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Expert Practice (expert + practice)
Selected AbstractsThe BSCC Code of Practice , exfoliative cytopathology (excluding gynaecological cytopathology)CYTOPATHOLOGY, Issue 4 2009A. Chandra Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology/cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Non-gynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes. [source] Mediating Among Scientists: A Mental Model of Expert PracticeNEGOTIATION AND CONFLICT MANAGEMENT RESEARCH, Issue 4 2009Kenneth Kressel Abstract Despite the considerable research on mediator behavior, the cognitive structures and processes that presumably guide the strategic and tactical choices of professional mediators are poorly understood. The current study made use of a reflective case study method to explore in considerable detail the strategic thinking of five experienced mediators. The project was conducted at the National Institutes of Health whose Office of the Ombudsman (OO) mediates disputes among the institute's scientists. Eighteen cases were studied. The thinking of the mediators in these cases displayed regularities that are described in terms of the ombuds team's working mental model of mediation. The mental model consists of two strongly contrasting intervention scripts: a deep problem-solving script (DPS) focused on identifying and addressing latent issues of an interpersonal or systemic kind and a tactical problem-solving script (TPS) focusing instead on the issues as presented by the parties. The tactical script was applied in either an integrative bargaining mode or a more distributive quasi-arbitration approach. The choice of which script to follow in a given case is determined by first order decision rules concerning the existence and nature of any latent problems that may be present, and second order decision rules concerning the parties' capacity to engage in "deep" problem-solving. Despite their very different foci, both DPS and TPS appear to follow the same metascript of problem-solving stages, beginning with an intensive diagnostic phase during which the decision rules are applied and a script "selection" is made. DPS is the preferred intervention mode of team members. Every case began with at least a preliminary effort to search for and address latent causes, and team members expressed dissatisfaction if they could not apply DPS in cases where latent problems were thought to be fueling the conflict. However, ombudsmen used the scripts flexibly and switched to TPS if DPS was unnecessary or impractical. Both scripts produced agreements that were useful to the parties and to the institution's scientific purposes, particularly the fostering of scientific competence. The mental model is heavily shaped by the social context in which the ombudsmen function. Thus, the primacy of DPS in the model appears to be due to the fact that the ombudsmen are "repeat players" in the life of the NIH and therefore in a position to become adept at recognizing the latent sources of its dysfunctional conflicts, are under a strong role mandate as ombudsmen to pay attention to covert patterns of organizational dysfunction, and deal with disputants pressed to address latent issues blocking scientific work. [source] Explicating Benner's concept of expert practice: intuition in emergency nursingJOURNAL OF ADVANCED NURSING, Issue 4 2008Joy Lyneham Abstract Title.,Explicating Benner's concept of expert practice: intuition in emergency nursing. Aim., This paper is a report of a study exploring the experience of intuition in emergency nursing in relation to Benner's fifth stage of practice development, ,the expert practitioner.' Background., Expert nurses anecdotally report actions and thoughts that present in their consciousness and have an impact on the care given. Benner used the term ,intuition' for the fifth stage of practice development. However, Paley has criticized Benner's model for its lack of clarity about the nature of an expert practitioner. This criticism is further justified by Benner's inadequate explanation of expert. Method., A hermeneutic phenomenological study was conducted using van Manen's approach and a Gadamerian analysis. Fourteen expert emergency nurses in Australia were interviewed between January 2000 and December 2003. Findings., The analysis resulted in the reconstruction of Benner's expert stage into three distinct phases: cognitive intuition, where assessment is processed subconsciously and can be rationalized in hindsight; transitional intuition, where a physical sensation and other behaviours enter the nurse's awareness; and embodied intuition, when the nurse trusts the intuitive thoughts. Conclusion., The findings validate the use of intuitive decision-making as a construct in explaining expert clinical decision-making practices. The validity of intuitive practice should be recognized. It is essential to recognize the conditions that support practice development, and in the prenovice stage (during their university course) factors such as reflection, research (in its broadest sense) and clinical curiosity should be fostered. [source] Assessing the impact of nurse and allied health professional consultants: developing an activity diaryJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Ann Humphreys Aims., To construct and test an activity diary designed to measure the impact and explore the activities of nurse and allied health professional consultants in relation to each speciality and function of the role. Background., This was part of a funded feasibility study to assess the contribution of nurse and allied health professional consultants. Design., This was an exploratory study. Method., Thematic analysis of guided discussions with five nurse consultants and one physiotherapy consultant identified activities which were used to construct an activity diary. The activities were grouped under the four pillars or functions of the consultant role; expert practice, leadership, research and education. Participants recorded their activities in a diary over a one-week period. Conclusion., Results suggest that with some modification, this activity diary could be used to capture the impact, complexity and diversity of activities of the consultant role. Relevance to practice., Advanced practice roles are essential to the healthcare workforce of the future. This tool provides a method for measuring the contribution and complexity of the consultant role. [source] A systematic review and meta-synthesis: evaluating the effectiveness of nurse, midwife/allied health professional consultantsJOURNAL OF CLINICAL NURSING, Issue 10 2007Ann Humphreys PhD, Cert Ed Aim., This paper presents the findings of a systematic review and meta-synthesis, which was undertaken to identify and assess studies that evaluated the nurse/midwife/allied health professional consultant role. Background., As part of the modernization agenda in the National Health Service the United Kingdom government proposed ,Consultant' posts for nurses/midwives and allied health professionals as an opportunity for experienced practitioners to extend their roles. Four key functions were identified as being significant to this role development: expert practice, leadership, education and research. Explicit within the proposal was a requirement of these new roles to be evaluated. Method., Inclusion criteria focussed on studies where an aspect of the role had been evaluated or where the consultant carried out the research. A total of 1931 citations was filtered to reveal 107 studies that possibly met the inclusion criteria. Of these 107, 14 studies were critically appraised and subjected to thematic analysis. Study methodology varied but of the 14 studies, 10 involved some form of measurement. The others adopted a literature review or descriptive approach. Conclusions., The extent to which consultants were involved in all aspects of the ,four pillars' was assessed in only a small number of studies. However, a number of studies implicitly implied active engagement in expert practice and leadership by focussing on specific service developments. Relevance to clinical practice., To date, a number of studies evaluating service developments, education, expert practice and leadership have been carried out. However although a number of studies have assessed perceived impact of the consultant role, no measure of actual benefit has been published to date. Studies that evaluate the cost benefit/outcomes of these roles in relation to both activity and quality of service are required. [source] Understanding the role of knowledge in the practice of expert nephrology nurses in AustraliaNURSING & HEALTH SCIENCES, Issue 3 2007Ann Bonner bappsc(nurs), mrcna Abstract This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice. [source] Beyond a code of ethics: phenomenological ethics for everyday practicePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2010Bruce Greenfield Abstract Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient. Copyright © 2010 John Wiley & Sons, Ltd. [source] | ||||||||||