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Novice to expert: an application of the Dreyfus model to management development in health care.

It has been the intent of the authors to describe a management development method which has as its basis a way to differentiate methods for skill development based on levels of skill acquisition. The intent is to provide an efficient and effective framework within which management development can occur as well as to test the utility of the Drefus model in the critical arena of developing management talent in health care environments. Further work and experience with both the model and the skills identified will continue.

Hospital Administrators↗

Use of survey information to develop a hospital-based medication teaching program.

As the volume of prescribed medications and complexity of regimen continue to rise, medication instruction is imperative, particularly for patients with chronic illness who must care for themselves without direct supervision of health care professionals. However, as hospital acuity levels increase and lengths of stay decrease, limited opportunity exists to adequately prepare hospitalized patients who are to be discharged with new prescriptions. Hospital-based medication teaching programs must be designed so that they encourage patient-professional interaction, yet also conserve nursing staff time. In this project, members of a hospital-based, interdisciplinary committee used survey information to develop a basic medication instruction program that emphasized 'need to know' content. The program was designed to involve patients and also to encourage them to seek additional information from other providers. Potential for successful implementation was enhanced by participation of nurse managers who developed the pilot implementation procedure.

Data Collection↗

SHORT REPORT Competence unfurled: Developing portfolio practice.

In this report some of the characteristics of competence are explored. Learning is identified as a feature of competence. If occupational therapists are to survive and thrive in a changing world they need to develop and use their learning skills effectively to maintain competence and to develop proficiency and expertise. Occupational therapists should take steps to document evidence of evolving competence in order to demonstrate professional growth over time, and justify continued registration with their regulatory body.

Journal Article↗

The HIV clinical tutorial for community mental health professionals.

HIV disease is an emerging community mental health concern. The need for specialized training to help community mental health professionals develop comprehensive knowledge and skills to serve this new population of clients is evident. The HIV clinical tutorial model is an innovative approach to continuing education characterized by an experiential and clinical orientation, a small participant group, and an interdisciplinary faculty. The three-day intensive workshop provides participants with experiences that can alter their perspective toward clients affected by HIV/AIDS and toward the role of the mental health system in responding to this epidemic. Similar training programs should be developed nationwide through collaboration among medical schools, teaching hospitals, public health departments and community mental health centers.

Community Mental Health Services↗

To do or not to do: use of the scope of professional practice in accident and emergency work.

The Scope of Professional Practice has the potential to revolutionise the practice of Accident and Emergency nursing. However, for such a revolution to take place re-evaluation of the thinking and doing of Accident and Emergency nursing is needed. In particular, many organisational approaches to work such as team-building and multidisciplinary work need to be recognised and the place of the nurse within them formalised. The make-up of nurses' work in Accident and Emergency needs to be understood, so that expansion of the role can encompass a wide range of 'caring' work as well as easily identify tasks. In addition the use of the Scope of Professional Practice should be based upon clarification and recognition of dilemmas which may lead to informed risk taking by Accident and Emergency nurses. Once nurses' work in Accident and Emergency is understood, the short- and long-term effects on the continuity of patient and family care of nurses' actions and non-action can be explored. Communication is seen as underpinning all professional and care development in relation to the use of the Scope of Professional Practice in Accident and Emergency. The art of listening as well as talking to colleagues, patients and families is important if the revolution is to take place.

Emergency Nursing↗

Modularisation - flexible or restrictive professional education.

In response to the Dearing Report [Higher education in the learning society. Report of the National Committee of Inquiry into Higher Education. HMSO, London, 1997] modularising courses has been a major activity in schools of nursing and midwifery. This should make it easier for students to transfer between courses, university to university with credit for academic achievement. In respect of mental health nursing students the effect upon opportunities for personal and professional development is considered. The paper questions whether a modular framework of learning experiences meaningfully prepares students for their future as mental health nurses. The continued use of an adapted [A. Beattie, in: P. Allan, M. Jolley (Eds.), The Curriculum in Nurse Education, Croom Helm, London, 1997] fourfold curriculum model in working with students is contrasted with the process of modularisation. Challenges that have arisen for mental health nursing lecturers to continue with this are discussed.

Curriculum↗

Ethics in perioperative practice--duty to self.

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this fifth of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the fifth statement, which emphasizes commitment to one's self.

American Nurses' Association↗

"Patient counselling" by pharmacists: four approaches to the delivery of counselling sequences and their interactional reception.

'Patient counselling' by pharmacists is a diverse and ill-defined activity. It is also an activity which is achieving more prominence as part of the 'extended role' which is seen as the way forward for the profession. This paper uses data from a hospital paediatric outpatient clinic in the United Kingdom to examine the process of patient counselling from a conversation analytic standpoint, with a particular focus on the varying ways in which these sequences are set up and the ways in which patients or carers respond. Four types of interactional approach to negotiating entry into a broadly defined 'patient counselling' sequence are identified. These approaches are considered within the broader frameworks of delicacy, morality and competence which impact upon the giving and receiving of advice and information more generally, as well as in this setting, and in the light of the continued development of the 'extended role'.

Communication↗

[Risks, chances and perspectives of restricting the free choice of doctors by patients].

Population surveys regarding free access to primary care physicians and medical specialists focus on selected aspects of public opinion. They are helpful but not sufficient in answering the relevant question: 'What are appropriate and efficient ways of access to the health care system?'. More important than survey results would be options for practical decisions by the patients themselves, based on a system offering different possibilities of choice. Competent piloting by 'gatekeepers' would need a problem- oriented and patient-centred medical education for primary-care physicians, starting during medical education and training and continuing throughout the professional medical careers. It should focus on three additional issues: New, alternative and unbiased ways of access to medical care should be developed, tried and evaluated to ensure beneficial use of the full potential of our health care system.

Forecasting↗

The match between motivation and performance management of health sector workers in Mali.

UNLABELLED: Human resources for health (HRH) play a central role in improving accessibility to services and quality of care. Their motivation influences this. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. OBJECTIVES: To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management. METHODS: First an exploratory qualitative study was conducted: 28 interviews and eight group discussions were held. This was followed by a cross-sectional survey, during which 370 health workers were interviewed. The study population consisted of health workers of eight professional groups. The following issues were investigated: motivating and demotivating factors; experiences with performance management, including: job descriptions, continuous education, supervision, performance appraisal and career development. FINDINGS: The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal). Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4x per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition. The results enabled the research team to propose adaptations or improvements upon existing performance management. CONCLUSION: The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation. This can be done by matching performance management activities to motivators identified by operational research.

Journal Article↗

The development of the paediatric nurse specialist.

Paediatric nurse specialists have, in the past, pioneered new roles in response to clients' needs. As a result, clinical practice and the service provided to families have been innovatory. Future paediatric nurse specialists will continue to lead and develop clinical practice through audit and research.

Job Description↗

Teaching basic ethical concepts and decision-making: a staff development application.

Academic nursing programs are increasing the amount of ethical instruction presented to undergraduate and graduate students. However, nurses who graduated several years ago may find themselves without the background and skills needed to discuss the complex bioethical dilemmas they now face. This article presents the development of a continuing education program to acquaint nurses with basic ethical concepts and bioethical decision-making processes. Presentations were piloted with a small group of nurses from the outpatient department of a pediatric tertiary care hospital.

Decision Making↗

Professional development in reproductive and sexual health--a pilot study from Suffolk, UK.

Staff from two neighbouring trusts working in the fields of family planning and sexual health worked together to develop joint guidelines and from this evolved a training initiative. It was acknowledged that staff were either primarily trained in family planning or in the management of sexually transmitted infections (ST1) and therefore the training would be interdisciplinary. In line with current educational thinking it was also decided to make it multiprofessional. A pilot training project was therefore set up to answer the question 'can self directed learning combined with facilitated small group study sessions provide theoretical updating for a range of health professionals within the field of reproductive and sexual health'. The project aimed to increase theoretical knowledge of contraception, sexually transmitted infections and termination of pregnancy for all relevant nursing and medical staff working within the two trusts. The stated outcome of the project was for all staff to achieve a wider core knowledge of the identified topics, regardless of whether their primary training and knowledge base was in family planning or sexually transmitted infection. The project spanned five months and offered professional development packages in hormonal contraception, non-hormonal contraception, termination of pregnancy, bacterial and minor STIs and viral STIs. The pilot project was well received and the process was shown to be an effective way of increasing the knowledge base. The knowledge shift was greatest in the opposing discipline to the primary discipline of each participant. There were added advantages in team building for staff within the same trust and networking across trusts. The strengths and weaknesses of the process were identified and used to develop ideas for future professional development initiatives.

Abortion, Induced↗

A spoonful of competence helps the medicine go down.

The Organisation Development Consultancy based in the training department of the North Western RHA has been involved recently in a variety of projects researching into management competencies. This article outlines the findings from a project undertaken at Tameside and Glossop HA. The aim of the research was to provide an information base on which to build an appropriate recruitment and selection strategy and training and development policy for the continued future development of the district.

Administrative Personnel↗

Fast, global, and entrepreneurial: supply chain management, Hong Kong style. An interview with Victor Fung. Interview by Joan Magretta.

Li & Fung, Hong Kong's largest export trading company, has been an innovator in supply chain management--a topic of increasing importance to many senior executives. In this interview, chairman Victor Fung explains both the philosophy behind supply chain management and the specific practices that Li & Fung has developed to reduce costs and lead times, allowing its customers to buy "closer to the market." Li & Fung has been a pioneer in "dispersed manufacturing." It performs the higher-value-added tasks such as design and quality control in Hong Kong, and outsources the lower-value-added tasks to the best possible locations around the world. The result is something new: a truly global product. To produce a garment, for example, the company might purchase yarn from Korea that will be woven and dyed in Taiwan, then shipped to Thailand for final assembly, where it will be matched with zippers from a Japanese company. For every order, the goal is to customize the value chain to meet the customer's specific needs. To be run effectively, Victor Fung maintains, trading companies have to be small and entrepreneurial. He describes the organizational approaches that keep the company that way despite its growing size and geographic scope: its organization around small, customer-focused units; its incentives and compensation structure; and its use of venture capital as a vehicle for business development. As Asia's economic crisis continues, chairman Fung sees a new model of companies emerging--companies that are, like Li & Fung, narrowly focused and professionally managed.

Commerce↗