To propose a universal model of nursing scholarship that (a) indicates the importance of professional practice disciplines, (b) incorporates the synthesis of intellectual pursuit with social change, and (c) is holistic in its design. ORGANIZING CONSTRUCT: Scholarship, traditionally viewed as part of or generated in the university enterprise, must be an expectation in all settings in which a community of scholars from both discipline and practice can and do coexist. METHODS: Review and synthesis of the literature on scholarship, nursing scholarship, nursing as a practice discipline. FINDINGS: The history, culture, and intellectual property of nursing comprise an appropriate basis for adopting a universal holistic model of scholarship built upon a set of universal assumptions about nursing scholarship. As a discipline and a profession, nursing should include four connected domains in a universal holistic model of scholarship: knowing, teaching, practice, and service. CONCLUSIONS: Confirmation of this universal holistic model of scholarship can contribute significantly to a larger nursing identity. Use of universal holistic model of nursing scholarship indicates responsibility of the nursing profession collectively and all nurses individually. Additional work is needed to understand how a universal holistic model of nursing scholarship evolves across cultures, domains, and work settings.

Humans↗

Implementing a perinatal clinical information system: a work in progress.

Implementation of a clinical information system is a work in progress. There are many factors to consider, including (a) clearly defining the scope of the project and associated goals, (b) identifying background, skills, and beliefs of the key players, (c) assessing the unit's strengths and weaknesses, (d) assessing the current documentation's strengths and weaknesses, (e) assessing the clinical information system's strengths and weaknesses, (f) determining the project's constraints, and (g) discussing different implementation strategies. This article describes how these factors were considered during implementation of a clinical information system in a labor and delivery unit.

Attitude of Health Personnel↗

Establishing dental hygiene education in Germany: current facts and future perspectives.

As there is a marked need to increase the number of dental hygienists (DHs) working in German dental practices, efforts are being made to establish dental hygiene education in accordance with international standards. However, as current German legislation does not envisage a perennial full-time training programme, dental hygiene education may currently be provided within a modular concept only. The basic qualification for enrollment in a modular hygienist training programme of this kind is accredited vocational training as a dental assistant (DA), followed by board-certified continuing education as an oral prophylaxis assistant. Thus, the current system of advanced training for qualification as a DH is subject to at least 6 years' work experience in the field of dentistry. A 950-h full-time advanced training course, meeting all the requirements of this concept, was established by the Westphalia-Lippe Dental Association in cooperation with the University of Münster. The curriculum underlying this programme was outlined considering the recommendations for dental hygiene education issued by the European Federation of Periodontology, although reduced in standards to comply with current German legislation. In addition, the recommendations for American Dental Hygiene education by the American Dental Association were used as a guide for programme development. The contents and implementation of the Münster Dental Hygienist Curriculum may allow the professional competence generated during practical work experience to be linked with international requirements of dental hygiene education.

Accreditation↗