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Investigation of transfusion reactions through microcomputer education software.

The purpose of this study was to develop educational software to simulate laboratory investigation of transfusion reactions. An interactive, branching-style program was developed using a 256K Personal Computer (International Business Machines, Boca Raton, FL). Over 75 institutions in the United States and Canada are currently using the software in preprofessional and continuing professional education programs.

Journal Article↗

Current trends in medical ethics education.

The unprecedented progress in biomedical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organization and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront the health professionals more frequently in an increasing range of problems and situations. Health care that has been practiced for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed to a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialized literature revealed that Healthcare Ethics Education became a basic requirement for any training program for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for the appropriate ethical reasoning, ethical attitude and decision-making. There is growing evidence that physicians' professional and moral development is not determined by the formal curriculum of ethics, rather more, it is determined by the moral environment of the professional practice, the "hidden curriculum" which deserves serious consideration by medical educators.

Education, Medical↗

Deinstitutionalization in context.

Unlike other policy developments, which are regular and cumulative or even circular, reforms in mental health have been characterized by a peak-trough movement. Public responses continue to be very different from professional responses to achieving the practical limits of mental health. Ironically, the lack of machinery to integrate special services into a broad national program has mobilized more creative energy in the United States than has been the case in Britain.

Community Mental Health Services↗

A model poison control system.

Responding to the need for a poison information, education, data collection and research resource in California's Bay Area and North Coast counties, the San Francisco Bay Area Regional Poison Control Center has become an integral part of the region's emergency medical services. In the first 33 months after it opened, more than 54,000 calls for assistance were received, nearly a third from medical professionals. Through the cooperation and collaboration of public, private and university resources and interests, a cost-effective, comprehensive and accessible system has evolved for public and professional use. Through our experience a system has developed that can serve as a model for poison information services throughout the western states. Emerging public concern for toxicology issues will continue to refine this model.

Humans↗

Trauma--the disease that was neglected. Progress: past and that to be.

Sir Harold Stiles has a historic spot in the annals of trauma care to which he and his military colleagues so richly contributed. For this we honour him today. Tremendous progress has been achieved during our lifetime in the field of trauma. Injury prevention has been the most important facet with progress underway in the fields of gun control, seatbelts, motorcycle and bicycle helmets, child restraint seats, airbags and particularly alcohol restraint. Overall, traffic fatalities are being reduced. Of great importance is the need for de-emphasis and deglamorization of violence by television, movie, and news media. Improved prehospital care has taken the form of professionalism of emergency medical services comparable to that in law enforcement and fire services. Improved hospital care is resulting, in part, from the widespread development of trauma and burn centres. Continued progress is needed in each field, particularly in gun control, alcohol control, overall traffic accident prevention, and in the understanding of cerebral oedema after head injury. The teaching of the principles of trauma prevention and community organization for better emergency medical response should be introduced into the Health or Civics curriculum perhaps at the 5th or 6th grade level in elementary schools. Perhaps the greatest potential for progress in the field of trauma which we have witnessed in our lifetime may prove to have been the actions of the United Nations in Korea in 1950 and Kuwait in 1991, proclaiming that 'war will no longer be tolerated as an instrument of national aggression'.

Accident Prevention↗

Reexamination/recertification: measurement of professional competence and relation to quality of medical care.

Over the past half decade, there has been an increment in forces moving the profession toward recertification and a decrement in the restraining forces. The whole process will be catalyzed by available funding through grants to implement continuing medical education, development of performance-, and competency-based assessment measures and recertification. Specialty boards serving relatively small numbers of candidates have serious difficulty funding certification, to say nothing of recertification. An adequate mechanism to implement recertification can emerge only from the profession itself, working through the American Board of Medical Specialties and specialty boards. The means to discharge this responsibility should, at the outset, come from public and private sources. Eventually the system may become self-supporting through evaluation and certification fees. The public interest will be best served when there are adequate mechanisms to assess continuing competence of all physicians. As a minimum, there must be a system to guard against incompetence through obsolescence of any of the practicing professionals.

Certification↗

Professional development: a guide to profiling and portfolios.

Portfolio development and self-profiling are the subject of a current debate in nursing. Nurses at all levels have become increasingly aware of the need to document and record their professional achievements. This article discusses what is involved in the profiling process and how to compile a portfolio.

Documentation↗

ABMS' Maintenance of Certification: the challenge of continuing competence.

The American Board of Medical Specialties, since its inception in 1933 as the Advisory Board for Medical Specialties, is concerned with the education, training and certification of physician specialists. Although not perfect, the initial certification process is quite good and accomplishes its intended purpose. However, initial certification is based on a primarily knowledge-based "snapshot." The newly developed Maintenance of Certification Program will evaluate the competencies, medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement and systems-based practices believed to be necessary and sufficient for certified physicians to have and maintain throughout their entire professional career. Furthermore, the process will focus on education and assessment to encourage continuous quality improvement in clinical practice.

Advisory Committees↗

An investigation into whether nurses change their learning style according to subject area studied.

The aim of this study was to investigate whether nurses' preferred learning styles varied according to subject area studied. Thirty nurses in a postgraduate centre specializing in cardiothoracic care were interviewed using a semi-structured technique. The results suggest that there is a change in learning style as different subjects are studied. Other factors emerging were the importance of previous learning experience, the wish to share, to be acknowledged and the need for close links between theory and practice. This calls for nurse teachers to examine their practice, to update and undertake professional development and also to establish close clinical links.

Attitude of Health Personnel↗

Creative models of spiritual care. As healthcare delivery changes, pastoral care departments must explore alternative staffing approaches.

Recognizing changes are coming to the healthcare delivery system, pastoral care departments are developing a new vision of spiritual care. As they educate and hire staff, many directors are finding that alternative staffing approaches can help them make the transition. Flexible schedules for pastoral care professionals improve the care they deliver and enhance morale. Restructuring responsibilities within the department and giving some patient populations priority can be helpful. Some facilities share chaplains' time to minimize on-call burden; others are increasingly using supervised volunteers. Pastoral care givers who are specialists in areas such as mental health and chemical dependency can often perform certain functions traditionally performed by other professionals. By assigning chaplains to a product or service line, pastoral care departments can improve the continuity of care patients receive. As parishes' role in the healing ministry takes on new meaning, healthcare institutions' pastoral care staff can help initiate and develop new parish services or provide assistance that complements existing parish efforts.

Appointments and Schedules↗

Developing portfolios for peri-operative nurses.

Compiling and maintaining a professional portfolio is a requirement for all practising nurses. This article focuses on the process of building a portfolio for nurses working in operating theatres.

Career Mobility↗

The development and implementation of a regional network of physiotherapists for exercise therapy in patients with peripheral arterial disease, a preliminary report.

BACKGROUND: Exercise therapy (ET) is the main conservative and proven effective treatment of patients with intermittent claudication. Currently, the most frequent exercise prescription is a single 'go home and walk' advise, without supervision or follow-up. There is no evidence to support the efficacy of this advise and compliance is known to be low. Therefore, a systematic approach was used to guarantee quality and standardisation of treatment, optimal guideline adherence and improved of inter-professional communication between vascular surgeons and physiotherapists. In this preliminary report we would like to outline the steps taken for the development and implementation of the Network Exercise Therapy Parkstad. METHODS: In October 2003 all 59 regional physiotherapy practices were invited to attend a symposium regarding ET in a physiotherapeutic setting. Attending physiotherapists interested in providing ET and willing to follow a certified course on ET, were asked to register. Three tastk groups were formed to accomplish the set targets: Exercise therapy education, Exercise therapy implementation and continuity, and Inter-professional communication in the Parkstad region. RESULTS: In total 27 physiotherapists, from 22 different practices followed the educational program and are now trained and accredited to provide ET according to the guideline of the Royal Dutch Society for Physiotherapy. A web-based database was designed to contain information on disease specific items provided by the vascular surgery department, and aspects with respect to ET registered by the physiotherapist. The information is regularly updated and available online. Access to the database is restricted to vascular surgeons and physiotherapists in the network. The secondary purpose of the database is to register essential benchmark data for future analysis of ET in a physiotherapeutic setting in the Netherlands and to enable physiotherapists continuous feedback on patient performance. A triage system was developed to detect patients with a compromised cardiac history. This group receives ET at the in-hospital department of revalidation with the possibility of immediate consultation of a cardiologist in case of cardiac complications or even CPR. CONCLUSION: The Network Exercise Therapy Parkstad of supervised ET is the first initiative in the Netherlands to provide ET close to the patient's home environment. With the implementation of supervised ET in an outpatient physiotherapeutic setting for all eligible patients with symptomatic PAD, the access to care has been improved. A web-based communication system provides physiotherapists and vascular surgeons with all the necessary and continues updated patient information. Future research, currently in progress, will investigate the therapeutic benefits and cost-effectiveness of exercise therapy in a physiotherapeutic setting.

Ambulatory Care↗

Recognition of client values as a basis for tailored care: the view of Dutch expert patients and family caregivers.

In the Netherlands confusion is signalled about the introduction of new care concepts like demand-oriented care. The aim of this article is to explore the phenomenon 'interaction aimed at care tailored to the client demand' as seen by expert clients: patients and their family caregivers. Focus interviews were held with expert patients and expert family caregivers of the 'Dutch Council of the Chronically ill and the Disabled'. Grounded theory methodology was used to analyse the results. Recognition by the professional of client values underlying their demand (uniqueness, comprehensiveness, continuity of life, fairness and autonomy) and underlying the care-relationship (equality, partnership and interdependence) emerged as central element within the interaction. Feelings of recognition with the client seem to reinforce autonomy, self-esteem and participation. Recognition was optimally felt in a dialogue. Four professional competencies could be identified related to recognition: attentiveness (ongoing actions to know and understand the patient); responsiveness (active, committed and responsible care guided by respect of patient identity); being a critical partner in care (giving and grounding professional opinion and discuss boundaries); being a developer of client competencies (facilitating and developing client participation within care). The findings offer possibilities to operationalize care concepts aimed at tailored care. Further research aimed at refining and testing the hypothesis developed is recommended.

Adult↗

Unmet education and training needs of rheumatology health professionals in adolescent health and transitional care.

OBJECTIVES: To determine the perceived education and training needs of health professionals involved in transitional care for adolescents with juvenile idiopathic arthritis (JIA). METHODS: Two distinct questionnaires to identify transitional issues in JIA were distributed to key health professionals (n = 908) and clinical personnel involved in the implementation of a transitional care programme (n = 22). RESULTS: The first survey was completed by 263 professionals. Education needs were reported by 114 (43%) of health professionals. Transition issues and informational resources were the most frequently reported areas of need. The second survey was completed by 22 clinical personnel who rated 'lack of training', 'lack of teaching materials geared towards adolescents' and 'limited clinic time' as the main barriers to providing developmentally appropriate care to adolescents. CONCLUSION: Unmet education and training needs of health care professionals exist in key areas of transitional care and provide useful directions for the development of future training programmes.

Adolescent↗

[Reflection upon returning from the Institute of Nursing Care Training: a space for dialogue in the development of the professional experience].

We were interested in the training practices undertaken by the trainers at the IFSI. And if there is a lot of research in this field, it is through the analysis of working situations, and more particularly in the field of professional education, that our research was carried out We observed how trainers proceed at the sessions when they come back from their training period, most often called "exploitation of training period". We tried to understand how they lead the reflective analysis, from the expression of the experience of the students in professional situations. We more particularly analysed how, from an object presented by a student, they act, contribute to progress, to the advance that will lead to the development of experience and therefore to the expansion of the students' capacity to act in working situations. We identified some particularly key elements. We used the concept of schema for the analysis, and our proposals also enable to expand the capacity of action of the trainers in the field of health.

Attitude of Health Personnel↗