Clinical Work Practice Research Articles

Using video observation to gain insight into complex clinical work practices.

Experience shows that the precondition for development of successful health-information-technologies (HIT) is a thorough insight into clinical work practices. In contemporary clinical work practices, clinical work and health information technology are closely integrated. Research within Virtual Centre for Health Informatics at Aalborg University, Denmark have during recent years focused on video observation to supplementing traditional ethnographical research methods in providing insight into complex clinical work practices. The objective of this paper is to argue for the potentials of the video observation method to inform and to improve HIT development compared to traditional ethnographic methods. Based on several studies conducted within the healthcare sector, we find, that the video observation method is superior to other ethnographical research methods when it comes to rapidly disclosing the complexity in clinical sociomaterial work practices. We also find that the video techniques used in the healthcare context allows us to revisit the field of observation through the data, to broaden our initial focus and to share data with both the clinical staff involved and other researchers. Hence, it provides us a more in depth insight in the complex clinical sociomaterial work practices than when observing by the use of pen and paper.

Practice-centred work analysis: towards ontology-based decision support in cross-boundary e-health

Ontologies are increasingly used as artefacts for representing human knowledge for problem solving and decision making. Studies have shown that the actual knowledge used in problem solving and decision-making often occurs at the work practice level – the level that typically goes beyond functional notions of work processes to include a wide range of contextual, socio-cultural, situated and dynamically changing factors through which individuals, in getting work done, seek to construct meaning out of their experiences and engagement with the environment. However, it still remains an open question how much of the issues encompassed by a notion of work practice is accommodated in current ontology design approaches in system design. In this paper, the creation and use of ontologies is analysed from a practice-theoretic perspective in order to understand the processes of shared conceptualisation and role of ontologies in explicating knowledge about actual clinical work processes and problem situations. We illustrate this using a clinical work practice ontology, which we refer to as WOPRON, and show its capability for representing clinical work practice knowledge for cross-boundary decision support in e-health.

Will information and communication technology disrupt the health system and deliver on its promise?

Investment in information and communication technology (ICT) in the health sector can bring important benefits. To date, the focus has been on automating clinical work practices such as ordering tests and prescriptions, which significantly improves efficiency and safety. Uptake of ICT has been slow and the results less favourable than anticipated for various reasons, including poor integration of systems into complex clinical work processes, limited training, and the intermittent nature of ICT funding. As a result, many health care organisations have been operating hybrid paper and computer systems that introduce new patient risks, staff frustration, and outcomes below expectation. The focus must shift from automation of clinical work to innovation; from evolutionary application of ICT to revolutionary uses. Health professionals must embrace ICT as a "disruptive technology" that will produce significant changes in their roles and responsibilities and lead to real health reform with new, innovative models of health care delivery. As other industries have shown, substitution and role changes are areas in which ICT can lead to the greatest gains.

Struggling with cultural prejudice while observing babies. Socio-centric and egocentric positions

This paper describes the challenge that different cultural beliefs about parenting pose for the practice of infant observation and direct clinical work. In particular it discusses the distinction between egocentric and socio-centric cultural views, how cultural presuppositions infuse our understanding and perception, and how hard it is not to judge others as a result of our own cultural beliefs and biases.

The development of nursing research about stuporous patients' leaved stomach tube

According to my own practice in clinical work together with the new viewpoint and the new method from nursing colleagues,Ⅰ summarized the nursing technology of stuprorous pafienm'leaved stomach tube,almming at choosing different methods of leaving tube for different patient to enhance the 8ucce88 ratio of inserting the tube. Key words: Stupamus patient; Stomach tube; Posting method; Matters needing aRention

Second Annual Nursing Leadership Congress

In September 2006, 75 nurse executives met in Asheville, N.C., to develop practical tools and recommendations for "Building the Foundation for a Culture of Safety," the theme of the second annual Nursing Leadership Congress. The Congress is sponsored by McKesson and Intel in collaboration with the American Organization of Nurse Executives, Institute for Safe Medication Practices, National Patient Safety Foundation, and Joint Commission Resources. Plenary speakers included David Marx, JD, president of Outcome Engineering and an expert on helping organizations create a "just culture." Representatives from Children's Hospitals and Clinics of Minnesota in Minneapolis/St Paul and Overlook Hospital in Summit, N.J., touched on several aspects of patient safety, from developing a road map and engaging physicians to workload management and rapid response teams. Researcher Monique Lambert, PhD, shared highlights of studies that Intel is conducting aimed at maximizing the benefits of technology in clinical work practice while minimizing the risk of introducing new sources of errors. Joseph Grenny shared techniques outlined in his 2 best-selling books on "crucial conversations" and "crucial confrontations." The cornerstone of the Nursing Leadership Congress is the roundtables. This year, participants broke into groups to brainstorm around 5 topics: disclosure and team building, reflections of culture in large-scale clinical implementations, measuring change, effecting change, and mentoring. This article presents highlights from both the plenary sessions and roundtables.

Novel Multilayer Coatings on Polyethylene for Acetabular Devices

Total hip replacement is a common practice in every day clinical work. Artificial hip implants consist of a femoral component and an acetabular component. Nowadays the acetabular component is composed of a polymeric cup and a metallic shell. This study focuses the development of an innovative acetabular component substituting the metallic shell by a multilayer coating on the acetabular cup. A titanium coating was deposited onto ultra-high molecular weight polyethylene (UHMWPE) samples by physical vapour deposition (PVD), having an in situ pretreatment with argon ion bombardment in order to optimize the adhesive strength by surface modification, followed by the deposition of a thin film of hydroxyapatite (HA) using rf magnetron sputtering technique, at room temperature. Results obtained seem to indicate that these multilayer coatings can be a viable alternative to the metallic shell, leading to the substitution of a two part for a one part acetabular component.

What’s so different about mobile information communication technologies (MICTs) for clinical work practices? A review of selected pilot studies

This article seeks to highlight some distinctive issues involved in the use of mobile information and communication technologies (MICTs) in the healthcare context. A three-layered framework for analysing cases of MICT-in-use is developed from the literature and employed to analyse evidence from a number of healthcare MICT pilot studies. These indicate that MICTs create new implementation challenges, and that developers and implementers appear to pay little attention to the particular workflow modalities of mobility and their relationship with the type of MICT. In terms of effects on clinical work practices, MICTs seemed to make access to information easier but not necessarily faster. Better integration of MICTs with other hospital systems and use of wireless networks were seen as necessary to achieve greater uptake. Areas for further research that might support the implementation of MICTs in healthcare are identified.

Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice

ObjectiveIt is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. DesignCombined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. MeasurementsThe questionnaireQuestionnaireQuestionnaire (English translation available as an online data supplement at www.jamia.org) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. ResultsThe physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. ConclusionScanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

Marital Cohesion, Flexibility, and Communication in the Marriages of Nontraditional and Traditional Women

The purpose of this study was to compare reported levels of marital quality, marital stability, and the marital processes of cohesion, flexibility, and communication in the marriages of nontraditional and traditional women. Selected data from the Marital Instability Over the Life Course Data Set were used. A subsample of 74 married women who were defined as nontraditional and a comparison group of 274 traditional women were selected according to their occupational status and gender role orientation. Nontraditional women included those reporting a nontraditional gender role orientation and employment in a professional or managerial position. Traditional women included those who reported a traditional gender role orientation and employment in a clerical, sales, service, or private household worker occupation. Results of repeated measures multivariate analysis of covariance indicated many similarities between the two groups; however, nontraditional women reported greater flexibility in their marriages. Implications of the findings for practice in clinical work with couples are addressed.

Changing Patient Trends and Clinical Work Practices in the Psychogeriatric Day Hospital "Klinikum am Europakanal, Erlangen"

OBJECTIVES: The aim is to describe and analyse the concepts of multimodal clinical work and the impact of changing patient trends on clinical work practices in our Psychogeriatric Day Hospital since it opened in 1986. METHOD: Day hospital statistics concerning length of stay, referral rates and readmission over the years were analysed. In two evaluation studies, client satisfaction and daily living activities were assessed. RESULTS: There is firm evidence for the effectiveness of day hospital treatment, as demonstrated by the results of the evaluation studies. In the last two years the average length of day hospital stay reduced significantly, while referrals for day hospital treatment increased rapidly. Despite these changes, the number of staff has stayed the same from 1986 to now. CONCLUSION: For day hospital intervention to remain effective in the light of changing patients trends, adequate time needs to be given for diagnostic and therapeutic procedures including psycho-educational work with patients' family members. This is not only a question of cost-effectiveness, but also an ethical approach bearing in mind future trends towards an increasingly aging population where demand will increase for this type of provision.

Current Trends in Health Care: Our Profession Is Our Business

Current Trends in Health Care: Our Profession Is Our Business

Women and Thinness: The Watch on the Eve of the Feast. Therapy with Families Experiencing Troubled Eating

Research from historical, anthropological, and psychological perspectives tells us that extraordinary forms of appetite control have been practiced by women for centuries. Eating disorder have often been conceptualized in the literature as a phenomenon of personal and familial maladjustment. The author argues that the experience of troubled eating is more aptly situated in a social and cultural context. Presently, self-starvation has much to say about cultural values that place slenderness on the highest pedestal of female accomplishment. The author contends that a critical aspect of the intricacies that comprise troubled eating is self-surveillance. This phenomenon is significantly related to our present social context and has important implications in the practice of clinical work with families in which a member is experiencing troubled eating. The effects of self-surveillance can be understood and addressed by therapists in a way that challenges the devastation, which self-surveillance and troubled eating can rend in the lives of those under its tyranny. As therapists, we become aware that we participate in the creation, maintenance, and living of discourses and beliefs that surround the topic of physical beauty and aesthetic ideals. The author suggests that we are therefore obligated to live and practice in ways that defy the strategies of self-surveillance both in our personal and professionals lives, and in the work we do with families.

A Delphi approach to describing service models of community mental health practice.

The activities of mental health practitioners are poorly understood and described because of a lack of generally accepted and understandable categories. Greater precision is needed for accountability, planning, and evaluation. The objective of this study was to identify a valid and reliable set of categories to describe the clinical work practices of intensive case managers in the United Kingdom. Eight intensive case managers participated in a Delphi process to produce a set of categories that described their clinical work practices. They each completed three questionnaires and participated in a final group discussion. The initial open questionnaire generated 38 potential categories after exact duplicates were removed. In round 2, the intensive case managers each rated the 38 categories from 1 to 5 (essential to unimportant). A high degree of consensus on the relative importance of the 38 suggested practice categories was rapidly achieved. In round 3, they re-rated the categories in the light of group medians and their own round 2 ratings. In a structured face-to-face discussion group, the intensive case managers then reduced the 38 potential categories to ten comprehensive and mutually exclusive categories that were judged to adequately and accurately reflect work practices. They were housing, finance, daily living skills, criminal justice system, occupation and leisure, engagement, physical health, caregivers and significant others, specific mental health intervention or assessment, and medication. Delphi methods were effective and relatively straightforward in producing an agreed-on set of categories with which to record clinical activity and inform care planning.

Modelling nursing activities: electronic patient records and their discontents.

A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are at least partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses' and doctors' work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development.

Objectification and negotiation in interpreting clinical images: implications for computer-based patient records

This paper concerns the role of images and visualization in clinical practice and decision making. In particular, how physicians talk about and use images are discussed. Findings from evaluation studies of clinical imaging computer information systems suggest that the role and interpretation of images is negotiated, an example of how what is seen is influenced by the practice community, and, therefore is situated in specific instances of clinical decision making. An understanding of professional vision with respect to how physicians use and think about images may aid in developing clinical imaging systems, computer-based patient records, and other clinical information systems that could integrate well with clinical work practice.

Teacher education: Research as reflective practice

Teacher educators are often torn between their practice of teaching and clinical work, and expectations for conducting research. This article argues that research and practice need not be thought of as separate; rather, teacher educators are asked to consider defining a broader conception of research, one which may be described as disciplined, reflective inquiry into practice. Drawing upon current conceptions and practices in teacher education, the author defines an approach toward research on practice. In her argument, she presents a rationale for reflective inquiry into teacher education, a description of the characteristics of such research and several exemplars.

Self-Directed Learning as a Post-Basic Educational Continuum

The importance of applying theory to practice has always been a major consideration for occupational therapy training, especially at a pre-qualification level. The focus of this article is on continuing education at a post-basic level with the emphasis on self-assessment and reflective practice in clinical work. The educational process is related to self-directed learning, with recommendations for consideration for implementing a strategy to bridge the theory-practice divide and develop clinical excellence.

A growing involvement in homœopathy

Given the topic 'In the light of experience', I chose the above title, hoping to contribute something helpful from different clinical experiences in general practice in clinical work in consulting practice in teaching and in research. I was born into a family where homceopathy was in everyday use. My mother (born in 1884) and her mother before her gave homoeopathic treatment in the home as a matter of course. I knew from earliest childhood, for example, that Bryonia was a cough remedy, but I also knew it as a headache remedy because in my family it produced headaches, and I knew that Belladonna was specific for sore throats and scarlet fever. During my student days at the London School of Medicine for Women and The Royal Free Hospital, I continued to use my hom0eopathic medicines, finding that Belladonna did indeed deal with a haemolytic streptococcal throat infection. When I could I would attend a lecture at the Royal London Homceopathic Hospital. After qualifying I had no opportunity during house jobs at my own teaching hospital and other hospitals, or in army service, to use my hom~eopathy; but I still carried my own homceopathic medicines with me, although I had no other practical experience in their use. In 1948 I found myself in general practice in Bath using only conventional medicines, but these would not always do what I wanted. I had a few patients who preferred homoeopathy, so at their request I began to return to my homceopathic medicines. Imagine my fear when I first used Stramonium in homceopathic doses---but it worked! Then I had a Royal National Mineral Water Hospital patient who had been on gold for severe and advanced rheumatoid arthritis. Her hair was falling out in handfuls and her teeth

The practice of part-time clinical work and the value of epidemiological research: the opinions of consultant community physicians in the South-East Thames Region

The practice of part-time clinical work and the value of epidemiological research: the opinions of consultant community physicians in the South-East Thames Region