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PubMedDate not supplied

Practice characteristics of dental hygienists operating independently of dentist supervision.

PURPOSE: This paper presents business characteristics of ten experimental independent dental hygiene practices operating in California between 1987 and 1990. Sixteen dental hygienists participated in the experiment, the Health Manpower Pilot Project 139 (HMPP 139). HMPP 139 dental hygienists wanted to work independently in traditional office-based settings, institutional settings, and other arrangements. They worked in group and solo practices, on a full- or part-time basis. METHODS: Data were collected from the HMPP 139 practices on services provided, patient visits, fees charged, referrals to dentists, acceptance of Medicaid patients, and services to organizational clients. Data collection methods varied, depending on the question addressed. Surveys of dentists' offices provided data on fees and Medicaid policies for comparison with the independent dental hygiene practices. RESULTS: All experimental practices attracted new patients for each quarter in operation. These practices mostly provided prophylaxis treatments; however, a wide variety of services was provided. Fees charged in HMPP 139 office-based practices were less than comparable fees charged in dentists' offices. At least one-third of patients in the HMPP 139 office-based settings received a referral to or an opinion about a dentist from the dental hygienist. HMPP 139 practices were more available to Medicaid patients than were California dentists offices. Each experimental independent practice provided care to at least one client in a nontraditional setting. CONCLUSIONS: The HMPP 139 practices consistently attracted new patients. This suggests independent practice for dental hygienists may be a viable and flexible alternative if the practices can stabilize total patients at a sufficiently high level. An independent practice alternative might increase access to care, contain fees, and direct the flow of patients to dentists. Further study is needed to test these findings.

California↗
PubMed1997

[Guidelines for clinical practice].

Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete suggestions for the various steps in the development of guidelines and their actual compilation.

Adolescent↗
PubMedDate not supplied

Is dental hygiene a profession? A literature review.

From a literature review of theories of professionalism, the historical development of the attributes of a profession are discussed. This paper then discusses various theories of professionalism and specifically examines the extent to which the criteria developed by Greenwood are fulfilled by dental hygiene. Greenwood's model, which discusses certain attributes that a profession should possess, is selected to provide a broader model to analyze the current professional status of dental hygiene. Greenwood's model states that a profession has acquired: 1) systemic theory, 2) authority, 3) community sanction, 4) ethical codes, and 5) a culture. The author will conclude by suggesting possible steps the dental hygiene profession could continue to take to acquire these attributes and thereby recognition as a profession by other professions, governments and the public.

Canada↗
PubMed1998

["All that time we were working hand in hand ..." a comparative study on the effects of professionalization on German and American intensive care nurses].

The discussion about improving and reevaluating nursing education and nursing practice in Germany is often oriented at the US-american nurses' training. Here one finds a higher degree of professionalisation and university nursing programs. A German-US-American comparative study of 13 ICU nurses each analyzes what effects a higher degree of professionalism has on every day nursing practice. Using the data of structured interviews, dimensions of job perception and aspects of coping capabilities with stress in regard to patient care and relation with physicians of both nursing groups are compared. Results show that US-American nurses often refer to cognitive aspects of being in control of a situation and emphasize their professional part. When assessing their experiences they mainly describe actions they took emphasizing cooperation and help they gave each other. German nurses accentuate the emotional side, describing fear, anger, rage and helplessness. In their relations with physicians the US-American nurses are more likely to insist on their nursing competence, while German nurses tend to be annoyed, resignated, and try to withdraw from the situation. These differences are discussed in relation to the different nursing programs. The US-American education, stressing supervision and the ability to reflect upon one's action seems to have a positive influence on coping capabilities and enhance job satisfaction.

Adaptation, Psychological↗