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PubMed1998

"Codependency". A disease or the root of nursing excellence?

A hermeneutic phenomenological study was conducted to explore how eight professionally competent nurses experienced and evaluated the relation between their childhood adaptation to dysfunctional families and their nursing careers. From the participants' discussion of this topic, the following themes emerged: escaping difficulties by becoming a nurse, coping roles guide nursing career, sensitivity to the untold, transforming dysfunctional responses, and wounded healers. The study did not support the view that children of alcoholics seek careers in nursing to meet their codependent needs for self-esteem, control, or belonging. Instead, its findings indicate that some children of alcoholics become competent nurses by finding positive application for the coping skills they learn in their families. This indicates that, when working with individuals from dysfunctional families, nurses could support them to create new avenues for their coping skills instead of trying to "exterminate" them because of their "codependent" nature.

Adaptation, Psychological↗
PubMed1994

Guilt and nursing practice: implications for nurse education and the climate of care.

This paper considers the influence of guilt within nursing practice. The author draws on her experience as a nurse tutor to show how guilt has implications for the well-being of both nurses and patients. It is suggested that nurses' experience of guilt, and the fear that they may be considered guilty, are indicative of a moral climate that rests predominantly upon rules. While rules fulfil a requirement for professional and organizational accountability, they need not be perceived as statements about the trustworthiness of nurses, or as a disciplinary threat. Nurses need to feel trusted to bring judgement to their practice.

Education, Nursing↗
PubMed1996

Ethical dilemmas faced by the Nursing Disciplinary Committee.

This article presents the complicated ethical dilemmas that arise in the procedures and proceedings of the Nursing Disciplinary Committee, which deals with matters of life and death (e.g. patients' rights to quality and safe care, professional integrity and accountability, and the nurse's future). The article also describes the composition and function of the Committee, the type of case it deliberates, its limitations, and the dilemmas its members may encounter.

Advisory Committees↗
PubMed1997

The human condition of the professional: discretion and accountability.

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it.

Ethics, Nursing↗
PubMed1998

The limits of confidentiality.

Two conditions are commonly taken to constitute an obligation of confidentiality: information is entrusted by one person to another; and there is an express understanding that this will not be divulged. This conception of confidentiality, however, does not match much of the practice of health care. Health care practitioners would, for example, hold themselves to be under an obligation of confidentiality in situations where neither of these conditions obtain. The discussion proposes, therefore, two additional grounds for confidentiality. This is in order to clarify, in general terms, the scope of this obligation (i.e. to clarify at what point confidentiality can be said to have been broken). The 'limits of confidentiality', it is argued, are set by the wishes of the client or, where these are not known, by reference to those whose right and need to know relate to the care of the client. Anonymous references to the client outside this limit may not be breaches of confidence; whether they are or not depends, it is suggested, on if such reference is responsible.

Confidentiality↗
PubMed1999

Describing expert practice in physical therapy.

In this article, the authors demonstrate how grounded theory may be used to develop models for understanding clinical practice. Through a series of research studies involving novice, experienced, and expert physical therapy practitioners, conceptual frameworks were continually revised based on data obtained from returning to the field and relevant literature available at the time. As concepts and relationships moved to larger themes, a theoretical framework for expertise in clinical practice was proposed. Current work on verifying the theoretical framework continues. Grounded theory is an excellent research approach to bound and help guide a multistage research program involving multiple researchers working in multiple settings.

Humans↗
PubMed2005

The relevance of standards of professional school nursing practice.

This descriptive correlational study assessed school nurses' knowledge of and perceived relevance of the Standards of Professional School Nursing Practice. Of the 1,162 Ohio school nurses sent questionnaires, 345 returned usable questionnaires (30%). The typical respondent was a 50-year-old Caucasian woman with 24 years of nursing experience, 12 years of school nursing experience, and a caseload of 3 public schools serving 1,500 students. Factors that positively related to the school nurses' knowledge and perceptions of the relevance of the standards were age, advanced degree preparation, school nursing experience, and practicing in a metropolitan area. Factors that negatively related to knowledge and perceived relevance were practicing in a rural area and caseload of special needs students. Standards of practice provide a mechanism for defining and supporting practice roles for nurses. Thus, it is important to increase awareness and use of the standards, especially among school nurses practicing in rural areas.

Adult↗
PubMed1980

Continuing education for the improvement of professional intervention in patient care.

Continuing education has a vital and unique role to play in enabling the practitioner to maintain professional competence. The contributions of continuing education supplement formal preparatory education and practice experience. The future for pharmacy continuing education is tied to the transition currently underway as pharmacy emphasizes involvement in patient care. The Pharm.D.'s affect on the pharmacist, acceptance of the pharmacist in a new role, preparation of pharmacists to deal with an aging population, and capitalizing on the movement toward health promotion are all challenges that face continuing pharmacy educators.

Clinical Competence↗
PubMed2001

The role of traditional birth attendants in Atakumosa, Nigeria.

All 26 traditional birth attendants (TBAs) and their 109 clients in 15 settlements in Atakumosa West Local Government Area (LGA) in Nigeria were interviewed to assess TBA training, practices and utilisation. The study showed that more than 80% of TBAs were older women with more than four children, practiced single-handedly and held other occupations. About 54% of those studied had no designated room for deliveries; twenty-one (80.8%) did not consider any pregnant woman to be at high risk; three (11.5%) perform intravaginal examinations during labour and only a few recognise complications; twelve (46.2%) never refer patients. Despite these deficiencies, TBAs continue to practise in appreciable numbers and their services continue to be on demand in the communities under study. Nearly all of the clients interviewed had started to use TBAs by the age of 25 and 50% had used TBAs for all of their deliveries. Most TBAs provide antenatal care and 77% had a case load of less than five clients per month. Ninety-six per cent of the clients had not been referred by the TBA before. Although 61% of clients felt TBAs in a future pregnancy and 49% would recommend TBA care to other women. Low socio-economic status, illiteracy, poor awareness of modern maternal health (MCH) facilities, personalized care, strong family influence and easy access to TBA services were strong factors promoting traditional midwifery in the LGA. If adequately trained, equipped, supported and supervised, TBAs can contribute towards safe motherhood in Nigeria and in other developing countries.

Adult↗
PubMed2005

Nurse and client perceptions of home health wound care effectiveness after a change in Medicare reimbursement.

The purpose of this study was to begin to explore client and nurse perceptions related to how a change in a Medicare reimbursement, Prospective Payment System (PPS), affects home health care. The target population included home health clients with stage III or greater decubitus ulcers, age 65 years or older. Six Virginia home health agencies were randomly selected. From those sites, all 39 charts that met population criteria were accessed and analyzed, and then 16 care recipients were purposely selected. In addition, 26 home health nurses with pre- and post-PPS experience were purposefully selected. Semistructured, audiotaped interviews were conducted, transcribed, and analyzed using thematic content analysis. Results demonstrated PPS adaptive behavior and an increase in use of education and family caregivers related to wound care. Themes that emerged included professional competence, caregiver as key, and sense of support. Perceptions emphasize the necessity for resource management, collaboration, and patient advocacy.

Adaptation, Psychological↗
PubMed2005

Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study.

BACKGROUND: Many health professionals lack the skills to find and appraise published research. This lack of skills and associated knowledge needs to be addressed, and practice habits need to change, for evidence-based practice to occur. The aim of this before and after study was to evaluate the effect of a multifaceted intervention on the knowledge, skills, attitudes and behaviour of allied health professionals. METHODS: 114 self-selected occupational therapists were recruited. The intervention included a 2-day workshop combined with outreach support for eight months. Support involved email and telephone contact and a workplace visit. Measures were collected at baseline, post-workshop, and eight months later. The primary outcome was knowledge, measured using the Adapted Fresno Test of Evidence-Based Practice (total score 0 to 156). Secondary outcomes were attitude to evidence-based practice (% reporting improved skills and confidence; % reporting barriers), and behaviour measured using an activity diary (% engaging/not engaging in search and appraisal activities), and assignment completion. RESULTS: Post-workshop, there were significant gains in knowledge which were maintained at follow-up. The mean difference in the Adapted Fresno Test total score was 20.6 points (95% CI, 15.6 to 25.5). The change from post-workshop to follow-up was small and non-significant (mean difference 1.2 points, 95% CI, -6.0 to 8.5). Fewer participants reported lack of searching and appraisal skills as barriers to evidence-based practice over time (searching = 61%, 53%, 24%; appraisal 60%, 65%, 41%). These differences were statistically significant (p = 0.0001 and 0.010 respectively). Behaviour changed little. Pre-workshop, 6% engaged in critical appraisal increasing to 18% post-workshop and 18% at follow-up. Nearly two thirds (60%) were not reading any research literature at follow-up. Twenty-three participants (20.2%) completed their assignment. CONCLUSION: Evidence-based practice skills and knowledge improved markedly with a targetted education intervention and outreach support. However, changes in behaviour were small, based on the frequency of searching and appraisal activities. Allied health educators should focus more on post-workshop skill development, particularly appraisal, and help learners to establish new routines and priorities around evidence-based practice. Learners also need to know that behaviour change of this nature may take months, even years.

Adult↗
PubMed2006

Medical student and academic staff perceptions of role models: an analytical cross-sectional study.

BACKGROUND: This study explored the associations between the perceptions of students and the perceptions of academic staff about the characteristics of clinical lecturers at the Department of Internal Medicine at Kerman University of Medical Sciences (KUMS). It also assessed what characteristics constitute a 'role model' from the point of view of students and staff. METHODS: Staff and students were questioned about the characteristics of their colleagues and lecturers, respectively. They were asked about 15 characteristics under four headings: personality, teaching skill, group working and overall performance as a role model. Associations between lecturers' characteristics were explored using Pearson correlation and characteristics were allocated into groups by partition cluster method. In addition, predictors of being a valuable lecturer were assessed using logistic regression analysis. RESULTS: Based on staff responses, the strongest association observed was between honesty and being respectful (r = 0.93, p < 0.0001). Based on student responses, the strongest association observed was between being professional and honesty (r = 0.98, p < 0.0001). None of the correlations between student and staff perceptions were significant for any characteristic. Two groups were recognized among the characteristics. group one contained those characteristics which were related to the lecturer's activity; while the second group contained characteristics that were related to the personality or teaching performance of the lecturer. The predictors of lecturer as 'role model' (i.e., perceptions of students) consisted mostly of characteristics from the first group, while the predictors of a 'role model' by fellow academic staff consisted of characteristics that were in both groups. CONCLUSION: These findings showed considerable differences between the perceptions of students about their lecturers when compared with perceptions of staff about their colleagues. Students were more concerned with the personality of their lecturers, while staff also considered their ideas and behaviors. This suggests that a more comprehensive assessment of a lecturer's performance could be obtained by taking into account feedback from both students and colleagues.

Adult↗
PubMed2005

Online clinical reasoning assessment with the Script Concordance test: a feasibility study.

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6th year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence.

Clinical Competence↗
PubMed2003

Promoting the dignity of the child in hospital.

This article aims to deconstruct the concept of dignity in a way that is meaningful, in particular to nurses and other health workers who seek to promote the dignity of children in their care. Despite the emphasis in a variety of codes and policies to promote dignity, there is a lack of a clear definition of dignity in the literature. In particular there is little reference to dignity, theoretically or empirically, as it relates to children. Without clarity it is not possible to act in an ethical way on behalf of children whose dignity could otherwise be compromised. The theoretical position taken has evolved from the medico-nursing and philosophical discourse concerning the nature of human dignity and more recent sociological texts that discuss the social construction of the child and childhood. The article is further influenced by additional insights derived from an ethnographic pilot study at a large district general hospital. This study was undertaken in an attempt to appreciate the subjective experience of dignity by children, and to begin to address the empirical gap in the literature and promote discussion. The concept of a macro and a micro dignity is discussed, together with the role of the nurse in articulating the relationship between the two. The importance of control and witnesses in the experience of dignity is discussed and, finally, also the ethical implications when seeking to promote the dignity of children.

Anthropology, Cultural↗
PubMed2006

Developing the concept of moral sensitivity in health care practice.

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team's understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.

Adult↗
PubMed1997

Dubious and bogus credentials in mental health practice.

Within an ethics framework, this article explores mental health practitioners' use of credentials that lack acceptable accreditation or authority. Increased competition among mental health care providers has elevated the importance of credentials for marketing professional services. Practitioners worried about economic survival, along with certain personality characteristics (e.g., sheer ego), are tempted to rely on credentials that lack proof of quality, thereby potentially jeopardizing professionalism. Specific assertions and recommendations are set forth in the interest of safeguarding consumers and promoting professionalism.

Counseling↗
PubMed2000

When expertise and ethics diverge: lay and professional evaluation of psychotherapists in Israel.

Do psychotherapists' unethical practices influence how they are perceived? The 202 Israeli lay and professional psychology participants rated systematically varied descriptions of effective therapists and potential clients under conditions of no difficulties (standard), practice without a license, and a previous sexual boundary violation on indexes of evaluation and willingness to refer. Participants completed a measure of important variables in therapist selection. Effective standard therapists were rated most favorably, unlicensed therapists were rated favorably, and therapists who violated sexual boundaries in the past were rated least favorably. When results were analyzed by respondent characteristics, laypersons rated unlicensed professionals (p < .01) and sexual boundary violators (p < .0001) more positively than did clinical psychologists. Men rated the violators more favorably than did women (p < .05). Factor analysis of therapist selection measures identified professional and personal factors, but only the former were associated with ratings of "problem" therapists. The results underscore the gap between ethical standards and applied decisions made by professionals and laypersons. Further investigation is needed to ensure quality care in both professional and consumer approaches to psychotherapy.

Attitude of Health Personnel↗
PubMed2003

A survey on low-dose oral contraceptive transactions at pharmacies.

Low-dose oral contraceptives (OCs) were approved by the Japanese Ministry of Health, Labor and Welfare in 1999. However, few women use low-dose OCs (married 1.9%, unmarried 0.7%). A survey of pharmacies was conducted to determine the current status of OC transactions. Of the 449 pharmacies randomly selected from each prefecture in Japan, 408 agreed to be interviewed. The survey results indicated that few pharmacies (15.1% of the total) stocked low-dose OCs. Even among pharmacies where they were available, only a few (13.5%) offered a wide variety of low-dose OCs for immediate dispensing. The price of low-dose OCs varied widely (yen 1,167-yen 7,000). In many pharmacies, the amount of space and interior structure were not adequate for users to seek advice on and receive low-dose OCs. The survey revealed that the current environment of many pharmacies is not adequate for users to visit, consult on OC use, and receive their prescriptions. To promote wider use of low-dose OCs, the facilities of pharmacies as well as the behavior of pharmacists need to be improved to safeguard the privacy of users.

Contraceptives, Oral↗