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PubMed2005

Contextual factors influencing research use in nursing.

BACKGROUND: Contextual factors are perceived to be significant barriers to research-utilisation-related activity, but little is known about how context impacts on specific research-based decisions, or how the individual interacts with the organisation in the requirement for research-based change. AIM: This study describes the impact of contextual factors on the practical reasoning of nurse specialists in the construction of policy for practice. METHODS: Three groups of clinical nurse specialists were observed during a series of meetings convened to construct evidence-based guidelines for nursing practice. Transcripts of the meetings were analysed to identify and categorise the physical, social, political, and economic influences on 31 nursing issues. FINDINGS: Multiple contextual factors influenced each decision made, with decisions about nursing practice bounded by setting and system considerations, relationships with others in the care team, and resource constraints. Practitioners were involved in weighing up alternative scenarios, contexts, and contingencies for each decision, requiring strategies to adapt and reconstruct the nature of care, to influence others, and to affect organisational decision-making processes. DISCUSSION: The practical accomplishment of evidence-based practice required diverse skills: translating between evidence and practice; mediating the values, preferences, and working practices of multiple stakeholders; negotiating organisational complexity and the management of boundaries; and coordinating inter-organisational and inter-agency working. Nurse specialists in this study had a significant role in instigating, fuelling, and coordinating policy review, predominantly by communication across professional and organisational boundaries. IMPLICATIONS/CONCLUSIONS: Clinical specialists acting as organisational boundary spanners require skills in the informal cultural work of organising, facilitating, and maintaining links across professional, team, and organisational boundaries. If their role in the negotiation of evidence-based practice patterns across professional and organisational boundaries is to be successful, wider skills than information management need to be recognised and their development and enactment supported.

Decision Making, Organizational↗

PubMed2001

Practice unwinds and disengagements.

Many employed physicians are being forced to consider entering the private practice arena as physicians networks and groups are contemplating total or partial divestitures. Still other physicians are evaluating the possibility of leaving their current practice or hospital based network and opening their own practice. This article is designed to better prepare a physician for this situation ad proactively plan for their future.

Community Networks↗

PubMed2002

But what are we trying to prove?

Chaplaincy and Clinical Pastoral Education (CPE) in the health care setting can and should approach their ministries more scientifically, primarily by incorporating the methods and results of quantitative and qualitative research. Such an approach, however, should have a carefully considered rationale. Proponents of a scientific approach should avoid associating their advocacy with dubious notions of health care "reform." They should attend to the perceptions--and fears--that chaplains may have of "science" and research as these affect pastoral care. In particular, fears for professional and programmatic survival should be recognized for their potential to predispose chaplains either favorably or unfavorably toward a scientific approach. Ultimately, chaplains should increase their openness to scientific methods in order to learn more about their ministry and improve their practice, without expecting that the adoption of research methods will be a magical solution to the problems posed by the current environment.

Chaplaincy Service, Hospital↗

PubMed2001

Dialysis patient characteristics and outcomes: the complexity of social work practice with the end stage renal disease population.

This article describes a demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients. The study is unique in including an interdisciplinary research team to guide the process, using available data contained within the medical record and focusing on interventions and outcomes over time rather than at one or two points in patients' treatment histories. It demonstrates the complexity of practice with dialysis patients and the crucial role for social workers in enhancing patient outcomes. Secondary benefits of this methodology and implications for social work practice and research are discussed.

Academic Medical Centers↗

PubMedDate not supplied

[10 years' research in the social sciences on AIDS in Burkina Faso. Elements for prevention].

The first cases of AIDS in Burkina Faso were reported in 1986. During the past ten years, there have been several types of research conducted in Burkina Faso in the field of social sciences, including KABP, focus groups, and ethnographic studies. This article reviews approximately 100 publications and presents the results most relevant to prevention. Although general knowledge of the disease, its transmission and means of protection has improved, part of the population remains poorly informed; erroneous ideas remain prevalent and certain concepts, for example asymptomatic infection, are ignored. Young women in rural areas have the poorest knowledge. Understanding the information is conditioned by underlying perceptions of blood and physiology, the "components of the person", pre-existent and sexually transmitted diseases, and modes of transmission. Research on sexuality has elucidated the age at which individuals become sexually active, and paramatrimonial practices. The prevalence of STD is high. STD are mostly treated by traditional practitioners or by automedication. Family planning is insufficiently developed. AIDS prevention should be integrated into wider considerations of reproductive health. The popular perception that "Others" are responsible for bringing AIDS into the country has often been reinforced by health messages. Consequently, people do not sufficiently consider themselves vulnerable to HIV infection. The populations that are most vulnerable, for various reasons that have been analysed, include young girls and women, married women, prostitutes, truck drivers, and young men from rural areas. The message "Fidelity or condom" has been widely used. However, it has hindered the generalisation of the use of condoms, because asking for a condom consequently implies distrust of the partner. The interpretation of fidelity is diverse, and many people who choose this means of prevention believe erroneously that they are protected. Studies of the social impact of AIDS reveal fragmentation of society, reactions causing social exclusion and discriminative practices, and no social visibility of HIV infected persons. After ten years of preventive actions, the prevalence of HIV is still increasing, evidence of the failure of the preventive strategies. It is no longer sufficient to see prevention as the transfer of knowledge from professionals to the population. Preventive strategies such as voluntary testing and the participation of HIV+ persons in informative actions need to be developed. Prevention should be understood on new bases. The concept of "vulnerability" might help the definition of in-depth actions and also focus interventions. The idea of developing social cohesion to confront the epidemic may help avoid some of the adverse consequences of previous actions. Do these concepts conform to current AIDS prevention attitudes? To answer this question, social scientists should study the ideologies, knowledge, beliefs, and practices of institutions and professionals working in the field of AIDS prevention.

Acquired Immunodeficiency Syndrome↗

PubMed1984

Medical history as justification rather than explanation: a critique of Starr's The Social Transformation of American Medicine.

This paper discusses the major positions presented in Paul Starr's The Social Transformation of American Medicine and critically analyzes the major ideological and political assumptions that sustain Starr's explanation of the evolution of the institutions of medicine in the United States. These assumptions include, among others, that the evolution of medicine is an outcome of conflicts among the different interest groups that exist within medicine, interacting within the parameters defined by the majority of Americans whose beliefs and wants eventually determine what occurs in medicine, and the hegemonic positions in the ideology, practice, and institutions of medicine are dominant because of their powers of persuasion. This paper questions these positions on theoretical and empirical grounds and it presents an alternative explanation of the evolution of medicine. In this alternate explanation, the evolution of medicine (including its recent corporatization) is viewed as the outcome of power relations defined not by the majority of Americans but by a series of conflicts between classes, races, genders and other power groupings, within a matrix of dominant-dominated relations, in which dominance is reproduced by coercion and repression, and not merely by persuasion. Specific historical events are analyzed and alternative explanations are given to Starr's interpretations.

Attitude to Health↗

PubMed1978

The hospital as 'medical practitioner'.

Many institutions are "practicing medicine" in their communities by creating new services or adjusting existing ones to match perceived community needs. This trend has implications for governance and the role of the physician in planning and quality assurance.

Community-Institutional Relations↗

PubMed1986

Professional behavior in collaborative practice.

Cost containment, increased severity of illness, earlier patient discharge, and high staff turnover are causing nurse executives to implement new systems of health care delivery. One such delivery system, collaborative practice, strives to maximize efficient and effective use of staff, to improve nurse retention, and to enhance patient care. The authors present one approach to implementing collaborative practice and the empirical findings related to the system's impact on physician-nurse professionalism.

Connecticut↗

PubMed1993

[Activity of the Department of Clinical Epidemiology during the 25 years of its existence in the clinical arena].

Twenty-five years ago in the Institute of Tuberculosis and Respiratory Diseases in Bratislava was created a Department of Clinical Epidemiology. It was the first department to bear this title. The authors analyze the activity of this department. They paid special attention not only to quantitative characteristics of the gained results, but also to the description of the used strategy in inserting clinical epidemiology into practice of institutions of therapy and prevention. After the lapse of 25 years the authors consider the establishment of the mentioned department as a correct decision which led to qualitative improvement and more effective activity of the Institute. (Ref. 8.)

Epidemiology↗

PubMed2004

Negotiating multiple roles: link teachers in clinical nursing practice.

BACKGROUND: The background to this study was a concern about the teacher's role in clinical practice. Experience suggested that teachers believed that their role in practice was important but that there were significant forces which impeded their ability to move with ease between education and practice. A discrepancy between previous research findings and theoretical discussions, and the reality experienced by teachers, led to the adoption of grounded theory as a way of exploring uncertainties in the situation. METHOD: Data were gathered over a period of 7 years and involved 28 in-depth interviews with nurses with a range of educational roles, employed in educational institutions and practice settings in inner city and provincial areas in the South of England. FINDINGS: The data revealed four categories, 'gaining access', 'negotiating credibility', 'being effective' and the core category 'negotiating multiple roles'. The core category is addressed in this article. Experiences of moving from a position of clinical practitioner to link teacher involved: 'disassembling the self' through leaving behind old identities; 'reconstructing the self' through clarifying new ways of being; and, finally, 'realizing the self' through reciprocal interpersonal activity with students, educational and nursing colleagues. CONCLUSIONS: It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co-ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice.

Clinical Competence↗

PubMed1991

Ambulatory care--1990: a view from the trenches.

In summary then, many of the changes that have accompanied the massive shift to outpatient care in the past decade have been good. However, change itself is not inherently good, and the effect of change upon the individual physician is extremely important. In my opinion, the increasing hassle, overregulation, and second guessing that have accompanied recent changes have had a significant negative effect upon physicians. The signs of this happening are clear. This in turn does not bode well for patients and the quality of medical care that will be available to them in the future. I would submit that the focus of any scrutiny of the benefits of changes in our medical care delivery system should be the practicing physician. The impact of such changes upon physicians and their ability to carry out their mission of patient care will provide our best guide for the course that we choose for our future.

Ambulatory Care↗

PubMed2001

Using available clinical information in practice-based research: mining for silver while dreaming of gold.

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated "gold standard" experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.

Data Collection↗

PubMedDate not supplied

[Psychology and psychopathology of women undergoing voluntary abortion].

When facing the abortion question the following are necessary: more complete information on the consequences of indiscriminate sexual relations; a wider spread knowledge of contraceptive practices; the institution of special aid to unmarried mothers so as to prevent abortion remaining the only possible solution for an unbearable situation and which hides a serious psychological risk.

Abortion, Induced↗

PubMed1998

Hospitalists reduce LOS, slash costs in academic medical center.

San Francisco-based Moffitt-Long Hospital introduced a "managed care service" led by hospitalists who practice and teach cost-effective, evidence-based medicine. Hospitalists can significantly reduce costs and length of stay in an academic setting if they get involved early and steer the trajectory of inpatient care.

Academic Medical Centers↗

PubMed1986

Practice implications of health promotion and disease prevention in allied health.

Allied health professionals are practicing health promotion and disease prevention in many settings. This article describes existing practice settings and identifies expanded roles for allied health professionals. Some background on the changing societal expectations regarding health and wellness and a rationale for the health professionals' commitment to health promotion are given.

Allied Health Personnel↗

PubMed1998

Hospitalists: an efficient, new breed of inpatient caregivers.

Hospitalists are a relatively new segment of the physician population (primarily internists and critical care practitioners) specializing in managing the overall care of hospitalized patients, a responsibility traditionally assumed by primary care physicians. Managed care organizations, large medical groups, practice management companies, and hospitals that have adopted inpatient programs incorporating hospitalists report reductions in length of patient stays, decreased costs, and improved efficiency of delivery, with no adverse effect on patient satisfaction. Use of hospitalists is being encouraged by some managed care organizations, but local medical communities remain largely resistant to the introduction of hospitalist programs. Healthcare systems should proactively evaluate the benefits of instituting a hospitalist program.

Attitude of Health Personnel↗

PubMed1981

A practice plan in a municipal teaching hospital: a model for the funding of clinical faculty.

Academic-practice plans have become increasingly important as a source of financial support for the faculty of academic centers. We describe the planning, implementation, and development of one such plan in a municipal hospital, a major affiliate of a medical school. The incorporated practice plan is nonprofit and is owned and governed by physicians. Its success during the eight years of its existence has resulted in growth of the faculty, the development of innovative ambulatory-care programs, and increased financial stability of the hospital. Although such problems as payment for teaching costs and academic advancement for primary-care physicians remain, it is clear that academic-practice plans can support the clinical, teaching, and research goals of academic physicians.

Community Health Centers↗

PubMed2005

Does anything go? Towards a framework for the more transparent assessment of psychoanalytic competence.

It has been difficult to know what does and does not constitute competent psychoanalytic work and so equally difficult to assess when it is being practised and when it is not. This makes difficult any form of disciplined evaluation of the outcome of training, which has a series of problematic outcomes for psychoanalytic practice, psychoanalytic institutions and the relationship to allied disciplines and professions. In this paper, the author considers how far it might be possible to devise aframework for assessment of training programmes within a disciplined psychoanalytic pluralism. The aspiration is to develop a transparent framework, based on an empirically supported demonstration of analytic capacity. The framework needs to be sensitive and subtle, and to be able to withstand challenge. It needs to take cognisance of the twin facts that there is more than one way to practise psychoanalysis and that it is necessary to avoid 'anything goes'. Drawing on an ongoing project undertaken by European IPA institutes, the author describes some of the problems colleagues have been experiencing in European institutes, because they have not had available transparent criteria for assessment. He outlines a preliminary form of a proposed method for making more transparent and supportable assessment. The author intends for this paper to inspire hope, enquiry and debate.

Awareness↗