Professional Boundaries (professional + boundary)

Distribution by Scientific Domains

Selected Abstracts

Preparedness for rural community leadership and its impact on practice location of family medicine graduates

Wayne Woloschuk
Abstract Objective:,To identify non-clinical dimensions of preparedness for rural practice and to determine whether preparedness for rural practice is predictive of rural practice location. Design:,Cross-sectional postal survey mailed in 2001. Setting:,Communities across Canada where graduates were practising. Subjects:,,Graduates (n = 369) of the family medicine residency program at the universities of Alberta (U of A) and Calgary (U of C) between 1996 and 2000, inclusive. Interventions:,Using a 4-point scale, graduates rated the extent to which the residency program prepared them for eight dimensions of rural practice: clinical demands of rural practice, understanding rural culture, small community living, balancing work and personal life, establishing personal/professional boundaries, becoming a community leader, handling a ,fish bowl' lifestyle, and choosing a suitable community. Main outcome measure:,Identification of non-clinical dimensions of preparedness for rural practice and whether scores on preparedness scales are predictive of rural practice location. Results:,The overall response rate was 76.4%. Factor analysis of the eight preparedness items produced two factors, ,rural culture' and ,rural community leader' which explained 72% of the variance. The alpha coefficient for each factor was 0.87. Odds ratios revealed that family medicine graduates prepared for rural community leadership roles were 1.92 (CI = 1.03,3.61) times more likely to be in rural practice. Rural physicians were also 2.14 (CI = 1.13,4.03) times as likely to have a rural background. Conclusions:,Preparedness to be a rural community leader and having a rural background were predictive of rural practice. Educators should consider this in both family medicine residency admissions policy and practice and when designing and implementing family medicine residency curricula. [source]

Review of small rural health services in Victoria: how does the nursing-medical division of labour affect access to emergency care?

Elise Sullivan
Aims., This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. Background., The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge , traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. Methods., This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. Results., In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. Conclusion., A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour. Relevance to clinical practice., This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care. [source]

Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organizational identity

Gill Haddow MA PhD
Abstract Rationale, aims and objectives, To explore stakeholder perspectives of the implementation of a new, national integrated nurse-led telephone advice and consultation service [National Health Service 24 (NHS 24)], comparing the views of stakeholders from different health care organizations. Methods, Semi-structured interviews with 26 stakeholders including partner organizations located in primary and secondary unscheduled care settings [general practitioner (GP) out-of-hours cooperative; accident and emergency department; national ambulance service, members of NHS 24 and national policy makers. Attendance at key meetings, documentary review and email implementation diaries provided a contextual history of events with which interview data could be compared. Results, The contextual history of events highlighted a fast-paced implementation process, with little time for reflection. Key areas of partner concern were increasing workload, the clinical safety of nurse triage and the lack of communication across the organizations. Concerns were most apparent within the GP out-of-hours cooperative, leading to calls for the dissolution of the partnership. Accident and emergency and ambulance service responses were more conciliatory, suggesting that such problems were to be expected within the developmental phase of a new organization. Further exploration of these responses highlighted the sense of ownership within the GP cooperative, with GPs having both financial and philosophical ownership of the cooperative. This was not apparent within the other two partner organizations, in particular the ambulance service, which operated on a regional model very similar to that of NHS 24. Conclusions, As the delivery of unscheduled primary health care crosses professional boundaries and locations, different organizations and professional groups must develop new ways of partnership working, developing trust and confidence in each other. The results of this study highlight, for the first time, the key importance of understanding the professional ownership and identity of individual organizations, in order to facilitate the most effective mechanisms to enable that partnership working. [source]

Consent and long-term neuroleptic treatment

N. R. Harris phd bsc(hons) rmn
The involvement of clients in the process of developing their care and treatment package is well established. If a genuine collaboration in treatment is achieved one of the fundamental bases of this process lies with ,informed consent'. Neuroleptic medication forms the basis of relapse prevention treatment for people suffering from schizophrenia with non-adherence to treatment seen as the largest cause of relapse. This paper reviews the complex and difficult issues in obtaining informed consent for this client group from within the context of the nurse's role and the problems that arise as a consequence of the blurring of professional boundaries. Throughout the paper reference is made to the expectations made by the UKCC, which provides clarification of nurses' practice in this area. [source]

Multiprofessional clinical supervision: challenges for mental health nurses

K. Mullarkey ma bsc(hons) rn cpncert rnt
Recent reform and developments in mental health care provision have increasingly espoused the value of multiprofessional teamwork in order to ensure that clients are offered co-ordinated packages of care that draw on the full range of appropriate services available (DoH 1999a; DoH 2000). Supervision in some form is seen as a key part of all professional practice to provide support to practitioners, enhance ongoing learning, and, to a greater or lesser degree, offer some protection to the public (Brown & Bourne 1996, UKCC 1996). Clinical supervision has gained increasing momentum within the nursing profession, but to a large extent this has been within a uni-professional framework , nurses supervising other nurses. This paper seeks to explore the ways in which multiprofessional working and clinical supervision interlink, and whether supervision across professional boundaries might be desirable, possible, and/or justifiable. Whilst our own view is that multiprofessional supervision is both possible and desirable, we seek to open up a debate, from our perspective as mental health nurses, about some of the issues related to the concept. Our motivation to explore this topic area emanates from our experiences as supervisors to colleagues within multiprofessional teams, as well as the experiences of those attending supervisor training courses. Following a brief overview of the development of clinical supervision in mental health care and recent policy guidelines, some models of clinical supervision are reviewed in terms of their suitability and applicability for multiprofessional working. [source]

Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anaesthesia crises

Jennifer M Weller
Objectives, We placed anaesthesia teams into a stressful environment in order to explore interactions between members of different professional groups and to investigate their perspectives on the impact of these interactions on team performance. Methods, Ten anaesthetists, 5 nurses and 5 trained anaesthetic assistants each participated in 2 full-immersion simulations of critical events using a high-fidelity computerised patient simulator. Their perceptions of team interactions were explored through questionnaires and semi-structured interviews. Written questionnaire data and interview transcriptions were entered into N6 qualitative software. Data were analysed by 2 investigators for emerging themes and coded to produce reports on each theme. Results, We found evidence of limited understanding of the roles and capabilities of team members across professional boundaries, different perceptions of appropriate roles and responsibilities for different members of the team, limited sharing of information between team members and limited team input into decision making. There was a perceived impact on task distribution and the optimal utilisation of resources within the team. Conclusions, Effective management of medical emergencies depends on optimal team function. We have identified important factors affecting interactions between different health professionals in the anaesthesia team, and their perceived influences on team function. This provides evidence on which to build appropriate and specific strategies for interdisciplinary team training in operating theatre staff. [source]

Students' perceptions of race, ethnicity and culture at two UK medical schools: a qualitative study

Jane H Roberts
Context, Globalisation has profoundly affected health care by increasing the diversity of clinicians and their patients. Worldwide, medical schools highlight the need for students to understand and show respect for patients and peers of different ethnicities. Yet a sound theoretical approach and robust methods for learning about cultural awareness are lacking. The reasons for this are unclear. Objective, To explore Year 2 medical students' understanding of the concepts of race, ethnicity and culture. Methods, This study was set in 2 universities in the north of England. The student population of each was of a similar ethnic mix but the universities differed in terms of local demography (a wide patient ethnic mix versus a predominantly White patient population with experience of social deprivation) and curricula (a curriculum involving problem-based learning and paper-based cases versus a curriculum involving early contact with patients). Participants comprised 49 Year 2 medical students (mean age 208 years), 40% of whom came from ethnic minority groups. Seven focus groups were held across the 2 universities to explore students' understanding of cultural awareness. Students were asked to discuss the terms ,race', ,ethnicity', ,culture' and ,cultural diversity'. Interviews were transcribed and analysed qualitatively using grounded theory. Themes were identified and validated by an independent researcher. Results, Four overarching themes emerged: ,White fears' at discussing race-related issues; ethnic minority discomfort at being viewed as ,different'; difficulties in relating to professional boundaries, and barriers against talking about race beyond legitimate disease-related discourse. Conclusions, For students, discussion of race beyond the confines of medical discourse was problematic. If students are to develop professional holistic values towards patient care, they need more support in understanding their own personal values and uncertainties. [source]

Practices and views on fetal heart monitoring: a structured observation and interview study

S Altaf
Objective, To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design, Qualitative study. Setting, Large teaching hospital in the UK. Sample, Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods, Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures, Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results, All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion, Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. [source]

Privacy, professionalism and Facebook: a dilemma for young doctors

Joanna MacDonald
Medical Education 2010: 44: 805,813 Objectives, This study aimed to examine the nature and extent of use of the social networking service Facebook by young medical graduates, and their utilisation of privacy options. Methods, We carried out a cross-sectional survey of the use of Facebook by recent medical graduates, accessing material potentially available to a wider public. Data were then categorised and analysed. Survey subjects were 338 doctors who had graduated from the University of Otago in 2006 and 2007 and were registered with the Medical Council of New Zealand. Main outcome measures were Facebook membership, utilisation of privacy options, and the nature and extent of the material revealed. Results, A total of 220 (65%) graduates had Facebook accounts; 138 (63%) of these had activated their privacy options, restricting their information to ,Friends'. Of the remaining 82 accounts that were more publicly available, 30 (37%) revealed users' sexual orientation, 13 (16%) revealed their religious views, 35 (43%) indicated their relationship status, 38 (46%) showed photographs of the users drinking alcohol, eight (10%) showed images of the users intoxicated and 37 (45%) showed photographs of the users engaged in healthy behaviours. A total of 54 (66%) members had used their accounts within the last week, indicating active use. Conclusions, Young doctors are active members of Facebook. A quarter of the doctors in our survey sample did not use the privacy options, rendering the information they revealed readily available to a wider public. This information, although it included some healthy behaviours, also revealed personal information that might cause distress to patients or alter the professional boundary between patient and practitioner, as well as information that could bring the profession into disrepute (e.g. belonging to groups like ,Perverts united'). Educators and regulators need to consider how best to advise students and doctors on societal changes in the concepts of what is public and what is private. [source]