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The nurse practitioner: redefining occupational boundaries?

This paper explores aspects of the controversy and conflict that has arisen within the nursing and medical professions regarding the emergence of nurse practitioners in the United Kingdom (U.K.). Difficulties in establishing satisfactory definitions of nurse practitioners, that allow them to be viewed decisively either within nursing or medical occupational roles, are discussed. The paper argues that the key to the debate may hinge on professional and occupational boundary redefinition which is currently resisted by some members of both the nursing and medical professions. The idea that nurse practitioners may be an evolving and discrete professional group, outside the currently accepted professional and occupational definitions of nursing and medicine, is explored. It is argued that both nursing and medicine are faced with a particular challenge in the nurse practitioner movement that is resulting in conflict as new boundaries are established.

Humans↗

Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders.

BACKGROUND: This review provides an overview of the range of methods that have been developed for the assessment of exposure to risk factors for work-related musculoskeletal disorders. METHODS: Relevant publications and material on exposure assessment techniques have been gathered for inclusion in this review. RESULTS: The methods have been categorized under three main headings: (1) self-reports from workers can be used to collect data on workplace exposure to both physical and psychosocial factors by using methods that include worker diaries, interviews and questionnaires; (2) observational methods that may be further subdivided between (a) simpler techniques developed for systematically recording workplace exposure that enable an observer to assess and record data on a number of factors using specifically designed pro-forma sheets for establishing priorities for workplace intervention; and (b) advanced techniques developed for the assessment of postural variation for highly dynamic activities that record data either on videotape or are computer analysed using dedicated software; (3) direct measurements using monitoring instruments that rely on sensors attached directly to the subject for the measurement of exposure variables at work. CONCLUSIONS: The choice between the methods available will depend upon the application concerned and the objectives of the study. General, observation-based assessments appear to provide the levels of costs, capacity, versatility, generality and exactness best matched to the needs of occupational safety and health practitioners (or those from related professions) who have limited time and resources at their disposal and need a basis for establishing priorities for intervention.

Disclosure↗

[Attitude of nursing staff towards the nursing profession and work community].

This study discusses the attitudes of nurses and other nursing staff towards the nursing profession; their views on the community in which they carry out their daily work; and their opinions on how their job is being affected by ongoing efforts to develop the hospital organization. The study was carried out in two hospitals, where we selected for closer analysis the nursing staff of the inpatient wards (N = 153). The data were collected using a semi-structured questionnaire. Methods of statistical description included percentage distributions, means and standard deviations, and cross tabulation. Content analysis was used in the case of the open-ended answers. The majority of the nursing staff described the general atmosphere of their work community as open. It was also widely agreed that cooperation among different occupational groups on the ward was good or fairly good. Both of these factors were considered essential in view of the common objective of improving nursing quality. All occupational groups had a high regard for their profession. Similarly, most of the respondents believed that with the general development of nursing they would be able to further develop their own professional competence. About half of nursing staff took a positive attitude towards the ongoing campaign to develop the hospital work organization; they were described as justified and meaningful. This campaign implied, for example, a stronger patient-orientation and an improved quality of nursing. Most of the respondents felt they had good opportunities to influence decision-making in matters related to their own daily job. However, there were also critical voices saying that most innovations are in practice implemented by hospital management.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

The Nursing & Allied Health (CINAHL) data base: a guide to effective searching.

The Cumulative Index to Nursing & Allied Health Literature is now available online through both BRS and DIALOG. Known as the NURSING & ALLIED HEALTH (CINAHL) file, it is the data base of choice for professionals in these fields. Unlike the National Library of Medicine's Medical Subject Headings (MeSH), CINAHL has a strong nursing orientation and a specific, current nursing vocabulary. Search techniques are similar to those used on MEDLINE since CINAHL has adopted the powerful MeSH tree structure format. The arrival of this data base is a significant advance for the nursing profession.

Health Occupations↗

Challenges and strategic solutions for a research emergent profession.

This paper explores some of the truisms associated with evidence-based practice. The intention is to remind the reader that evidence-based practice is a decision-making tool and not a rule; and to propose a strategic approach to overcoming the challenges we face as a research emergent profession.

Empirical Research↗

Moving toward a core curriculum in Schools of the Allied Health Professions: knowledge and skills considered important by department chairs in four disciplines.

An adaptation of the Delphi method was used in four parallel studies to survey chairs of baccalaureate programs in clinical laboratory sciences, health information management, occupational therapy, and physical therapy in schools of the allied health professions which held membership in the Association of Schools of the Allied Health Professions. The purpose was to assist the chairs in coming to consensus regarding requisite knowledge and skills of graduates beyond those required for professional accreditation and credentialing, and prerequisite or cognate courses that may be utilized to develop them. Three rounds of questionnaires were administered to each group. The final round was completed by 45 chairs in clinical laboratory sciences (83% of the population); 18 in health information management (86%); 18 in occupational therapy (56%); and 24 in physical therapy (67%). Statistical analysis of third round responses via one-sample, one-sided Z tests indicated consensus among the chairs in the four disciplines on 16 items of knowledge and skills as most important for graduates. Similar consensus was not evident, however, regarding courses to develop the knowledge and skills, with only two courses considered most important by all four groups of chairs.

Allied Health Personnel↗

Historical research methods in occupational therapy.

This article discusses the process and methods of historical research in relation to occupational therapy. The paper reviews the process of writing history, including data gathering, organization, and interpretation as well as the responsibilities of the historical researcher. The authors propose that the methods of historical research can be used by occupational therapists as a means to develop a body of knowledge about the profession's history.

Data Collection↗

Retention strategy: a clinical ladder for occupational therapists.

This article explores the issue of retention of occupational therapists and its impact on the facility, client, department and the profession. It also describes the use of a clinical ladder as a retention tool and presents the experience of one clinical facility in developing a clinical ladder. The literature, in association with the experience of the aforementioned clinical facility in the development of a clinical ladder in an occupational therapy department, does not provide conclusive evidence of the efficacy of a clinical ladder as a retention tool. However, it does lend enough support for the concept to encourage its further use in occupational therapy departments. There is a need to be creative in the design of retention methodologies which will decrease turn over and attrition from the profession in order to provide a stable pool of personnel to agencies that employ occupational therapists.

Career Mobility↗

An overview of occupational hazards among veterinarians, with particular reference to pregnant women.

Veterinarians are challenged by an imposing group of occupational hazards, including exposure to ionizing radiation, injury, infectious agents, and chemicals. In this paper, the health hazards in the typical veterinary practice are inventoried, and the risks of each are assessed. During the past few decades, there has been a significant increase in women entering the veterinary profession. Information is presented concerning the impact of various occupational hazards on the health of female practitioners and paraprofessionals, particularly in regard to the reproductive system. Many of the occupational hazards are exclusively, or more significantly, detrimental to females (particularly when pregnant) and to their unborn. Women must be aware of and avoid these hazards in their clinical environment. The purpose of this review is to assist practitioners in identifying and assessing the hazards in their practice and determining what steps must be taken to eliminate or reduce them.

Animals↗

Risk of affective and stress related disorders among employees in human service professions.

OBJECTIVES: To examine the risk of affective and stress related disorders among men and women employed in human service professions. METHODS: Population based case-control study using data from national registers. Cases (n = 28 971) were identified in the Danish Psychiatric Central Research Register among all hospitalised patients and outpatients aged 18-65 who received a first time ever diagnosis of affective (ICD-10, F30-39) or stress related (ICD-10, F40-48) disorder from 1 January 1995 to 31 December 1998. Each case was assigned five never admitted referents (n = 144 855) of the same gender and age, randomly drawn from a 5% sample of the Danish population obtained from Statistics Denmark's Integrated Database for Labour Market Research. Occupation held the year before matching was classified according to the Danish version of the International Classification of Occupation. Health care, education, social work, and customer services were defined as human service professions and constituted 21% of all employed in the study. Adjusted risks (hazard ratios) relative to all other occupations were calculated for 24 human service occupations. RESULTS: The relative risk of depression in human service professions was 1.35 (95% CI 1.24 to 1.47) for women and 1.49 (95% CI 1.29 to 1.73) for men. The risk of stress was 1.18 (95% CI 1.11 to 1.26) for women and 1.49 (95% CI 1.32 to 1.67) for men. Specific professions contributed differentially to the magnitude of risk, with education and social services displaying the highest risks. No increase in risks was found in customer service occupations. Gender was a significant modifying factor with the highest risk levels in men. CONCLUSIONS: There was a consistent association between employment in human service occupations and the risk of affective and stress related disorders. Risks were highest for men working in these typically female professions. More work is needed to distinguish work hazards from effects attributable to selection mechanisms and personality characteristics.

Adult↗

[Early diagnosis and classification of occupational fluorosis].

On the basis of evaluating the clinical course and supplementary method of examination carried out in 132 patients suffering of professional fluorosis and in 200 workers in the premorbid state the author proposes criteria of early diagnosis. Considering Zislin's classification of professional fluorosis, literature data and own findings the author introduces 2 new criteria in the classification, namely, content of fluorine in the urine and length of work in this profession.

Air Pollutants, Occupational↗

Physician shortage in occupational and environmental medicine.

OBJECTIVE: To determine future training needs for physicians in occupational and environmental medicine based on goals established by the Institute of Medicine (IOM) for clinical practice in the field. DESIGN: A critical review of previously published estimates of the need and supply of physicians with clinical training in occupational and environmental medicine with the application of currently available data to produce revised estimates. MEASUREMENTS AND MAIN RESULTS: Need estimates reviewed from the National Institute for Occupational Safety and Health, the Graduate Medical Education National Advisory Committee (GMENAC), and the Bureau of Health Professions. Supply figures reviewed from GMENAC, the American Medical Association, the American College of Occupational Medicine, and the American Board of Preventive Medicine. Revised need figures are based on the estimated number of occupational and environmental physicians needed to provide adequate nationwide coverage as full-time academic faculty, community-based specialists, and public health physicians in state and local agencies. Revised supply estimates are based on review of available data. Need is estimated at 4600 to 6700 physicians (board-certified or eligible or with special competence in occupational and environmental medicine). Supply is estimated at 1200 to 1500. CONCLUSIONS: This review identified a deficit of 3100 to 5500 physicians in this newly evolving specialty. In order to address this shortfall in the next decade, graduate specialty training would need to be increased to about 3 to 5 times the current maximum capacity.

Environmental Health↗

Confluence: moving forward with affective strength.

The term confluent education describes a flowing together of the affective and cognitive elements of learning. Confluent education accords high value to affect because of its core principle that the realization of human potential includes attention to the affective elements of human nature. This article reviews the literature on confluent education, extends a previous introduction of the topic, and proposes an integration of affect into all realms of occupational therapy practice. The visual metaphors, philosophical principles, and practical strategies developed in the literature on confluent education are useful when applied to the functions of occupational therapy practitioners engaged in direct care, education, or research. Because the contexts within which occupational therapy practice occurs today often challenge its affective elements, the author proposes confluence as a timely approach. To advance into the future with the affective strength that has characterized occupational therapy since its inception is a matter of reclaiming the profession's heart.

Cognition Disorders↗

Putting occupation into practice: occupation as ends, occupation as means.

This article addresses a difficulty that many occupational therapists experience: maintaining occupation as the core of their therapeutic intervention. This difficulty not only results from but also contributes to occupational therapy's struggle with professional identity. Current manifestations of the problem are described as component-driven practice and the narrowing of occupation to basic activities of daily living. The concepts of occupation as ends and occupation as means are proposed as a practical solution to guide treatment planning and merge remediation and adaptation within a single occupational session. Each concept is investigated in terms of its history within the profession and its usefulness for analyzing and solving therapeutic problems. These concepts are discussed as useful guidelines to help occupational therapists not only in their clinical decision making but also in their understanding and expression of the field's unique expertise. A case example, applying occupation as ends and occupation as means to evaluation and treatment, is presented.

Activities of Daily Living↗

An interdisciplinary pediatric rehabilitation project in Vietnam: the Temple team experience.

Four faculty members (two nurses, one physical therapist, one occupational therapist) from the College of Allied Health Professions, Temple University in Philadelphia, PA, were invited to Vietnam in March 2001 to present an interdisciplinary workshop on cerebral palsy to the rehabilitation staff at a large hospital for children in Hanoi. The purpose was to present lectures on pediatric rehabilitation, to demonstrate techniques, to conduct clinical assessment rounds, and to increase the staff's knowledge about outcome evaluation. After adjusting to the cultural differences, the team worked with Vietnamese professionals in their respective fields. The goals of the workshop were met except that it was not possible to evaluate outcomes by customary methods. However, trainees indicated verbally that they understood the new materials and techniques. The workshop was part of an ongoing project in rehabilitation in Vietnam that is sponsored by Health Volunteers Overseas, a voluntary agency in Washington, DC.

Attitude of Health Personnel↗

[Is drug dependence an occupational risk for physicians?].

Physicians are probably a high-risk group for the development of dependency. In addition to the particular demands associated with the profession of medicine, another cause is to be sought in the specific aspects of a doctor's personality. Occupational stress and an inability to develop adequate compensatory mechanisms can lead to burnout and addiction. Over and beyond treatment, rational prophylaxis is urgently required, and this should not fail to include a critical consideration of the self-image of the medical profession.

Alcoholism↗

Cause and control: education and training of professional industrial hygienists for 2020.

By the year 2020, the environmental movement will have established a recognized profession, expert at studying deleterious effects in the working and public domains. Environmental science practitioners will be better able to identify and relate ill effects to the presence of adverse agents in the environment; they will not, however, necessarily be skilled at developing systems for control. Industrial hygienists should provide the unique and special skills required to establish economically optimum control systems. Industrial hygiene should by then have been redefined to emphasize this critical role of its professional members. A new orientation for education is therefore proposed to provide a sound basis for the professional needs of industrial hygienists who should be at the peak of their careers in 2020. Members of the profession should then be the leaders in research on, and practice of, the science and engineering of design, installation, and monitoring of control systems for occupational and environmental hazards. The preferred educational background for entry to the profession should be some branch of engineering, which by then must have recovered its lost status and be divided into fewer specialized compartments than it is today. Engineering should provide a broader base for students entering professional education in this field, who will be more concerned with prevention and engineering control of both occupational and environmental hazards, rather than with measurement and epidemiology of the biological and toxicologic sciences. Preparation for professional work in industrial hygiene will call for the specialized education of engineers required to design and maintain processes that minimize the use, production, or generation of hazardous substances.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗

Industrial vision revisited.

With the Occupational Safety and Health Act of 1970 and other government agencies addressing the protection of employees from occupational hazards at their work place, there has been a reemphasis in the industrial eye care field. Industrial vision programs are reviewed and an overview of the Army's occupational vision program is presented. If optometry is to continue progress in this sphere of public health, optometrists must become more involved in and knowledgeable of the visual requirements of the local industrial community, and the profession should consider the establishment of a certification program for occupational doctors of optometry.

Military Medicine↗