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Practice Models (practice + models)
Selected AbstractsDeterminants in the development of advanced nursing practice: a case study of primary-care settings in Hong KongHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2005Sheila Twinn BA PGCEA PhD RN RHV Abstract Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes. [source] An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary studyJOURNAL OF CLINICAL NURSING, Issue 6 2006Engle Angela Chan PhD Aim and objective., Like other health-care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS-like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses' efficiency, infection control practices and views of the two models. Design and methods., This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight-hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video-taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t -tests. Textual data were coded and categorized for common meanings. Results., Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional. Relevance to clinical practice., This study findings lay the foundation for clinical trials, which would evaluate the significance of patient-care quality, cost-effectiveness and better human resource management by restructuring current nursing practices. [source] Pregnant with possibilities: drawing on hermeneutic thought to reframe home-visiting programs for young mothersNURSING INQUIRY, Issue 3 2009Lee SmithBattleArticle first published online: 11 AUG 200 Although the positive outcomes achieved in home-visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse,family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After describing how a scientific,clinical gaze misrepresents teen mothers and contributes to a rational,technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life-world. Dialogical understanding also disrupts the scientific,clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers' long-term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know-how that ,strays' from protocol-driven care is addressed. [source] Race, Worldviews, and Conflict Mediation: Black and White Styles of Conflict RevisitedPEACE & CHANGE, Issue 1 2008Mark Davidheiser The article offers a wide-ranging, critical reflection on intercultural mediation theory and practice. Rather than following the standard format of literature review and discussion, the author uses his experiences as a mediator and researcher to frame the culture question and analyze intercultural practice models. We begin with the White American author's realization that culture is important, following a mediation session in which the other participants were Black. Reading Kochman's Black and White Styles in Conflict reinforced that realization, and, combined with other works, suggested a relatively straightforward relationship between culture and mediation managed through cultural competency. However, original field research on third-party peacemaking in West Africa complicated the issue by indicating that worldviews and associated conflict styles are highly diverse, varying both within and across social groups. The second half of the paper examines the nature of cultural perspectives or worldviews and considers proposed methods for intercultural mediation. By analyzing prominent responses to the issue of sociocultural variation, the paper explores the challenge of creating a broadly applicable mediation methodology that addresses the complexity of worldviews. [source] Ensuring the Preconditions for Transformation Through Licensing, Regulation, Accreditation, and StandardsAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2007Robert E. Lieberman MA Residential treatment is a potentially powerful intervention for children and families, currently facing the imperative to fundamentally change practice models to achieve greater quality efficacy, efficiency, and effectiveness. Such transformation is best accomplished from a solid foundation which is created by licensing, regulation, accereditation, and internal standards. [source] Clinical reasoning in neurology: Use of the repertory grid technique to investigate the reasoning of an experienced occupational therapistAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2009Kathy Kuipers Background/aim:,The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as a result of brain injury. Method:,Repertory grid interviews were completed before and after exposure to a protocol designed to guide clinical reasoning and decision-making in relation to upper limb neurological rehabilitation. Data were subjected to both qualitative and quantitative analyses. Results:,Qualitative analysis focussed on clinical reasoning content. Common themes across the pre- and post-exposure interviews were the use of theoretical frameworks and practice models, the significance of clinical expertise, and discrimination of ,broad' and ,specific' aspects, as well as differentiation between ,therapist and client-related' aspects of the clinical situation. Quantitative analysis indicated that for both pre- and post-exposure repertory grids, clinical reasoning was structured in terms of two main concepts. In the pre-exposure grid, these were related to the therapist's role, and to the ,scope' of practice tasks (either broad or specific). In the post-exposure grid the two main concepts were upper limb performance, and client-centred aspects of the therapy process. Conclusions:,The repertory grid technique is proposed as an effective tool for exploring occupational therapy clinical reasoning, based on its capacity for accessing personal frames of reference, and elucidating both the meaning and the structure supporting clinical reasoning. [source] Exploration of Australian and New Zealand indigenous people's spirituality and mental healthAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2005Samson Tse Background:,Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models. Methods and Results:,To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems. Conclusion:,The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered. [source] Knowledge Translation at the Macro Level: Legal and Ethical ConsiderationsACADEMIC EMERGENCY MEDICINE, Issue 11 2007Gregory Luke Larkin MD, MSPH Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT. [source] Our responsibility in a developing world: from ethics to pragmatismCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2002Jamie La Nauze FRANZCO MMedSci(ClinEpi) Abstract If development is defined as a process of enhancing human capabilities, that is, to expand choices and opportunities so that each person can lead a life of respect and value, then poverty is the deprivation of these capabilities. Nobel Laureate for Economics, Amartya Sen, states: ,as people who live , in a broad sense , together, we cannot escape the thought that the terrible occurrences that we see around us are quintessentially our problems'. This year's Council Lecture examines issues of individual and institutional responsibility in a developing world. Aspects of development relevant to ophthalmology are discussed and a review of Australian efforts undertaken. With a view to encouraging Fellows to take a more active role in development, it is demonstrated that there are a range of contributions that can be made. Appropriate practice models are explored and a strategy for College involvement presented. [source] Physician professionalism for a new centuryCLINICAL ANATOMY, Issue 5 2006James W. Holsinger Jr. Abstract During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society. Clin. Anat. 19:473,479, 2006. © 2006 Wiley-Liss, Inc. [source] | ||||||||||