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PubMed1992

Telephone follow-up of ambulatory surgery patients following discharge is a nursing responsibility.

The ambulatory surgery nurse manages care for a diverse population of patients who may or may not be ideal candidates for early discharge after surgery. Integral to the nursing care is the postdischarge follow-up contact, which allows the nurse to assess the patient's level of recuperation and evaluate the care provided. A number of reasons, besides completion of the nursing process, indicate that this contact is a nursing obligation. These include compliance with national standards of care, improvement of quality of care, and reduction of the facility's liability exposure. These calls also show a sense of caring about patients and help to market the ambulatory surgery program in the community. The nurse develops a true sense of professionalism and often benefits by increased job satisfaction.

Ambulatory Surgical Procedures↗
PubMed1984

A residency program in community pharmacy practice.

As pharmacists increase their involvement in patients' drug therapy, the lack of opportunity for advanced clinical and administrative training becomes more critical, particularly for community pharmacists. To assist in the postgraduate development of community pharmacists, the faculty of pharmaceutical sciences at the University of British Columbia began a residency program in community pharmacy practice in June 1981. Modeled on the successful hospital pharmacy residencies, the program goals are to provide advanced clinical training in ambulatory patient care, and detailed and practical management training, and to develop pharmacists with skill in clinical teaching who will participate in the undergraduate programs of the faculty. The 12-month residency includes guided self-study and a series of practica in areas of therapeutics, management, drug information, clinical and teaching skill, professional service, and continuing education. These practica are served mainly in clinical practice settings such as community pharmacies, clinics, physicians' offices, and teaching hospitals. The residency has demonstrated its value and viability. Growing interest in such programs, and the success of this program in particular, should encourage the development of similar programs in Canada.

British Columbia↗
PubMed1992

Family-centered early intervention: an opportunity for creative practice in speech-language pathology.

Services for developmentally delayed children from birth to age three consider the family first. Eligibility for services is determined through a multidisciplinary assessment. Once a child qualifies for service, a multidisciplinary team that includes the family develops an IFSP. The SLP may serve as the service coordinator for the plan or as a team member. The plans must contain specific information that includes documentation of current status and major outcomes for the coming year. An SLP may find that contributing effectively to an IFSP requires new competencies. First, the SLP will need to learn to function in the family-centered, multidisciplinary process of early intervention. Second, the SLP may need to develop creative models to deliver effective service. SLPs can contribute valuable information to the IFSP by finding ways to activate daily life routines to promote a child's communication skills. SLPs can explore the child's life-space, including routines and partners, as a source of contexts for treatment. SLPs also can explore partner communication strategies, note their effects on the child's communication experiences, and recommend additional strategies for treatment. The case study illustrated an individual, home-based intervention program (Gillette, 1989; Lombardino and Magnan, 1983). Other service delivery models can include classroom-based approaches (Wilcox, Kouri, and Caswell, 1991); group parent training approaches (Weistuch, Lewis, and Sullivan, 1991; Cheseldine and McConkey, 1979); and video-assisted approaches (McConkey, 1988; Johnson and Harrison, 1990; Gillette, in press). Many SLPs may find that the process of early intervention with the birth-to-three population offers unique opportunities for practice in their profession. To function effectively in this process, the SLP needs communication-based information to promote the child's communication skills within his or her daily life and sensitivity with which to design a plan that considers the family first, yet meets the needs of the child. Although alternative models of delivering speech-language service have been explored, the process of early intervention will continue to require professionals who can creatively match family priorities with the child's intervention needs.

Child↗
PubMed2002

Physicians' professional responsibility to improve the quality of care.

Physicians have long recognized a professional responsibility to improve the quality of care. However, that responsibility should be evolving in light of developments in both the science of quality improvement and the ethical base of professionalism. Over the last 30 years, quality science has moved from static/structural measures to a much more sophisticated set of outcome and process issues. It has also self-consciously integrated notions of continuous improvement. The ethical base of professionalism is also more dynamic, today emphasizing the policy activist attributes of so-called civic professionalism. The combination of modern quality measurement/improvement and activist professionalism is a virtual call to arms for the profession to advocate care that is systematically better. Recent developments in the domain of quality dealing with medical errors can be used to illustrate this synergy, and provide a set of mandates for the new professional commitment to quality.

Humans↗
PubMed2002

Evaluation of a family-oriented continuing medical education course for general practitioners.

OBJECTIVE: To explore the long-term effects of a 2-year Family Systems Medicine course. Fifteen experienced GPs participated in the training programme. SETTING: Continuing Education Centre, University of Tampere, Department of Public Health Science and General Practice, University of Oulu, Finland. METHODS: The participants assessed the development of their professional skills on the Doherty-Baird scale and filled in 2 questionnaires. The material obtained from the application form and 2 questionnaires was analysed using the grounded theory method. RESULTS: The reasons for taking part in the course seemed to be the constant increase in the workload, problems caused by the demands for change and adaptation, stress and exhaustion. Furthermore, 10 health centres out of 15 had adopted the population-based practice, which requires different working methods compared to the old routines. Some trainees reported that their family-centred working methods improved during the course. A year after the end of the training, all of the GPs who had participated were using such methods in their daily practice. Half of the participants felt that they had also improved the functioning of their working group by making it more family-oriented. The significance of multi-professional collaboration was one of the most important insights during the course. CONCLUSION: The 2-year family-oriented training programme provided GPs with systemic thinking and with new skills, including the ability to work with families. The programme raised awareness of the need for multi-professional collaboration in the primary care settings.

Adult↗
PubMedDate not supplied

Development of educator competencies and the professional review process.

As staff development educators prepare themselves and their organizations for forthcoming healthcare challenges, educators influence the practice of staff development through the use of competencies. Because competencies and peer review are expectations for staff, educator competencies and educator professional review should be essential for those who train staff. Based upon the American Nurses Association Standards of Practice, National Nursing Staff Development Organization research, and Patricia Benner's work, competencies for educators reflect practice levels from novice to expert and challenge educators to attain levels of excellence in practice. Use of educator competencies includes the professional review process components of peer input, self-evaluation, and portfolio development. Portfolio development provides documentation of educator accomplishments for the organization. This approach to educator competencies serves as a strategy to position educators to meet healthcare demands and demonstrates leadership in the profession. The staff development educators at a large Midwestern health system have refined this process during the past 2 years, and their unique approach to educator competencies and professional review can benefit both individual educators and healthcare organizations now and in the future.

Education, Nursing, Continuing↗
PubMed2006

Learning outcomes and behavioral changes with a pharmacy continuing professional education program.

OBJECTIVE: To examine the results of an interactive curricular-based 3-month long pharmacy continuing professional education (CPE) program on short- and long-term learning outcomes and behavioral changes of current and potential preceptors. METHODS: A CPE program was developed that covered specific disease states and teaching skills. The goals of the course were to provide knowledge and skills needed to precept the College's new advanced rotations, and to attract more pharmacists to serve as preceptors. The course included pre-readings and 3-hour long workshops over a 3-month period of time. Learning and behavior were assessed by a pretest and posttest and follow-up survey. RESULTS: Ninety-nine pharmacists completed the course. Fifty participants completed the assessments and were included in the analysis, yielding a usable response rate of 52%. However, only 30 participants completed the follow-up survey instrument, resulting in a response rate of 30%. There was a significant increase in test scores between the pretest and posttest, but a significant decline in test scores between posttest and the follow-up survey. CONCLUSIONS: An interactive, curricular-based pharmacy CPE program is effective in increasing learning, but participants may not maintain the acquired knowledge over time. The program was not an effective mechanism to attract pharmacists to serve as preceptors.

Behavior↗
PubMed1977

[Surgical intensive care].

Patients for intensive care in surgery can be divided into 3 groups: 1. Patients in poor preoperative conditions which should be corrected before surgery is performed; 2. Patients with extensive operations and expected or unexpected postoperative complications; 3. Patients with extensive traumas. --In the postwar period medicine developed at a tremendous speed. Modern intensive treatment of those patients with managed by a new group of doctors who had based their primary training in Surgery and continued their professional career in Anaesthesiology. In the last two decades, however, pathophysiologic thinking found its way and a new type of surgeon emerged. Special fields such as cardiovascular-endocrinological-gastroenterological surgery etc, appeared. Nowadays preoperative as well as postoperative treatment is considered to be an important factor in surgery and applied by all specialists. --Anaesthiologists however still play a major role in intensive medicine for surgical patients. But due to the fact that surgical training only plays a little or no part in their professional training, their role is hardly more than that of an important and necessary consultant. A new type of a doctor for surgical intensive medicine may perhaps develop somewhere in the future, but at present successful intensive care in surgical patients can only be achieved by perfect cooperation.

Anesthesiology↗
PubMed2002

Easy and effective--web-based information systems designed and maintained by physicians: experience with two gynecological projects.

It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Data Collection↗
PubMed2001

Relapse prevention in schizophrenia: attitudes of neurologists-psychiatrists.

The overall high relapse rates observed in schizophrenia are attributed to several causes. One important factor influencing satisfactory prevention of relapse is the lack of consistent treatment strategies among medical doctors, especially neurologists-psychiatrists. Nearly one-third of the members of the Hellenic Society of Neurology and Psychiatry were asked to fill in anonymously a structured questionnaire on their treatment attitudes and prescribing tactics regarding schizophrenic patients both after the first schizophrenic episode and after multiple episodes. The majority of Greek neurologists-psychiatrists seem to adopt prescribing habits that approximate the current international standards for prevention of schizophrenic relapse. Their attitudes regarding the treatment and prevention of relapse for the first schizophrenic episode and first relapse are determined from multiple factors. These are: the expected relapse rates after the first episode, the expected prevalence of extrapyramidal side effects following a long-term neuroleptic treatment, the patient's expected treatment compliance after the first episode, the doctor's experience with treating schizophrenics, and lastly the knowledge of current literature on the topic. These results point to the need for continuing education, especially of the younger mental health professionals and those working in the private sector, addressing the issue of the actual risk of developing side effects from the treatment. In due course, benefits could result for everyday psychiatric practice and the patients' compliance with treatment.

Adult↗
PubMed1997

Management tools and organization as key factors towards quality care: reflections from experience.

Health care organization in French hospitals has become an increasingly important issue, as efforts to ensure better cost control have increased financial constraints, as patients have demanded ever better results and quality, and as nurses' expectations for better working conditions have grown. Organizing a health care unit requires an articulation between individual efforts--necessary both for gathering accurate information on each patient and for providing patients with personalized care--as well as an integrated system of various logistics, specialized services such as nursing care, custodial care, technical examinations, and administrative procedures. Coordination between these different components continues to be a significant challenge to hospitals, as each category has developed independently its own specialty and sense of autonomy, resulting in different professional rationalities, cultures, approaches, and sometimes conflicting behaviour. Pointing out these difficulties is not sufficient to solve the problem, however, and since the management tools currently in use (activity measurements, procedures used to develop choices and judgements) are often kept in place for external reasons, they may actually perpetuate these behaviours. This paper is a set of reflections derived from a long period of experience and research in the management of French hospitals and health management institutions. It reports that the financial reforms implemented in budgeting procedures for French hospitals, and the efforts to control costs better in the national health insurance system, have resulted in new types of behaviour in physicians, nurses and health care managers, as well as the need for information that deals not only with health care activities but also with quality.

Cost Control↗
PubMed2000

Partnership 2000: a journey to the 21st century.

Building partnerships is a valuable strategy for achieving success in forming a strong foundation for nursing in the 21st century. The demands of the changing health care environment require that managers and staff change the context in which patient care delivery is accomplished. Managers must be willing to unleash the power of the human capital of staff nurses. Staff nurses must be willing to take a seat at the table and share the leadership role with their manager. Both must engage in building an environment that facilitates continued learning, establishes effective relationships with other health care team members and patients, creates an environment that attracts and retains professional nursing staff, expects professional development from one another, and realizes that collective accountability can be achieved through sharing the leadership.

Cooperative Behavior↗
PubMed2002

The interdisciplinary approach to the treatment of multiple sclerosis patients in Italy: an aspiration or a reality?

The aim of the study was to assess whether the components necessary for an interdisciplinary approach to the treatment of multiple sclerosis (MS) patients exist in Italian MS clinics and to identify factors that make the difference between reality and aspiration for this type of approach. One hundred two out of 147 neurology departments with MS clinics throughout Italy compiled a questionnaire about characteristics and organizational structure of the clinic, type and number of professionals and resource needs. Eight hundred twenty-three healthcare professionals are currently working in MS clinics: 50% (412) neurologists, 28.7% (236) nurses, 15.1% (124) physical therapists, 3.4% (28) psychologists and 2.8% (23) social workers. Neurologists are evenly distributed between northern and southern parts of the country even though there are nearly double the number of patients followed in northern dinics compared to those in the south. Physicians reported themselves as most in need of continuing education, twice that which the same physicians reported for any other professional. The study has identified issues that contribute to the difficulty in developing and applying an interdisciplinary approach to providing care and services to Italian MS patients. Several factors have been delineated that require significant reshaping in order for this approach to begin to develop.

Ambulatory Care Facilities↗
PubMed1990

Mental healthcare: expand with caution. There is more involved than financial incentives.

Increased needs, insurance coverage, and physical expansion are evidence of mental healthcare's growth. Greater societal acceptance, the demand for more local care with deinstitutionalization, and liberal reimbursement have expanded mental health services. However, reduced federal funding and competition demand specialization in such areas as geriatric services. Ambulatory services make mental healthcare more affordable and accessible. Providers must target populations who use such outpatient care and study local trends before planning these programs. Inpatient mental health services continue to expand, although at a slower rate. Thus organizations and professionals have begun selective contracting, and capitation reimbursement based on case management is developing. Providers considering expansion or initiation of mental health services confront competitive marketing and must recognize trends in outpatient, chronically ill patient, and after-care services. Strategic planning is essential to uncover opportunities and potential risks. Other issues to consider include the psychiatrist shortage, uncertain payment systems, and a possible reversal of growing mental health services and declining acute care needs.

Attitude to Health↗
PubMed2002

Patient-centeredness: a new approach.

The following six components are necessary for patient-centered care: Exploring both the disease and illness with the patient. As suggested, this is done by asking questions about how the illness impacts the patient. Understanding the whole person. Open-ended questions and cultural sensitivity assist in gaining more information about the patient. Finding common ground regarding management. Dialysis centers can invite patients to treatment planning meetings and involve family. Incorporating prevention and health promotion. Provide patients with information about disease management in a patient-friendly manner. Enhancing the doctor-patient relationship. Authoritative approach that focuses only on the signs and symptoms of patients. In that model of care, the professional asks direct questions and gives patients directives. When failure occurs, it is seen as the patient's fault. The patient-centered model encourages patients' ideas, views patients and physicians as partners, takes patients' emotional and social environments into account, and requires open-ended questions and mutual participation. Embracing patient-centered care is clearly a win-win situation for patients and professionals. When provided with patient-centered care, patients report higher satisfaction and improved outcomes without significant increases in time and money for the provider. Patient-centered care also benefits health care professionals who become more fulfilled by the care they provide. Patient-centeredness is not something that will develop overnight; it will take practice, continued education, and in-services to be effectively provided to patients. For more information on patient-centered care, visit the Mid-Atlantic Renal Coalition's Web site at www.esrdnet5.org

Counseling↗
PubMed2004

Distributed interactive virtual environments for collaborative experiential learning and training independent of distance over Internet2.

Medical knowledge and skills essential for tomorrow's healthcare professionals continue to change faster than ever before creating new demands in medical education. Project TOUCH (Telehealth Outreach for Unified Community Health) has been developing methods to enhance learning by coupling innovations in medical education with advanced technology in high performance computing and next generation Internet2 embedded in virtual reality environments (VRE), artificial intelligence and experiential active learning. Simulations have been used in education and training to allow learners to make mistakes safely in lieu of real-life situations, learn from those mistakes and ultimately improve performance by subsequent avoidance of those mistakes. Distributed virtual interactive environments are used over distance to enable learning and participation in dynamic, problem-based, clinical, artificial intelligence rules-based, virtual simulations. The virtual reality patient is programmed to dynamically change over time and respond to the manipulations by the learner. Participants are fully immersed within the VRE platform using a head-mounted display and tracker system. Navigation, locomotion and handling of objects are accomplished using a joy-wand. Distribution is managed via the Internet2 Access Grid using point-to-point or multi-casting connectivity through which the participants can interact. Medical students in Hawaii and New Mexico (NM) participated collaboratively in problem solving and managing of a simulated patient with a closed head injury in VRE; dividing tasks, handing off objects, and functioning as a team. Students stated that opportunities to make mistakes and repeat actions in the VRE were extremely helpful in learning specific principles. VRE created higher performance expectations and some anxiety among VRE users. VRE orientation was adequate but students needed time to adapt and practice in order to improve efficiency. This was also demonstrated successfully between Western Australia and UNM. We successfully demonstrated the ability to fully immerse participants in a distributed virtual environment independent of distance for collaborative team interaction in medical simulation designed for education and training. The ability to make mistakes in a safe environment is well received by students and has a positive impact on their understanding, as well as memory of the principles involved in correcting those mistakes. Bringing people together as virtual teams for interactive experiential learning and collaborative training, independent of distance, provides a platform for distributed "just-in-time" training, performance assessment and credentialing. Further validation is necessary to determine the potential value of the distributed VRE in knowledge transfer, improved future performance and should entail training participants to competence in using these tools.

Computer Simulation↗