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PubMed2005

Implementing clinical guidelines for nutrition in a neurosurgical intensive care unit.

Patients in neurosurgical intensive care have individual needs concerning nutrition because of their conditions. An important therapeutic goal is to prevent the development of malnutrition as it contributes to an increase in mortality and enhances the risk of complications in these patients. The health-care team has a mutual responsibility for this, although it is a complex task and a correct assessment of patients' nutritional needs is vital. Multidisciplinary clinical guidelines focused on nutrition might help the health-care staff in decision-making and allowing individualized treatment for patients. The aim of this study was to evaluate the implementation and use of such a guideline. The results show that the guideline is used in varying degrees by the health-care team. Areas that focused on more practical aspects of nutritional support seemed to have a unified approach, whereas areas on nutritional assessment and routine nutrition orders demonstrated both a lack of knowledge and unclear role responsibilities. The results reveal how different professional groups in health care perceive the implementation of a clinical guideline. Some areas need further clarification, there needs to be continuing development of nutritional guidelines, and education of staff is needed in order to enhance the nutritional care of patients.

Critical Care↗
PubMed2005

Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development.

AIMS AND OBJECTIVES: The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long-term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs. BACKGROUND: Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner. DESIGN: This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development. METHODS: This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates. RESULTS: Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter-professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team. CONCLUSIONS: There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors. RELEVANCE TO CLINICAL PRACTICE: A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi-disciplinary teams. A greater level of day-to-day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.

Adaptation, Psychological↗
PubMed1997

Long-term ventilation in children with severe central nervous system impairment.

Absent from the list of indications for long-term ventilation (LTV) is its use for children with severe central nervous system impairment, including those with severe mental retardation or in a permanent vegetative state. Over a two year period, we evaluated eight children with severe CNS dysfunction for whom long-term ventilation was being contemplated. Of these eight patients, three were in a permanent vegetative state and the remainder were severely neurologically impaired, with minimal cognition. The following recommendations were developed: (1) LTV for patients in a permanent vegetative state is inappropriate. (2) In a patient with severe neurologic disease, the process of informed consent must be viewed as dynamic; once the patient's condition is diagnosed, discussion should begin about the likely course of the disease (upper airway obstruction, respiratory failure, or both) and available treatment options. (3) Continued efforts must be made to resolve conflicts between healthcare professionals and surrogates concerning aggressive support of children with severe CNS dysfunction. Discussions should continue even after a decision to provide long-term ventilation is made. (4) Currently, requests by surrogates for LTV in patients with severe neurologic impairment are usually honored because of respect for family values. (5) Physicians and other healthcare professionals should develop an open and fair process for determining inappropriate care. (6) Once LTV is initiated, efforts to transfer the child to home or a long-term care facility should be made. Further life-saving support should be discouraged. (7) Irremediable patient suffering is reason to refuse a surrogate request for LTV. A patient's preservable existence might be so torturous, painful, or filled with suffering that continued medical intervention would be inhumane or abusive.

Adolescent↗
PubMedDate not supplied

Putting CATS/APEL accreditation into practice.

Expanding opportunities mean that many nurses wish to update and extend their knowledge. A comprehensive framework for credit accumulation is needed. All practitioners must record their professional development in a personal profile or portfolio.

Accreditation↗
PubMed2005

The childbirth expectations of a self-selected cohort of Western Australian women.

OBJECTIVES: to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. DESIGN: a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. SETTING: : Perth, Western Australia. PARTICIPANTS: two hundred and two women who were pregnant or who had birthed within the last 12 months. FINDINGS: five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. IMPLICATIONS FOR PRACTICE: the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.

Attitude to Health↗
PubMed1994

Site coordinators: a critical component in providing quality nursing education at distance sites.

The Site Coordinator performs a critical role in the success of distance education in both continuing education and the RN/BSN program. As the local agent, the Site Coordinator is essential for the development of a relationship between the main campus and the distance site. These important people can ease, guide, support, and promote the ongoing development of self-directed learning skills--essential tools for professional lifelong learning.

Education, Nursing, Baccalaureate↗
PubMed2005

Synergy: a framework for leadership development and transformation.

The Synergy Model has been adopted as an organizing framework for nursing practice, education, and leadership at Clarian Health Partners, Inc. of Indiana. This article describes the evolution of educational programs at Clarian, in concert with the implementation of the Synergy Model. Philosophical and operational changes in staff orientation, professional development, and management development are described.

Career Mobility↗
PubMed2001

Continuing-education needs of the currently employed public health education workforce.

OBJECTIVES: This study examined the continuing-education needs of the currently employed public health education workforce. METHODS: A national consensus panel of leading health educators from public health agencies, academic institutions, and professional organizations was convened to examine the forces creating the context for the work of public health educators and the competencies they need to practice effectively. RESULTS: Advocacy; business management and finance; communication; community health planning and development, coalition building, and leadership; computing and technology; cultural competency; evaluation; and strategic planning were identified as areas of critical competence. CONCLUSIONS: Continuing education must strengthen a broad range of critical competencies and skills if we are to ensure the further development and effectiveness of the public health education workforce.

Credentialing↗
PubMedDate not supplied

Developmental supervision for nurses.

Developmental supervision is gaining increasing recognition in nursing as a form of clinical supervision that will promote professional growth and ultimately lead to improved patient care. Benner's (1984) model of career development is used as a framework in which to examine appropriate forms of supervision for each developmental stage. Directive, collaborative and non-directive supervision are applied to each of these developmental levels.

Career Mobility↗
PubMedDate not supplied

Hospital grand rounds in Australia.

OBJECTIVE: To determine whether grand rounds are becoming less common in Australian hospitals. DESIGN AND PARTICIPANTS: Between November 2003 and April 2004, we surveyed 88 clinicians with educational responsibilities in Australian hospitals. A written questionnaire evaluated whether grand rounds were held and how frequently; the structure and percentage of attendees; and the perceived value of grand rounds with regard to education, professional development and general characteristics. RESULTS: Clinicians in 73/88 hospitals completed the survey (83% response rate). Of the 73 respondents, 63 reported that their hospitals continued to hold grand rounds, and most considered them to be valuable in the areas surveyed. Grand rounds were more common in larger hospitals, public hospitals, and those having junior medical officers. The proportion of clinical staff regularly attending grand rounds was estimated to be 10%-50% by most respondents. CONCLUSION: Grand rounds continue in the majority of hospitals and are considered valuable for educational and professional reasons. There may be scope for improving attendance at grand rounds by greater emphasis on the specific needs of attendees.

Attitude of Health Personnel↗
PubMed1999

Seven years on: distance learning courses for first level registered nurses and midwives.

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.

Education, Distance↗
PubMed1992

The value of systematic reading. Retaining and applying current information is vital in developing leadership ability.

Keeping up-to-date, having the right information, and growing in knowledge and awareness are more important than ever. Reading is one of the primary ways to develop professional expertise and leadership ability--and to stay competitive. Many persons are facing the new reality: Job security is an inner factor based on inner competence. Part of that competence has to do with one's ability and skill in continually learning. People who read not only develop more competence in their current abilities but, equally important, develop confidence in their ability to learn and meet the demands of accelerated change. Reading helps people stay up-to-date and broaden their perspectives. Reading also provides enjoyment. But if we do not remember and apply what we read, it has little value. People therefore must read widely and read deliberately for retention and application. To make reading a part of their lives, people must make a commitment to read every day, read material that interests them, visit bookstores and libraries, work at retention and application, discuss with others what they are reading, and test what they read against their own experience.

Administrative Personnel↗
PubMed1965

CONTINUING MEDICAL EDUCATION: SOME THOUGHTS ON SPONSORSHIP.

The proper role of departments of continuing medical education in the medical faculties of universities needs to be more clearly defined. Much of the initiative for the development of extramural postgraduate instruction in this country came from organized medicine. The individual practising doctor has traditionally made his needs known most effectively through his professional organizations and should be encouraged to continue to do so. The individual doctor, professional organizations, hospitals and medical schools are all vital elements in any successful program of continuing medical education. A variety of administrative patterns may well emerge, each adapted specially to the region it serves. With a sense of urgency and the co-operation of all concerned, rapid progress in this important field is clearly possible.

Education, Medical, Continuing↗
PubMed1999

A review of intensive care nurse staffing practices overseas: what lessons for Australia?

In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes.

Cost Control↗
PubMed2000

A review of intensive care nurse staffing practices overseas: what lessons for Australia?

In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes. (c) 2000 Harcourt Publishers Ltd.

Journal Article↗
PubMed1996

The process of developing and validating national core competencies for diabetes educators.

The National Core Competencies for Diabetes Educators were developed on behalf of the Australian Diabetes Educators Association between July 1994 and November 1995. This paper traces the development of the competencies including the rationale for undertaking the project, the process involved and the measures taken to ensure their relevance and validity. The limitations of applying the competency concept to health professionals are discussed. The paper also explores issues affecting professional bodies which attempt to define and document competencies and describes some of the obstacles which may be encountered during the process.

Accreditation↗
PubMed2004

Finding the right complementary therapies course.

Over the past 8 years the number of full time, Complementary Therapies degree courses provided within UK Universities has increased from less than five to currently almost one hundred. In addition, the developments within the Further Education and private sector have added to the increase in provision. With so many different courses on offer, finding the most suitable, quality course is becoming a challenge for applicants. Course titles provide little insight into the philosophy, nature and quality of provision while details within an institute's prospectus or web site frequently do not clearly identify distinguishing features. Key characteristics of quality provision to look for in a course in complementary therapies are discussed. Aspects considered include: the type of institute, modes of study, which therapy and its current regulation, the skills development and clinical experience opportunities, the balance of subjects within a course, the experience of the teaching team and their research activities. Discussion is included of the need for adequate quality assurance procedures to ensure courses evolve to continue to meet the needs of those entering the rapidly developing profession. The relationship of the provider and the appropriate professional bodies is also discussed. A summary of aspects to consider when looking for a comprehensive, quality course has been provided in Table 2.

Complementary Therapies↗
PubMed2002

The Brighton Collaboration: addressing the need for standardized case definitions of adverse events following immunization (AEFI).

UNLABELLED: To further scientific progress of immunization safety, comparability of data from clinical trials and surveillance systems is essential. Comparability requires the availability of standardized case definitions for adverse events following immunization (AEFI) and guidelines for case determination, recording and data presentation. METHOD: International collaborative working groups, consisting of professional volunteers from developed and developing countries, conduct systematic literature reviews to develop 50-100 AEFI definitions. Case definitions are finalized after a comment period by a reference group consisting of organizations concerned with immunization safety, and will be disseminated via the world-wide-web and other means for free world-wide use. RESULTS: Literature reviews yielded substantial diversity in data collection and presentation. We have developed standardized case definitions together with guidelines for use in clinical trials and surveillance systems. CONCLUSIONS: Diversity in safety methods leads to considerable loss of scientific information. We have built the necessary international network of currently about 300 participants from patient care, public health, scientific, pharmaceutical, regulatory and professional organizations to develop and assess standardized AEFI case definitions and guidelines. Evaluation studies, global implementation, ongoing definition development and a continuously growing network will be essential for the success of the collaboration.

Adverse Drug Reaction Reporting Systems↗