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This article describes some of the barriers to professional development and discusses how research and development (R&D) officers can overcome these and support their colleagues in clinical practice.
The authors describe an evidence-driven approach used in designing a leadership development program targeted for nurses in middle management positions in an academically affiliated integrated healthcare system. A qualitative study was conducted to investigate leadership development needs and experiences of nurse managers across the health system. Study findings were used to inform educational programs and organizational initiatives responsive to needs of both novice and expert nurse managers across diverse clinical settings.
The United Nations Security Council reports HIV/AIDS as the fastest growing threat to human development. In addition, the World Health Organization [1] reports that nearly 5 million persons (4.3 million adults and 700,000 children) are newly infected with HIV each year; more than 95% of them found in developing countries. Since STDs as a group are a personal problem which few people feel comfortable discussing, we believe that hand-held PDAs can provide an opportunity for learning about this disease while insuring anonymity. This device will employ the newest technologies including Bluetooth wireless technology, which can transmit and receive data via a short-range radio link using a globally available frequency band (2.4 GHz ISM band), enabling rapid and accurate synchronous and asynchronous data communication. The first generation of Bluetooth permits exchange of data up to a rate of 1 Mbps, even in areas with much electromagnetic disturbance. This emerging technology can facilitate HIV/AIDS outreach around the globe.Recent advances in learning have taken a particularly cognitive perspective and these findings have implications for education in general as well as for the development of intelligent tutoring systems in particular. In the past, effective SmartBookstrade markhave been developed for AIDS education to disseminate the critical knowledge relevant to this epidemic [2].Since 1993, the proliferation of the World Wide Web has created a plethora of new opportunities for the delivery of electronic distance learning systems. However, we feel that it is important that a whatever technology is employed is based on a sound educational theory. A new, comprehensive, web-based learning system called SmartTutor has been developed, at Brooklyn College of The City University of New York [3]. This technology provides a user-friendly, self-paced, easy to modify, software environment intended to serve the user's learning needs and is based on a generic SmartTutor methodology organized around the use of concept mapping. Early assessment of SmartTutor has shown that it is well received by students and helps significantly in their learning processes. It is readily adaptable to the presentation of academic and more general subject matter such as the latest available information on HIV/AIDS. Our new HIV/AIDS SmartTutor will incorporate this SmartTutor paradigm. Our new SmartTutor would provide worldwide access to medical professionals as well as the general public to learn about HIV/AIDS. This new device could also provide a survey tool to facilitate HIV risk assessment. Demonstrations of the SmartTutor learning system will be presented and the continued development of the applications will be discussed.
BACKGROUND: Modern information technology enables alternative strategies for education and communication. This is a description of a project for systematic utilisation of the internet for distant meetings and professional communication within geriatric medicine. METHOD: A net site has been developed and is being used for the distribution of professionally relevant material, as well as visual aids for audio conferences. The hospitals take their turn giving introductions, and active audience participation is a must. The project has been assessed through a questionnaire survey. RESULTS: 88 audio conferences have been carried out since September 1998. The number of participating hospitals has increased from 6 to 28; the audience varies from 40 to 90 per session. On average, 56% are doctors, 19% nurses, 20% physiotherapists or occupational therapists, 4% have other backgrounds. 100 persons returned the questionnaire (response rate 86%). At an ordinal scale from 1 (bad) to 5 (good), respondents' median global assessment of the project was 4 (interquartile range 3-4); they were particularly satisfied with the professional standard of the lectures, and they found it motivating to work in a field in which modern information technology is put to use. Their use of the net site for other purposes than the audio conferences was very limited. INTERPRETATION: Health professionals in the field of geriatrics saw the project as a help in keeping themselves up to date. Audio conferences may supplement intramural educational sessions but cannot substitute for them.
OBJECTIVE: To present the reader with various psychobehavioral characteristics of muscle dysmorphia, discuss recognition of the disorder, and describe treatment and referral options. DATA SOURCES: We conducted a comprehensive review of the relevant literature in CINAHL, MEDLINE, SPORT Discus, EBSCO, PsycINFO, and PubMed. All years from 1985 to the present were searched for the terms muscle dysmorphia, bigorexia, and reverse anorexia. DATA SYNTHESIS: The incidence of muscle dysmorphia is increasing, both in the United States and in other regions of the world, perhaps because awareness and recognition of the condition have increased. Although treatment options are limited, therapy and medication do work. The primary issue is identifying the disorder, because it does not present like other psychobehavioral conditions such as anorexia or bulimia nervosa. Not only do patients see themselves as healthy, most look very healthy from an outward perspective. The causes of muscle dysmorphia are not well understood, which reinforces the need for continued investigation. CONCLUSIONS: Muscle dysmorphia is an emerging phenomenon in society. Pressure on males to appear more muscular and lean has prompted a trend in the area of psychobehavioral disorders often likened to anorexia and bulimia nervosa. Athletes are particularly susceptible to developing body image disorders because of the pressures surrounding sport performance and societal trends promoting muscularity and leanness. Health care professionals need to become more familiar with the common signs and symptoms of muscle dysmorphia, as well as the treatment and referral options, in order to assist in providing appropriate care. In the future, authors should continue to properly measure and document the incidence of muscle dysmorphia in athletic populations, both during and after participation.
This paper describes findings from an English study into the perceptions of multi-professional practice given by stroke patients, their informal carers and hospital staff. Unstructured interviews were conducted with nine stroke patients and eight informal carers. Case studies were developed from the interview data which formed the basis of a questionnaire designed to ascertain the aims of care for the case studies and the location of professional responsibility for meeting these aims. This was returned by 31 respondents from a range of professional backgrounds. The findings indicate that patients and carers sought out relationships with staff and other patients in order to gain information to help them understand their uncertain futures. Professional staff were reluctant to pass specific information on to patients as it might be misleading in each individual case. The uncertainty surrounding individual recovery means that supportive relationships initiated by patients and carers may need to be recognized and nurtured.
"South Africa has experienced a significant continuous outflow of professional and technical skills in recent decades. The international marketability of such skills has encouraged a 'brain drain' phenomenon of the type which is common from other developing countries.... The most popular destinations are the United Kingdom, Australia, New Zealand, Canada and the United States. This paper examines aspects of the phenomenon, with particular reference to the South African community now domiciled in Australia."
Given that most VAI prefer to be cared for at home and that their return home is the desire of families, health care professionals, and others concerned with LTMV, the effort to transform prolonged mechanical ventilation from a hospital-centered to a home-centered treatment needs to be continued and further developed. Nevertheless, the future of high-technology home care will undoubtedly be influenced by improvements in quality and containment of costs, as in its current status treatment of VAI at home too often leads to family disruption and presents a dramatically increasing cost burden. Careful selection of patients, closer attention to education and training, and collection of outcome data are all factors that presumably will facilitate the development of better-quality and cost-saving home care.
The therapeutic relationship is a concept held by many to be fundamental to the identity of mental health nurses. While the therapeutic relationship was given formal expression in nursing theory in the middle of the last century, its origins can be traced to attendants' interpersonal practices in the asylum era. The dominance of medical understandings of mental distress, and the working-class status of asylum attendants, prevented the development of an account of mental health nursing based on attendants' relationships with asylum inmates. It was left to Peplau and other nursing theorists to describe mental health nursing as a therapeutic relationship in the 1940s and later. Some distinctive features of colonial life in New Zealand suggest that the ideal of the attendant as the embodiment of bourgeoisie values seems particularly unlikely to have been realized in the New Zealand context. However, New Zealand literature from the 20th century shows that the therapeutic relationship, as part of a general development of a therapeutic discourse, came to assume a central place in conceptualizations of mental health nursing. While the therapeutic relationship is not by itself a sufficient basis for professional continuity, it continues to play a fundamental role in mental health nurses' professional identity. The way in which the therapeutic relationship is articulated in the future will determine the meaning of the therapeutic relationship for future generations of mental health nurses.
In this article we describe the findings of an exploratory study into the application of early recognition and early intervention methods aimed at prevention of psychotic relapses in patients with schizophrenia. Following the results we described in part 1, we now focus specifically on factors which favourably or adversely affect the use of early recognition and early intervention methods. The following issues will be addressed: (i) information and education; (ii) attitude of health care professionals; (iii) the patient's insight; (iv) acceptance of illness; (v) motivation; (vi) other relevant patient characteristics; and (vii) continuity of care. Finally, the implications of the findings for the development of a nursing intervention protocol will be discussed.
Chronic pain patients are among a growing group of medically underserved Americans. Despite increasing public awareness about pain and widespread legislative activity that is focusing on the needs of pain patients, there remain significant roadblocks in bringing the expertise of Pain Medicine specialists to these unfortunate people. This paper explores how the managed care revolution has impacted the practice of Pain Medicine in the United States. The dissolution of many prominent multi-disciplinary pain treatment centers has been paralleled by the evolution of pain management as an area of interest by several competing medical specialty societies. Despite this fragmentation, the American Academy of Pain Medicine continues to grow and to promote the needs of Pain Medicine specialists and their patients. The advantages and disadvantages of various practice patterns for Pain Medicine specialists is explored against a backdrop of discussions about: (1) the problems currently faced by chronic pain patients; (2) the role of organized Pain Medicine in helping patients to access and finance care; and (3) the future of American health care and the new responsibilities that will bring to physicians. Finally, we have some specific recommendations for pain medicine specialists about: (1) sharing risk; (2) exerting individual leadership; and (3) simplifying one's professional life in the new health care environment, that we hope will enable them to continue caring for as many chronic pain patients as possible. It is opined that the development of sophisticated regional specialty networks is the best model to accomplish this task in the future.
PURPOSE: To describe the definition of quality, as used in the Dutch literature, and to discuss the policy concerning quality assurance of dental care of both the Dutch government and the Dutch Dental Association. DATA SOURCE: Study of relevant literature. RESULTS: Quality is described as the degree to which the entire set of characteristics of a product, process or service satisfies established or obvious needs. With respect to quality assurance, the government merely tends to frame the setting, through legislation and stimulation, whereas the professional organization supports the responsibility of individual dentists by developing a quality, assurance system and by delivering tools for quality assessment. Possible activities within such a quality assurance system are continuing education, peer review, the use of practice guidelines and horizontal referral. CONCLUSION: In Dutch dentistry a start has been made with the development of a quality assurance policy, which is aimed at the improvement of oral health and the increase of patient satisfaction. However, further research should still be focused on quality of dental care and its assessment in practice.
Immunization is a key primary prevention activity which has assisted in the reduction of childhood morbidity and premature mortality. Uptake rates for two-year-old children are now in excess of 90 per cent throughout the UK and for the vast majority of infants immunization is a routine procedure with a high benefit-to-risk ratio. Concerns about particular children, either because of their previous medical history or an adverse vaccine event, have been responded to in various ways. The experiences of a specialist immunization facility established in 1987, which since inception has seen just over 3,000 children are described. The clinic operates four sessions a week, with two held in the District General Hospital and two in community clinics; the resource requirements for the clinic are identified. A parent satisfaction survey for the first 1,700 attenders was undertaken in 1992 and the results are reported; their comments led to changes in the method of service delivery. A study of GPs' views was also undertaken at the same time; their satisfaction with the service is reflected in the continuing level of referrals, It is believed that all provider units should consider developing a similar facility for five reasons. First, it provides a source of expert advice for both professionals and parents; second, it facilitates the immunization of children with problem histories; third, it enables the investigation of serious post-vaccination adverse events; and fourth, the clinic provides a means of co-ordinating and delivering neonatal immunizations (including BCG, HBV, Varicella zoster and the vaccination of pre-term infants). And finally the clinic offers training for health care staff involved in primary immunization programmes and travel vaccination services.
To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.
In this article, the development of nursing in Canada is described in terms of three major time periods: the emergence of lay nursing, including organization and registration, 1870-1930; the move to the hospital, 1930-1950; and unionization and the routinization of health care, 1950 to the present. This development is viewed in the light of the orienting concepts of professionalization, proletarianization, and medical dominance (and gender analysis). This historical trajectory of nursing shows an increasing occupational autonomy but continuing struggles over control of the labor process. Nursing is now using theory, organizational changes in health care, and credentialism to help make nursing "separate from but equal to" medicine and to gain control over the day-to-day work of the nurse. Nursing can thus be viewed as undergoing processes of both professionalization and proletarianization. As nursing seeks to control the labor process, its occupational conflicts are joined to the class struggle of white-collar workers in general. Analysis of nursing indicates the problems involved in sorting out the meaning of concepts that are relevant to occupational or class analysis but which focus on the same empirical phenomenon.
This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care.
GPs are involved in long term care of patients and families with complex conditions. They juggle the need for medical expertise, the relationships between family members, the cost of expertise, limitations of access, and the medicolegal environment. With this background, the GP is ideally placed to play an active role in the "new genetics". GP consultations involving the new genetics will include diagnostic testing for patients with clinical problems, preconception and prenatal testing for couples in relation to pregnancy, predictive testing for families with some genetic conditions, and community genetic screening in some circumstances. GPs will need to understand the language of the new genetics, undergo continuing education, and receive ongoing support to enable them to communicate effectively with patients and their families. Different models of care incorporating GPs, specialists and allied health professionals can be developed to provide maximum delivery of relevant genetic data for both genetic and common multifactorial disorders.
There is no doubt that the role of the nurse in New Zealand will continue to evolve. Developments in the US where clinical nurse specialists and advanced nurse practitioners are taking on roles and responsibilities that in New Zealand are undertaken by other health professionals, mainly medical, will ultimately permeate the New Zealand health care system. Today the nurse practitioner has a greater degree of professional independence than at any time in the history of the profession, and, if the recommendations of the taskforce are accepted and nurse prescribing eventuates, the nurse will have even greater independence and autonomy. With this increased professional independence comes a greater emphasis on the responsibilities of the nurse and professional accountability. The acceptance of greater responsibility will inevitably result in a proliferation of nurse "specialists". Postgraduate programmes must be established with carefully planned curricula to accommodate the requirements of these nurse specialists. Planning, content and design of these programmes must come from nurses in consultation with the Nursing Council, the Ministries of Health and Education, and health agencies. The functioning of the human species within their environment, in both wellness and illness, can only be adequately explained or explored with a sound knowledge of biological systems. It is for this reason that the study of biological sciences must be undertaken by nursing students to prepare them for the advanced role they are likely to play in the health care system of the 21st century.