Harmony Hospital: Integrating music in medical settings

Our Unified Scope and Standards of Practice

Academy Scope of Practice: Tools for Determining Competence and Advancing Practice

In late 2014, Credentialing and Privileging of Pharmacists: A Resource Paper from the Councilon Credentialing in Pharmacy was published simultaneously by three pharmacy association journals:the Journal of the American Pharmacists Association, American Journal of Health-System Pharmacy,and Consultant Pharmacist.

Review question/objective: The objective of this systematic review is to critically appraise and synthesize the best available evidence on the effectiveness of team nursing compared to total patient care on staff wellbeing when organizing nursing work in acute care ward settings. This review will seek to answer the following question: Is a team nursing or a total patient care approach the most effective model of care when organizing nursing work to achieve desired staff wellbeing (defined by outcomes of staff satisfaction, stress, burnout, absenteeism and turnover) in a general ward setting? Inclusion criteria: Types of participants This review will consider studies that include all nurses working on general wards in the acute care hospital sector. This includes registered general nurses or the international equivalent such as staff nurses and professional nurses, enrolled nurses or the international equivalent such as licensed vocational nurses or licensed practical nurses and unlicensed personnel such as nursing assistants or the international equivalent such as nurse's aides and auxiliary nurses. This will review will exclude: Nursing staff working on specialized wards and areas for example intensive/critical care areas, oncology wards, pediatrics, midwifery, mental health, primary care and aged care sectors, as they utilize specific models of care for their scope of practice. Types of intervention(s): This review will consider studies that investigate the use of a team nursing model when organizing nursing work. The comparator will be utilization of a total patient care model. Types of outcomes: The outcome of interest to this review will be staff wellbeing. Methodology for data collection will be grouped from the primary research papers based on the types of outcomes measures or tools that were used to promote homogeneity of pooled data. Data collection tools that have been used in initial searches of papers have included questionnaires for the collection of responses for staff satisfaction. The measurement tools considered for inclusion must be validated and reliable, examples of these tools are the Nursing Work Index tool which measures nursing values in relation to job satisfaction and productivity. This tool has been modified and used in various countries including Australia where it is referred to as the Nursing Work Index - Revised: Australian Tool, (NWI-R:A tool).23 Another reliable tool is the McCloskey/Mueller Satisfaction Scale (MMSS) which is a multidimensional questionnaire designed for hospital staff nurses. There are 31 items; the response format is a five-point Likert scale. The Nurse Satisfaction Scale (NSS) is also a validated tool which measures job satisfaction among nurses. The questionnaire is multidimensional and has 24 items. The response format is a seven-point Likert scale.24 Maslach Burnout Inventory tool has been utilized to measure staff burnout and stress levels other tools that measure staff burnout and stress will be considered for inclusion, providing it is a validated and tested tool for measuring staff burnout and stress levels. Nursing turnover and absenteeism rates will be extracted from included papers. Patient clinical outcomes will be excluded from the review.

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

An important review has commenced, which has the potential to impact health delivery in rural and remote Australia. Unleashing the Potential of our Health Workforce—Scope of Practice Review is an independent review that will examine the barriers and incentives health practitioners face working to their full scope of practice in primary care. Professor Mark Cormack from the Australian National University (ANU) College of Health and Medicine will lead the Independent Scope of Practice Review. The impetus for this review comes from the Strengthening Medicare Taskforce Report, which recommended governments work together to review the barriers and incentives for primary health care professionals working to their full scope of practice. It is important to note that the review focuses on health practitioners working to their current full scope of practice and is not examining recommendations on changes or extension/expansion of scopes of practice. Research suggests that regulating health professional scope of practice requires a balance between enabling flexibility and ensuring accountability.1 While regulation is only one of several key factors involved in influencing scope of health practitioner practice,2 this is an important concept to have front of mind when considering the potential benefits, risks and enablers of scope of practice. Flexibility allows health care teams to determine roles and responsibilities in alignment with population need, while accountability is essentially about protecting patient safety and ensuring practitioners work in line with the law and recognised standards of practice.1 In their assessment of regulatory approaches to health professional scope of practice across the USA, Canada, the UK and Australia, the aforementioned researchers proposed that appropriate management resulted in both the efficient and effective deployment of health workforce; enabled innovation, allowing the workforce to be responsive to local needs; and facilitated collaboration amongst health professionals within teams. The Alliance wishes to highlight the importance of considering both dimensions of scope, including breadth and depth or level of practice.5 Prioritising narrow over wide breadth of scope risks not meeting the needs of rural and remote populations, given their geographic isolation, lack of health workforce and reduced access to services. Rural generalist (RG) medical practitioners are essential to the provision of health care in rural and remote areas. They may work across both primary and secondary care and have advanced skills in a specific area in addition to general practice, such as obstetrics, emergency and anaesthetics. They can manage the broad range of conditions that people present with across the lifespan. The need to prioritise generalism (wide breadth of scope) in the medical workforce is highlighted in the National Medical Workforce Strategy.6 A focus on wide breadth of scope is inherent in the development and implementation of the Allied Health Rural Generalist Pathway (AHRGP)7 and the National Rural and Remote Nursing Generalist Framework.8 Both of these mechanisms aim to facilitate the development of a rural and remote workforce with the breadth of scope relevant for the context. The potential risk of reduced coordination and integration of care when health professionals are working to the top (full depth) of their scope of practice should also be considered. It has been proposed that this might occur where professionals are working in silos rather than collaboratively within a team. This is both a system-level consideration and one for individual professional educational providers and regulatory bodies. The provision of safe, high-quality care is essential, and rural, regional and remote communities are just as entitled to expect this as people living in major cities. As an outcome of this review, we would like to see a balance found that enables improved recruitment and retention of the rural, regional and remote health workforce and improved efficiency in the performance of that workforce, while maintaining high standards of patient care. This review is going to be undertaken over at least the next year, and the Alliance will be contributing input through various mechanisms. Clare Fitzmaurice: Conceptualization; investigation; writing – review and editing. Margaret Deerain: Writing – original draft.

Perceptions of pharmacists’ role in the health care team through student-pharmacist led point-of-care screenings and its future application in health care

Academy of Nutrition and Dietetics: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Intellectual and Developmental Disabilities

The Future of Pediatric Residency Education: Prescription for More Flexibility

The APhA Immunization Champion Awards recognize individuals and organizations in the pharmacy profession, and friends and allies of pharmacy, who have made outstanding efforts to improve vaccination rates within their communities.

This study investigated service use by individuals with serious and nonserious mental illness receiving mental health care in medical and mental health settings. Claims data from the New York State Medicaid Data Warehouse were examined for 8,988 patients who received at least one mental health service at an urban academic medical center during 2017 at a mental health setting, a medical setting, or both. Most patients (59%) received all of their mental health care in medical settings and from unaffiliated providers, including a large portion (16%) with serious mental illness. Despite the availability of integrated care in the medical setting and use of unaffiliated mental health providers, rates of mental health inpatient admissions were high among all patients in this setting (including those with serious and with nonserious mental illness), considerably higher than for patients treated in a mental health clinic within the system. Rates of medical and substance abuse inpatient admissions were also much higher for patients treated in the medical setting and by unaffiliated providers, compared with those treated in the system's mental health clinics. Findings suggest that when mental health services are available in medical and mental health settings within the same system, either patients with more severe physical illnesses are more likely to receive their mental health care in medical settings and from unaffiliated providers and thus have more hospitalizations of all types or affiliated mental health settings more effectively address clinical needs and thus reduce hospitalizations.

You have accessThe ASHA LeaderFeature1 Dec 2009Role Ambiguity and Speech-Language Pathology Coordinating Committee of the Vice President for Speech-Language Pathology Practice Coordinating Committee of the Vice President for Speech-Language Pathology Practice Google Scholar More articles by this author https://doi.org/10.1044/leader.FTR1.14162009.12 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In As the scope of practice for speech-language pathology has grown, clinicians in all practice settings have redefined their roles and expanded their knowledge to provide high-quality services to a growing population of persons with communication and swallowing disorders. A key component of these changes has been the increased use of collaborative models of care that require speech-language pathologists to learn new skills related to team dynamics and conflict resolution. During this period of rapid change, questions and concerns have been raised by some ASHA members about professional boundaries and ambiguous situations in which there is overlap in scope of practice with other professions. The term “encroachment” has been used by some ASHA members to describe these situations. Factors Affecting Scope of Practice In the schools, changes in laws and regulations (including the Individuals with Disabilities Education Act and the No Child Left Behind Act) have affected clinical best practices and collaborative interactions between SLPs and other professions. These mandates coincide with changes in the profession, including SLPs’ expanded role in reading and writing/literacy, and a gradual but steady growth in caseload and demand for more specialized knowledge and skills. In health care settings, SLPs are responding to increased demands to provide services for severely ill patients across the lifespan, many of whom require specialized knowledge and skills that go beyond those required for “generalist” practice. Increased productivity demands and decreased reimbursement rates create tensions that compel clinicians to do more with less. Further, changes in facilities’ organizational structures and other cost-containment measures have resulted in the increased use of template or protocol-based practices and multi-skilled personnel (e.g., aides and assistants) and have generated greater demands for fast and efficient outcome-oriented care. Two other factors complicate service delivery. First, the shortage of qualified personnel has resulted in the hiring of individuals without previously accepted qualifications to perform the work of SLPs. Additionally, the gap between research and clinical practice challenges SLPs who attempt to use evidence-based practices and demonstrate the measurable impact of speech-language services on communication and swallowing outcomes. ASHA’s Response In response to concerns of a gradual blurring of boundaries and the perceived loss of professional identity raised by ASHA members, Brian Shulman, then vice president for professional practices in speech-language pathology, convened a committee in October 2006 to examine the issues and make recommendations to the ASHA Board of Directors. Committee members included Anastasia Antoniadis, Suzanne Ducharme, Maureen A. Lefton-Greif, Sherry Sancibrian, and Lemmietta McNeilly (ex officio). Genncis Rosado joined the committee in 2008 following Antoniadis’ departure. “Encroachment” is a term that has been used by SLPs and ASHA in various contexts. Initial discussion focused on that term and its negative connotation. The committee sought to reframe “encroachment” by referring to the issue as “scope of practice” or “role ambiguity” to reflect more accurately the prevailing emphasis on team-driven models. Survey To determine the extent and scope of encroachment perception, the committee developed and disseminated an electronic survey to 50,335 members in May 2007. Responses were obtained from 4,708 members (ASHA, 2007), yielding a response rate of 9.4% (see Figure 1 [PDF]). Survey highlights are listed in the sidebar on p. 15 (the complete report is available online). Briefly, survey responses revealed: SLPs were evenly divided about the appropriateness of the term “encroachment” and how to define it. SLPs who have and have not experienced encroachment reported concern about this issue. SLPs were most likely to identify encroachment from professions with the greatest degree of overlap in scope of practice. Disorders/populations that require the highest level of teaming and collaboration were most susceptible to the perception of encroachment. SLPs’ perceptions and experiences of encroachment were related to internal factors (i.e., institutional patterns of practice and service delivery) and external factors (i.e,, reimbursement issues and patterns). ASHA cannot mandate the scope of practice for another discipline, but might be an agent to facilitate change. Many of the suggestions about steps to improve the situation are already in place or underway through ASHA programs. Many respondents reported concerns or ambivalence about the expanding scope of practice in the field. Some clinicians reported being asked to perform tasks or work in areas they deemed inappropriate given their training and comfort levels. Others indicated disapproval of SLPs’ involvement in specific areas of practice, including swallowing, literacy, and cognition. Survey results underscored some sharp contrasts within the field and the need for more discussion and debate. Recommendations Neutral Terminology The negative connotation of the term “encroachment” expressed by survey respondents has spurred an interest in adopting terminology that reflects a more accurate—and neutral—view of professions’ overlapping scopes of practice. A more appropriate term may be “role ambiguity,” as professional boundaries stretch as SLPs expand their roles to meet client needs. Team-Oriented Service Delivery It is ASHA’s position that SLPs do not “own” any aspect of their scope of practice, nor can they dictate what another profession can or cannot do. Clearly, speech-language pathology shares professional boundaries with related professions, and SLPs need to understand other team members’ expertise while articulating the value of their own unique knowledge and skills. A potential response to environmental changes in education and health care is to increase collaboration and teaming to enhance functional outcomes. “Teaming” emphasizes an individual-by-individual approach that focuses on the “whole” client as he or she functions within the environment, rather than a profession-by-profession approach. Each team must determine how to define and execute best practices for each client in that specific setting. Team-building and decisions for each client are affected by the individuals who make up the team and the professions they represent. Each professional brings a unique scope of practice, professional identity, skill set, and personal opinions about how to interact with other team members. Team Practice Models Teams are traditionally classified as multidisciplinary, interdisciplinary, and transdisciplinary. Boon, Verhoef, O’Hara, and Findlay (2004) propose an expanded conceptual framework with seven models on a continuum from parallel to integrative practice (see Table 1 [PDF]). Boon et al. emphasize that there is no single “best” model; different types and stages of care require different practice models. A child with a mild articulation disorder may be well-served by the parallel practice model, but an interdisciplinary or integrative approach might better meet the multi-faceted needs of a child with autism or an adult in rehabilitation after a stroke. A more intensive, integrative model may be preferable in initial stages of care, with a gradual shift to less integrative models as intervention goals are achieved. Teamwork has obvious advantages if one assumes that many perspectives yield better outcomes than fewer perspectives. Team members share knowledge and resources and provide integrated intervention rather than perform isolated tasks; teamwork may reduce redundancy and fragmentation of service and improve quality and cost-efficiency. Implementation of a team model may, however, be challenging. Barriers to effective team building and teamwork include: Lack of time. In an era of cost containment, increased productivity demands, and personnel shortages, time for team meetings is dwindling. This problem has been exacerbated by the inability to bill for team conferencing time (see Table 2 [PDF]), although it may change as new billing codes for team services are implemented. Lack of information. A survey of students in physical and occupational therapy and speech-language pathology found that although students were aware of the teamwork concept they had little teamwork experience (Insalaco, Ozkurt, & Santiago, 2007) and limited knowledge of other professions’ training and expertise. Lack of harmony. Friction among team members may arise from many sources, including differences in generation, gender, culture, stage of career development, hierarchical status, commitment to the team approach, personality, and work styles. Perhaps the most common source of tension comes from ambiguity over team members’ roles. Shared practice areas offer numerous opportunities for collaboration, but concern over protecting professional turf can destroy the trust and mutual respect required to function as a team. Teaming requires SLPs to develop skills to establish team relationships, navigate conflict, solve problems, deal with divergent thinking, and incorporate new paradigms for analyzing situations and implementing solutions. Recognizing these requirements, ASHA (2001) has identified workplace skills that graduate students need, including team-building, conflict management, “organizational agility,” and interpersonal skills. Opportunities for New Skills Teaming provides new opportunities for SLPs. Nancarrow and Borthwick (2005) reviewed how team members can develop and deliver skills within and across professional boundaries: Diversification: development of new treatment methods or techniques not previously practiced by any particular professional group, resulting in an expansion of the professional boundaries. Specialization: development of an increased level of expertise in an area adopted by a profession. Vertical substitution: adoption of tasks across professions with different levels of training or expertise (for example, changing the role of nursing to include the prescribing of medication). Horizontal substitution: providers undertake roles normally within the scope of another profession, not because of a desire for increased professional or financial status, but because of factors including staff shortages, work settings, and treatment populations. Resolution of Role Ambiguity The path to resolving role ambiguity may be blocked by structural or organizational obstacles (see Table 3 [PDF]). The management style of an organization may not allow a clinician to challenge the administration with questions of role ambiguity. Communication among providers and between providers and administration may not be open and bidirectional. Expectations of managers who have no direct contact with clients may differ from the practitioner’s view of quality of care. Practitioners may disagree on the primary roles of their own and other professions. There is a lack of models to help SLPs clarify issues stemming from role ambiguity and resolution of associated conflicts. A candidate model must be sufficiently fluid to allow for the integration of relevant facts (e.g., evidence-based methodologies) with judgments (e.g., perceived or desired roles of individual team members), regardless of work setting and specific populations served. Adaptation of a model that addresses ethical quandaries proposed by Lefton-Greif and Arvedson (1997) may provide a framework for managing the complex issues evolving from role ambiguity. The model includes: Identifying pertinent organizational systems and acquiring relevant facts about each of the systems. Defining potential actions and their consequences. Implementing “best” actions. Finally, individual SLPs face personal decisions regarding the need to balance the cultures of institutional and team systems with their professional scope and practices. For example, role expectations for SLPs differ across settings for a variety of reasons including, but not limited to, history (the way things have always been done), personnel shortages (past or current), and personal decisions. Future Directions Current trends suggest that SLPs and other allied health professionals will face even greater role diversification—and therefore issues of role ambiguity—in the future. Beyond role ambiguity, two related critical areas need to be addressed within the profession. First, personnel shortages demand recruitment of new SLPs educated in the current and anticipated needs of the populations served. Second, research is needed to establish the evidence base for speech-language pathology practice. Strategies are needed to improve recognition of the SLP’s role and ensure the highest quality of services. The profession must: Increase awareness of speech-language pathology among college undergraduates to encourage more students to consider the field. Develop graduate curricula with interdisciplinary training and information about the roles of SLPs on teams. Create post-graduate opportunities for mentoring and training that promote advanced levels of clinical practice and research. Conduct research that demonstrates the impact of the SLP’s expertise on outcomes. Advocate for changes in educational and health care policies that enhance the delivery of speech-language treatment and help establish appropriate salary and reimbursement levels. Educate consumers about SLPs’ services. Increase communication among professional organizations in allied health fields to enhance understanding of each profession’s knowledge base and develop models that promote interdisciplinary collaboration. Encourage use of current mechanisms—such as reimbursement codes—that support interdisciplinary models. Scope-of-practice issues are viewed both negatively and positively by SLPs and other professionals who serve on various patient management teams; these views are determined by a variety of factors that affect scope of practice. SLPs should value and respect one another’s roles and validate the specific roles of each individual team member in effective management of patients with communication disorders. It is also critical for SLPs to openly discuss specific roles with other team members so that the expertise of each professional can be maximized effectively to deliver services designed to meet the individual needs of each patient. The 2007–2009 Vice President for Speech-Language Pathology Practice Coordinating Committee included Brian Shulman, PhD, CCC-SLP (chair); Suzanne Ducharme, MS, CCC-SLP; Maureen A. Lefton-Greif, PhD, CCC-SLP; Genncis Rosado, MA, CCC-SLP; Sherry Sancibrian, MS, CCC-SLP; and Lemmietta McNeilly, PhD, CCC-SLP (ex officio). “Encroachment” Survey Highlights Responses to AHA’s 2006 survey offered insight to SLPs’ experiences with “encroachment.” Do SLPs face encroachment? Half of all respondents, evenly distributed across practice settings, said they had experienced encroachment as defined. Of those who had experienced encroachment, 44% considered it a minor problem; 34% registered moderate or significant concern. When asked about their level of concern about encroachment for the profession, more than 50% of the respondents, even those who had not experienced encroachment, perceived it as a moderately significant problem. Are specific professions perceived to encroach on SLPs? Respondents who reported encroachment experience indicated encroachment from academic language therapists (89%), occupational therapists (65%), teachers (58%), nurses (55%), and reading specialists (50%). The high level of experience with academic language therapists may reflect an issue of the survey sample, as some states do not have this title. When asked about the level of concern for encroachment from a variety of professions, respondents reported concern about occupational therapists (68%), reading specialists (61%), teachers (61%), educational therapists (49%), and academic language therapists (44%). Do specific populations seem vulnerable to encroachment? Respondents identified the following as sources of scope of practice issues: language/literacy (64%), autism spectrum disorders (ASD, 63%), learning disabilities (59%), early intervention (53%), and dysphagia/swallowing disorders (52%). When asked about their level of concern for potential encroachment, respondents who had experienced encroachment expressed the highest concerns about ASD (69%), language/literacy/learning disabilities (65%), dysphagia/swallowing disorders (60%), and early intervention (57%). Why does encroachment occur? Respondents strongly suggested that encroachment is due to lack of knowledge about the role of SLPs and their scope of practice (71%), administrative and facility-level policies (71%), changes in SLPs’ scope of practice with resulting overlap with others (47%), and personnel shortages (47%). Respondents did not feel that encroachment is the result of an outside force or entity’s attempt to undermine the profession or to narrow SLPs’ scope of practice. Who should address this issue? Almost half (47%) of respondents said ASHA, as a national organization, should address encroachment, followed by state associations (42%), state licensure boards (41%), and individual facilities through the development of policies and procedures (39%). What are some alternative terms to “encroachment”? Responses were fairly evenly divided over terminology: 45% responded that the term is appropriate; 55% responded that it is not appropriate or are not sure. Respondents offered a range of alternative terms. Some felt strongly that “encroachment” is too negative and not reflective of the collaborative reality in clinical practice. Suggested terms included mutual professional consideration, merged interests, crossover, and integration. In contrast, others resented the infringement of other professions and suggested terms such as trespassing, intrusion, and conflict. Other possibilities included role ambiguity and blurring of professional boundaries. This variety demonstrates the range of experiences with and attitudes about the profession’s closest professional colleagues. Resources on Role Ambiguity Resources that provide SLPs with information and training to help address issues related to role ambiguity include: ASHA’s Web site. Online resources include information on the SLP’s scope of practice, frequently asked questions on current issues, documents on collaboration, and policy documents. Special Interest Divisions. ASHA has 16 special interest divisions that provide access to e-mail lists, affiliates-only online content and Web forums, and discounts on select short courses at the ASHA Convention. Specialty Boards. Each of the three specialty boards –Child Language, Fluency Disorders, and Swallowing and Swallowing Disorders—provides a mechanism for SLPs to demonstrate acquisition of more advanced knowledge, skills, and experience and offers information on marketing to potential patients/clients. Find Out More June 2007 Encroachment Survey results Answers to the most commonly asked questions about the role of ASHA-certified SLPs in schools. Complete References American Speech-Language Hearing Association (2001). Responding to the changing needs of speech-language pathology and audiology students in the 21st century: A briefing paper. Rockville, MD: Author. www.asha.org/academic/reports/changing. Google Scholar American Speech-Language Hearing Association (2007). ASHA Survey: Encroachment in the speech-language pathology profession. Rockville, MD: Author. www.asha.org/research. Google Scholar Boon H., Verhoef M., O’Hara D., & Findlay B. (2004). From parallel practice to integrative health care: A conceptual framework. BMC Health Services Research. www.biomedcentral.com/1472-6963-4-15. Google Scholar Insalaco D., Ozkurt E., & Santiago D. (2007). The perceptions of students in the allied health professions toward stroke rehabilitation teams and the SLP’s role.Journal of Communication Disorders, 40, 196–214. Google Scholar Lefton-Greif M. A., & Arvedson J. C. (1997). Ethical considerations in pediatric dysphagia.Seminars in Speech and Language, 18, 79–86. Google Scholar Nancarrow S. A., & Borthwick A. M. (2005). Dynamic professional boundaries in the healthcare workforce.Sociology of Health and Illness, 27, 897–919. Google Scholar Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 16December 2009 Get Permissions Add to your Mendeley library History Published in print: Dec 1, 2009 Metrics Current downloads: 1,598 Topicsasha-topicsleader_do_tagasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings

Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings: A Primer for Clinicians, Executives, and Preceptors

As state legislatures across America look for ways to improve constituents'health and lower health care costs, interest in pharmacist-provided care evidently is increasing. Compared with this timelast year, related state legislative activity is up. Last year, 26 billshad been introduced. So far this year, 75 state bills addressing someaspect of patient access to pharmacists' care have been introduced,as Pharmacy Today went to press. Even more activity is possiblethis year because many states still have time to introduce bills in thissession (see Figure 1).