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Education, Nursing, Continuing↗
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Professional corporations--recent developments.
A lengthy, detailed article reviewing legal and tax problems of professional corporations has been withdrawn from this issue of California Medicine. Instead, we are presenting a status report which is simply another chapter in a continuing saga.
Economics, Medical↗
Have you looked in the mirror--what do you see?
"... And What About You?" is a regular column in Advanced Practice Nursing Quarterly featuring multiple facets of personal and career development. This column will provide tools and strategies to support the continual learning that is vital for self management of one's personal growth and career development.
Adaptation, Psychological↗
[Decade of quality health care: dentists in comparison with other health professionals].
In 1990 the Dutch organisations for health care providers, patients-organizations and insurance companies agreed on the implementation of quality systems in health care. Ever since, the health care professions--including dentists--are being involved in the development of quality systems to assure and improve the quality of care. In 2000 a national survey has been conducted to investigate which quality systems already were developed by Dutch health care professions and a comparison between the professions has been made. It appeared that the quality systems of the professions are characterised by four pillars. 1. professional expertise; 2. evidence based guidelines for good practice; 3. peer review directed at continuous improvement; and 4. re-licensing or certification to guarantee the quality. The study showed that the professions differ in the quality policies they pursue and in the progress which has been made. In dental practice an accent in the quality policy is on peer review (whereas in general practice the accent is on guidelines). Ranking the professions in the degree in which the quality system are developed, medical doctors and pharmacists are front-runners, dentist are in the middle rank whereas nurses and psychologists are lagging behind. For the years to come, a priority has been set on further implementation of the quality systems.
Certification↗
Physical assessment in the community pharmacy.
As pharmacists continue to define their role in the health care system of the future and implement pharmaceutical care, they will need new or enhanced skills in managing patient care cost-effectively. Their ability to perform basic physical assessments will be a vital tool in managing their patients' health status. By using the SOAP method of evaluation and plan development and by using a systematic approach to obtaining physical data, pharmacists can properly perform initial assessment and monitor the patients they now serve. This enhanced level of care will be well accepted by patients and other health care team members when pharmacists provide them in a professional manner and serve as partners with these practitioners in developing and managing appropriate care plans.
Aged↗
A community-wide RN refresher course: a collaborative success.
By combining forces, nurse educators and practitioners developed a unique RN refresher course that provided a supportive environment for successful reentry into professional nursing practice. Nursing faculty and administrators from a baccalaureate nursing program collaborated with nursing clinicians from seven acute care hospitals to meet the assessed needs of community nurses for reentry programs. The collaborative effort provided accessible courses at lower costs with qualified faculty and a variety of clinical practice experiences for nurses areawide. This article describes the planning, development, implementation, and analysis of this successful areawide RN refresher course.
Community Health Nursing↗
Development of an instrument measuring Chinese adolescent beliefs and attitudes towards substance abuse.
AIM: To develop an instrument measuring the beliefs and attitudes of Chinese adolescents towards substance abuse. BACKGROUND: It is documented that many negative consequences for youth, including physical, mental and psychosocial health problems are associated with substance abuse. There has led to a growing concern about promoting anti-drug education among health care professionals in Hong Kong. It is therefore important to conduct research on substance abuse to promote more effective anti-drug programmes for adolescents. To conduct research on the above aspect, valid and reliable instruments for measuring factors associated with drug abuse are needed. An instrument, namely the Beliefs and Attitudes of Substance Abuse Inventory (BASAI) was developed for the purpose of this study. DESIGN AND METHODS: Both qualitative and quantitative approaches to instrument development were adopted in the study. There were two phases to the study. Relevant literature and the Delphi technique were employed in the first phase of the study. A panel of experts was interviewed for the development of a pool of items for the instrument. Content analysis was used to manage the qualitative data obtained from the interviews. Factor analysis was used for the psychometric testing of the items of the BASAI. A Cronbach's alpha coefficient was used to test the internal consistency of the instrument. The standard error of the mean (SEM) was measured to further support the reliability of the BASAI. The results are estimates of the validity and reliability of the instrument. RESULTS: Three main categories and nine sub-categories were derived from the interview data in the first phase of the study. The overall inter-rater reliability of the categories was 0.89 (kappa statistics). In the second phase, a Content Validity Index (CVI) of 0.92 for the instrument was achieved with the assistance of another panel of experts. The factor structure of the instrument was identified by undertaking a Principal Component Analysis. Three factors were extracted with a total variance account of approximately 70%. Reliability was established with alpha = 0.82 for the entire scale and a range of 0.78-0.92 between the sub-scales of the instrument. A small SEM of 3.21% was calculated to further support the reliability. CONCLUSION: A culturally sensitive instrument was developed with a satisfactory level of validity and reliability. Further research is recommended to continuously improve and refine the instrument so that it can be useful currently in research and/or practice. RELEVANCE TO CLINICAL PRACTICE: To promote the healthy development of children and adolescents, child health professionals need to implement effective health promotion strategies including anti-drug programmes. The instrument that was developed in this study will hopefully contribute to the development of more effective and evidence-based anti-drug programmes for youths.
Adolescent↗
Medical writing departments in biopharma companies: how to establish a department.
Medical writers have important roles in preparing the documentation for approval for marketing of new products, writing manuscripts for publication, and other nonclinical, clinical, and promotional materials. Medical writing departments can be organized in different ways to accommodate the needs of the company. When organizing a new department or when determining metric for an existing department, it is important to understand what medical writers in the biopharma industry do, how they are recruited and trained, and how metrics are developed.
Drug Industry↗
Presentation skills. Learning unit 070.
This unit forms the first part of the 1997 Clinical Practice and Management Awards (see back page). Anyone who has attended a conference, listened to a talk or heard evidence being presented will know just how important good presentation is. If speakers cannot hold the audience's attention, the message they are trying to convey will fail to be heard, however important it is. Good presentation skills can be developed by everybody using some simple techniques and plenty of practice.
Communication↗
[Psychometric characteristics of questionnaires designed to assess the knowledge, perceptions and practices of health care professionals with regards to alcoholic patients].
UNLABELLED: Failure of the French health care services to diagnose and manage problem drinkers has been established on many occasions. This results from a relative lack of knowledge of the basics of alcoholism and the low level of involvement of health care professionals in the management of these patients. In response to this inadequacy, the French Public Health Ministry promoted the development of managed care and coordination of care for these patients. Teams in charge of coordinating care for problem drinkers have been implanted in 96 French hospitals since 1996. These teams aim to provide support to health care providers caring for problem drinkers. For this purpose, they have delivered continuing medical education designed to prepare health care providers to identify and manage these patients in various settings. However, no formal assessment of the impact of these interventions on the knowledge, perceptions, and practices of health care professionals has been planned. The assessment of these interventions can rely on qualitative methods such as observation, focus groups, or individual interviews. However, qualitative methods require specific skills, are time-consuming, and cannot be implemented on a large scale. In contrast, quantitative methods using survey questionnaires or standardized instruments appear to be more appropriate for large scale or repeated evaluations. However, the accuracy of ratings provided by these instruments can be affected by many methodological factors, including the quality of the instrument in terms of validity, reliability, and sensitivity to changes. The aim of this paper is to describe the properties of French and English language questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients. METHODS: The instruments were retrieved by searching the Medline, Pascal, and Sudoc computerized bibliographic databases from January 1964 to December 2002. The following medical Subject Headings (MeSH) and text words were used: "*alcoholism/psychology/therapy", "questionnaire", "healthy care surveys", "attitude of health personnel", and "*knowledge/attitude/practice". In addition, the table of contents of the French journals devoted to alcoholism that were not indexed in electronic bibliographic databases were examined (Alcoologie et addictologie, Alcoologie). The bibliographies of relevant articles were also examined for additional citations. Finally, a phone survey of 34 professionals caring for alcoholic patients located in French university hospitals was carried out to retrieve unpublished questionnaires. Two authors independently extracted data from each study using a standard date abstract form. Disagreements were resolved through consensus. They extracted information on the development process and properties of validity, reliability, and sensitivity to changes. Validity is a concept concerned with the extent to which an instrument actually measures what it is supposed to measure. It is assessed through different facets (content, construct, criterion, discriminant, and predictive validity). Reliability reflects the amount of error inherent in any measurement. Sensitivity to change corresponds to the property of an instrument to identify small but clinically significant changes in attitude or practice. RESULTS: A total of 57 relevant publications involving 39 original instruments were identified. Eighty questionnaires were not available, despite the solicitation of their developers. Overall, the study included 21 instruments. Of these, 20 were English-language questionnaires and one was in French. The conceptual frameword was specified for only two questionnaires: "the Addiction Belief Scale" and "the Alcohol and Alcohol Problems Perception Questionnaire". The number of items ranged from 9 to 122. Items were derived from qualitative surveys in only two cases. In the other cases, they were derived from the literature, expert panels, or form unknown sources. The internal construct validity of eight questionnaires was assessed using principal component analysis, factor analysis, or cluster analysis. We considered that external construct validity was analyzed by testing empirical hypotheses derived from the literature for 15 of the instruments studied. Predictive validity cas evidenced for only one questionnaire. Internal consistency was documented for seven instruments, using Cronbach's coefficient. Test-retest or inter-rater reliability was assessed for none of the instruments. The sensitivity to change of two instruments was analyzed. The response rate to the instruments ranged from 46% to 93%. DISCUSSION: The main finding of this study is that properties of validity, reliability, and sensitivity of questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are neglected. Moreover, these questionnaires generally lack a theoretical background. Hence, the interpretation of responses to these questionnaires may be misleading. The present study has several limitations. The search strategy could be criticized for searching only a small number of databases, and selecting French and English language questionnaires. However, given the large range of journals included, it was unlikely that the strategy has limited the generality of the results. In addition, we identified no additional relevant articles by contacting professionals working with alcoholic patients in French university hospitals. Articles reporting instruments designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are incomplete. Journals should require minimum evidence of validity, reliability, and sensitivity when reporting results of surveys, development of questionnaires or standardized instruments. CONCLUSION: The psychometric characteristics of French language questionnaires were given very little attention. In order to evaluate the effectiveness of their continuing medical education programs, the teams that train French medical staff caring for alcoholic patients should either develop a standardized survey questionnaire following a strict methodology or translate an English language instrument, which would also require a cross-cultural validation.
Alcoholism↗
Ethnogeriatric education: a collaborative project of Geriatric Education Centers.
Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the GEC Collaborative on Ethnogeriatric Education developed a Core Curriculum on Ethnogeriatrics and Ethnic Specific Modules. Faculty from 34 GECs wrote, reviewed, revised, expanded, and disseminated the Curriculum in Ethnogeriatrics. The 16-module, web-based Curriculum provides detailed information and teaching resources about important historical and cultural influences on the health care experience of the diverse U.S. population of elders. The Stanford GEC has tracked usage of the ethnogeriatric curriculum and reports favorable responses regarding its effectiveness. Many GECs have used the modules in their continuing education programs. GEC faculty share their teaching methods with others at professional meetings and present training sessions in their own geographical areas.
Aged↗
The need to incorporate professional principles, attitudes and ethics in optometric education.
This paper reviews the development of ethical principles for the profession of optometry over the past 90 years, and how these principles have been modified and expanded in conjunction with the scope of practice during that period. The author discusses the mandated principles of licensing boards as well as Medicare and Medicaid requirements. In addition, areas of "non-mandated" ethical principles are reviewed such as the aging and AIDS patient, over testing, continuing education, corporate employment, patient records and referrals. The author suggests that ethical issues should be incorporated into all optometric courses in the curriculum and not just in a specific ethics course in order that many role models offer their input to students in the development of an ethical model for their professional lives.
Attitude of Health Personnel↗
CQI-2--a new measure of holistic interpersonal care in primary care consultations.
BACKGROUND: The Consultation Quality Index (CQI) is a holistic quality marker for GPs based on patient enablement, continuity of the care and consultation length. AIM: To evaluate the CQI-2, a new version of the CQI incorporating a process measure of GP empathy (the Consultation and Relational Empathy Measure). DESIGN OF STUDY: Cross-sectional questionnaire study. SETTING: General practice in the west of Scotland. METHOD: Empathy, enablement, continuity, and consultation length were measured in 3044 consultations involving 26 GPs in 26 different practices in the west of Scotland. CQI-2 scores were calculated and correlated with additional data on GPs' and patients' attitudes. Comparisons were also made with the UK-wide data from which the original CQI had been calculated. RESULTS: CQI-2 scores were independent of deprivation, access, demographics, and case-mix. GPs with lower CQI-2 scores valued empathy and longer consultations less than these GPs with higher CQI-2 scores. 'Below average CQI-2' GPs (those in the bottom 25%) also felt less valued by patients and colleagues. Patients' showed less confidence in and gained less satisfaction from these doctors. Data ranges from the study were comparable with the UK data ranges used to construct the original CQI. CONCLUSIONS: The CQI-2 is a new measure of holistic interpersonal care. In a small but representative sample of GPs it appears to differentiate between below and above average doctors. CQI-2 scores may reflect important aspects of morale, core values and patient-centred care. There may be potential for its use as part of professional development and as a component of the general medical services contract.
Attitude of Health Personnel↗
Child abuse and neglect in American Indian communities.
Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.
Alcoholism↗
[Curriculum revision for a master's program in public health].
The Master's degree program of the Escuela de Salud Pública de México (ESPM) has undergone a continuous process of evaluation and re-design since January 1988. An analysis of the program for 1985 showed problems of organization, sequence and integration of the curricular contents, as well as lack coherence with the stated objectives of the program and with the desired profile of the public health professional. Attention to environmental and population problems was almost absent. The Division of Academic Programs was created, and with the active participation of the academic staff a new design was developed, which resulted in the program to be applied in 1989. The next phase in this continuous process of evaluation and updating consists of the project Prospective Planning for Public Health Education in the Year 2005.
Curriculum↗
Patterns of continuing professional education in registered dietitians and dietetic technicians, registered.
This study compared the continuing professional education (CPE) activities of registered dietitians (RDs) with those of dietetic technicians, registered (DTRs). A descriptive research study was used with data from the baseline survey evaluating the Commission on Dietetic Registration's (CDR) Professional Development Portfolio. The survey was sent to 3,530 randomly selected RDs and DTRs; 1,429 surveys were returned (40.5% response rate), with 41% of RDs contacted responding and 32% of DTRs responding. Guidance used when selecting CPE activities and type of CPE activity selected were measured. DTRs sought more guidance than RDs when selecting CPE activities (P=.001). A significantly higher percentage of RDs than DTRs selected lectures, workshops, journal clubs, satellite courses, exhibits, professional leadership, professional reading, and poster sessions as CPE activities (P<.05). These findings will aid CPE providers in knowing which CPE activities are typically selected by both dietetics credential groups. DTRs may need guidance in selecting CPE activities.
Adult↗
Comparison of roles and professional development needs of nurse executives working in metropolitan, provincial, rural or remote settings in Queensland.
This research provides a profile of nurse executives' roles, career opportunities and professional development needs across metropolitan, provincial, rural and remote settings in Queensland. A cross-sectional survey was posted to all Directors/Assistant Directors of Nursing in the Queensland Public Health Sector (n = 281), with a response rate of 52.3% (n = 147). Findings indicated that the role of nursing executives has expanded and diversified, with multiple role responsibilities increasing with distance from the metropolitan area. Nurse executives in remote areas were less satisfied with the quality of supervision and mentorship they received, and least likely to participate in career enhancing activities. Metropolitan nursing executives utilised more of the career enhancing opportunities provided by the Queensland Public Health Sector than did provincial, rural or remote nursing executives. Provincial nurse executives were the group most likely to network, attend conferences and participate in informal educational activities. Professional development needs, although generally common to all groups, were more practice specific for those in rural and remote areas. Many nurse executives begin their careers in rural or remote areas where limited opportunities for career development may be detrimental to their future development.
Career Mobility↗
A multicentre survey of hand hygiene practice in intensive care units.
A detailed survey of hand hygiene in 16 intensive care units (ICUs) in Yorkshire was undertaken with the aim of following up the results of a national survey of infection control policies and practices which had been conducted in 1990 (Inglis et al., Br J Anaesthesia 1992; 68, 216-220). The main problems associated with infection control were identified as: the limited relevance of some infection control policies to the specialist nature of intensive care, poor compliance by nurses to local infection control policies, sub-optimal hand hygiene by all healthcare professionals and a need for more effective communication of research-based infection control recommendations in the ICU. Our results suggest that hand hygiene practice in the ICU is sub-optimal as a consequence of ineffective communication of infection control recommendations, insufficient promotion and enforcement of agreed research-based infection control practices, and a deficiency in infection control education. The current methods of communicating infection control recommendations have a limited effect on compliance rates in the ICU and are not evaluated adequately. Recommendations for further development in this field are to prioritise surveillance of infection rates in ICUs and to feedback infection rates to intensive care staff, to identify local priorities for infection control and to introduce continuous infection control education for all healthcare professionals. Further research is required to investigate and understand why educated health professionals are not complying with recommended research-based infection control practices.
Clinical Protocols↗