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Staff development is an accepted and essential part of health care and nursing. Understanding how the principles of health care reform--simplicity, quality, savings, and choice--interact within the framework of staff development sets the stage for understanding the professional and business opportunities awaiting staff development educators.
OBJECTIVE: To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. SUMMARY BACKGROUND DATA: The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeon's life, and the quality of patient care. METHODS: Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. RESULTS: After the work-hour changes, surgical residents have decreased "burnout" scores, with significantly less "emotional exhaustion" (Maslach Burnout Inventory: 29.1 "high" vs. 23.1 "medium," P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was "somewhat worse" because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient-focused, less continuity of care with a loss of critical information with each handoff, and a decrease in the patient/doctor relationship. CONCLUSION: Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.
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Continuing education is now recognized as essential if nursing is to develop as a profession. United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) consultations are currently seeking to establish appropriate preparation for a 'higher level of practice' in the United Kingdom. The relevance of Masters level education to developing professional roles merits examination. To this end the results of a 10-year follow-up study of graduates from the Masters programme at the University of Edinburgh are reported. The sample was the entire cohorts of nurses who graduated with a Masters degree in the academic sessions from 1986 to 1996. A postal questionnaire was designed consisting of mainly closed questions to facilitate coding and analysis but also including some open questions to allow for more qualitative data to be elicited. The findings indicated clearly that the possession of an MSc degree opened up job opportunities and where promotion was not identified, the process of study at a higher level was still perceived as relevant to the work environment. This applied as much to the context of clinical practice as to that of management, education or research. The perceived enhancement of clinical practice from a generic Masters programme was considered a significant finding. Also emerging from the data was an associated sense of personal satisfaction and achievement that related to the acquisition of academic skills and the ultimate reward of Masters status. The concept of personal growth, however, emerged as a distinct entity from that of satisfaction and achievement, relating specifically to the concept of intellectual sharing, the broadening of perspectives and the development of advanced powers of reasoning.
The development of transitional care is one of the major challenges for the twenty-first century as the survival rates and medical outcomes for child and adolescent recipients of transplants continue to improve. Such developments must include both paediatric and adult providers and is likely to require training of professionals in both arenas. Transition is a multidimensional process with transfer to adult care, only one event within that process. The aim of this paper is to present the philosophy of transition and an evidence-based approach to transitional care in terms of the need for it, proposed models of care and the evidence of the benefits of transitional care programmes. Examples of some key clinical aspects of transitional care including communication skills, parenting, self advocacy, vocation will be presented. Adherence issues will be presented in accompanying papers in this journal. Finally, potential barriers to successful transition will be explored.
Knowledge and skills in biomedical sciences have reached a level, which is difficult to pass on to students in the traditional one to two years by traditional lecture methods and are still expanding. Recently, innovative methods of enabling the students to acquire the knowledge and skills have been evolved, and include student-centered and problem-based learning strategies, among others. These are strategies in which the student is taught how to learn for him/her self and then becomes responsible for his/her own learning with a certain minimum amount of guidance from the teachers. Other advantages of using these strategies of learning and teaching include development of competencies in continuous self and peer evaluation, self-directed learning leading to continuing medical education for life, team work, professionalism and professional ethics. These strategies also increase the chances of attitudinal molding, enhancing good personal characteristics while discouraging bad ones. Communication skills are greatly enhanced.
BACKGROUND: This article describes how nurse educators at The Hospital for Sick Children, Toronto, have used Benner's findings as a framework to direct the advancement of professional development programs, specifically preceptorship, orientation, and central education programs. METHOD: Narrative methodology was introduced as a key educational strategy to capture the complexity of pediatric clinical practice and enhance learning experiences. RESULTS: The shift in content and structure of the education programs from a structured behavioral teaching-learning framework to the use of narrative methodology has enhanced learning, professional development and clinical practice. CONCLUSION: Participant evaluations of these programs suggest a high level of satisfaction with the use of narrative methodology. Evaluative measures focusing on the relationship between narrative methodology, professional development, and client outcomes is needed. This evaluative approach that measures outcomes is imperative to future directions in program planning.
An international program in health professions training has involved the development of a teaching materials library by teams of African faculty authors and U.S. instructional materials specialists. Communications difficulties and differences in culture and technology have made it necessary that the instructional designers develop new production and management strategies, in order to meet program objectives and to assure the quality of the teaching materials. These strategies would seem to have continuing applications to domestic as well as international instructional development programs.
Communication plays a vital role in an increasingly complex healthcare environment. Quality patient outcomes and successful collaboration depend upon the healthcare provider's ability to communicate needs. A self-directed work team at a large southeastern hospital used a quality improvement process to design a new series of workshops to enhance staff communication skills. The redesigned programming reduced duplication of education content and built upon a conceptual foundation that cultivates professional development. The workshops feature content such as self-awareness, personal effectiveness, and leadership of others.
In the field of continuing postgraduate education, the reading of professional journals is an accepted method of keeping informed in regard to new developments and contemporary thought on different philosophies of treatment. Not only is such reading realized as being an efficient educational vehicle, but there is now a growing awareness of the actual necessity for any clinician to set aside specific time to the exercise. It is not always readily apparent, however, how great the time commitment can be, even when the reading is limited to selected articles. This paper sets out to indicate in quantitative terms the time that could be expected to be utilized by both general dental practitioners and academic teachers if a thorough and conscientious perusal of the journals were to be undertaken. A practical strategy for facilitating at least part of the problem is put forward in the hope of reaching a helpful compromise.
Staff development specialists were surveyed regarding their reasons for participation in continuing nursing education programs. Hospital-based staff development specialists (n = 279) from American Hospital Association member facilities responded to the Participation Reasons Scale (PRS). Using a Likert scale 1 to 7 rating, mean scores ranged from 3.52 to 6.40. There were significant differences in the responses of certified and noncertified staff development specialists for four items. Those with a mandatory requirement for continuing education responded differently from those without the requirement. Findings can help continuing education professionals make decisions about programming.
Nursing in Slovenia is undergoing an extensive series of changes as the country adjusts to its recent independence. Nursing is succeeding in its professional development with the establishment of university degree programmes, active participation at international conferences and contributions to international publications. Nursing research is being carried out by individual nurses and through the WHO Collaborating Centre. Continued professionalization is being planned and the Nurses Association of Slovenia is vital to its implementation.
This paper outlines the results of a national census of practice nurses in England and Wales. It not only shows that the numbers of practice nurses have increased dramatically in recent years but also demonstrates how their role has evolved. Many practice nurses are now involved in health promotion, and home visiting, as well as advice and counselling. The findings also indicate that many practice nurses express a need for training. Continuing education for practice nurses is important in ensuring practice nurses are fully qualified and trained for the tasks they undertake. In addition, it also enables them to develop their role and work alongside other community health professionals.
In nursing, purposeful career planning is essential if nurse practitioners want to make the right decisions about their work in order to strive towards and accomplish a meaningful quality of working life. Nurses should identify their career goals to be able to investigate their different career opportunities in their field of interest and direct their work according to a work strategy for years ahead. The purpose of this study was to explore and describe the career goals of post-basic nursing students with the aim of describing management strategies to guide the future career of post-basic nursing students in climbing the career ladder effectively and obtaining their set career goals. An explorative, descriptive, qualitative design was selected where the researcher worked inductively to explore and describe the needs (goals) and future planned actions of the participants regarding their career management as viewed for a period of five years. The researcher purposively and conveniently identified the sample as all the post-basic nursing students, namely 250 students, who were registered for the first, second and third year of nursing management courses in that period at a South African residential university. Two structured, open questions were developed. Each participant received the questions in writing and was asked to answer them. The QSR NUD*IST program was used for the qualitative management (categorization) of data. The results of the research questions related to five categories, namely becoming empowered, being promoted, being educated and professionally developed, partaking in research and taking up new projects.
The successful treatment of pediatric malignancy by multimodality therapy has improved the outcome for children with cancer. It has been estimated that 0.1% of individuals 20 years of age are survivors of childhood cancer. This represents a large cohort nationally who, with maturation, may be increasingly beset by the medical and social consequences of treatment. The study of long-term effects of cancer chemotherapy has grown enormously in the past decade. Any side effect that does not resolve after the completion of therapy is a long-term effect of therapy. Side effects recognized during the therapeutic period are usually addressed by the treating physicians. More problematic are those effects of therapy that are subclinical at completion of therapy but manifest years later. These are the true late effects of therapy and are the focus of this review. The cytotoxic effects on maturing tissues become apparent only with development. Thus physical, intellectual and pubertal development as well as reproductive potential may be impossible to assess for a decade or more, depending upon the age at the time of treatment. Nonetheless, the ability to predict the likelihood of a given adverse outcome is enormously helpful to the survivor and may allow for the mitigation of severe effects. Organ injury may also be subclinical initially. With aging and additional stress, compensatory mechanisms may fail. The development of effective screening methodologies may be essential for early interventions. Lifestyle changes may reduce exposure to further toxins and mutagenic agents such as alcohol and cigarette smoke that may lead to secondary malignancy, particularly if compounded in some instances by genetic predisposition. Programs for survivors of childhood cancer were developed within pediatric oncology. As the children become adults, the likelihood of continued care at the initial treating institution decreases. Oncologists and other health care professionals who become responsible for the health care of this maturing cohort will need to understand the risks engendered by childhood cancer therapy.
The history of psychoanalysis in Germany during the Second World War must be seen in the context of institutional and professional developments along the lines of the intersection of medicine and psychology during the first half of the twentieth century. The moral ambiguities of the integration of psychoanalysis and psychotherapy into the structures of modern industrial society were magnified and brutally supplemented in the course of the partial professionalization of these disciplines in Germany under the Nazi dictatorship. A study of the continuities in the history of psychoanalysis and psychotherapy in Germany since 1939 can provide insight into the moral and practical vicissitudes of professionalism in modern society as well as into the social history of Germany under Hitler.