Development Of Practice Standards Research Articles

The Application of Schneider’s Critical Discourse Analysis Framework for a Study of Spirituality in Nursing

Using a critical discourse analysis approach in analyzing data is useful in exploring meanings and the wider social, political, and historical context of the meanings. However, analyzing data using a critical discourse analysis approach can be difficult and complex. Hence there is a need for well-defined explicit approaches for discourse analysts to follow. The aim of this paper was to explore a clearly explained framework as a method for data analysis in a study investigating spirituality in nursing. Schneider’s method provided the researcher with such a clearly structured framework underpinned by critical discourse analysis that was used in the analysis of a series of interviews conducted with Australian registered nurses involved in the development of practice standards and those applying them in clinical practice. Schneider’s work steps provided a means of applying Fairclough’s and Chilton’s approaches to critical discourse analysis in a systematic and efficient manner to the analysis of the interview texts. The application of this method enabled the generation of findings that revealed the participants’ discursive constructions of spirituality.

Outpacing the resistance tsunami: Antimicrobial stewardship in equine medicine, an overview

SummaryAntimicrobial stewardship (AMS) is the term increasingly used to describe the multiple approaches needed to sustain the efficacy of antimicrobial drugs in the face of the increasing development and spread of antimicrobial resistance in bacterial pathogens, and the global crisis in medicine that it is engendering. The concept and the practices associated with AMS continue to evolve but the general approach is a dynamic and multifaceted one of continuous improvement based on reducing, improving, monitoring and evaluating the use of antimicrobials so as to preserve their future efficacy and to protect human and animal health. Using many equine examples, this basic overview discusses the multiple and interacting elements of AMS: Practice guidelines, infection control and prevention, clinical microbiology, resistance and use surveillance, dosage, pharmacokinetics and pharmacodynamics, regulation, education and owner compliance, leadership, coordination and measurement. There have been impressive advances in recent years in reporting and analysis of AMR in horses, in the scrutiny and assessment of how antimicrobial drugs are used in horses and in identification of areas for improvement including dosing, surgical prophylaxis, infection control, development of practice standards and the use of clinical microbiology. Antimicrobial stewardship is taking shape as we start to see the emergence of evidence‐based recommendations but far more is required. Containing and even rolling back AMR will need the continued engagement of practitioners, equine national and international practitioner organisations, researchers and educators in the academic community, horse owners, regulators and others.

Informing the development midwifery standards for practice: A literature review for policy development

AimTo critically appraise and synthesise the literature regarding the role and scope of midwifery practice, specifically to inform the evidence based development of standards for practice for all midwives in Australia. DesignA structured scoping review of the literature Data sourcesCINAHL Complete, MEDLINE Complete and Cochrane Libraries databases, online and grey literature databases Review methodsComprehensive searches of databases used key words and controlled vocabulary for each database to search for publications 2006–2016. Studies were not restricted by research method. FindingsThere is no substantive body of literature on midwifery competency standards or standards for practice. From 1648 papers screened, twenty-eight papers were identified to inform this review. Eight studies including systematic reviews were annotated with three research papers further assessed as having direct application to this review. To inform the development of Midwife standards for practice, the comprehensive role of the midwife across multiple settings was seen to include: woman centred and primary health care; safe supportive and collaborative practice; clinical knowledge and skills with interpersonal and cultural competence. Key conclusionsMidwifery practice is not restricted to the provision of direct clinical care and extends to any role where the midwife uses midwifery skills and knowledge. This practice includes working in clinical and non-clinical relationships with the woman and other clients as well as working in management, administration, education, research, advisory, regulatory, and policy development roles. Implications for practiceThis review articulates the definition, role and scope of midwifery practice to inform the development of contemporary standards for practice for the Australian midwife.

Taking the pulse of multidisciplinary cancer conferences for breast cancer care in Canada: A stocktake of current practice

AimInternational guidelines highlight the importance of implementation supports and quality monitoring of multidisciplinary care for breast cancer. In Canada, Ontario has standards for formal multidisciplinary cancer conferences (MCCs), but other provinces/territories do not. This study aimed to stocktake MCCs for breast cancer in Canadian sites participating in the RUBY cohort study (Reducing the Burden of Breast Cancer in Young Women) to better understand variations in multidisciplinary care across Canada and to add to the international literature. MethodsA cross-sectional survey was conducted with surgeons and surgical oncologists representing 34 clinical centres participating in RUBY. Questions were grouped according to: type of multidisciplinary care, implementation, function, practice, participation and presentation, operation, and demographics, and included a mix of Likert-based, tick box and open-ended questions. ResultsTwenty-two responses (65%) were received. 91% of respondents reported that formal MCCs are part of regular practice. However, variation exists in the supports in place for ongoing implementation of MCCs, the understanding of the functions of MCCs, and the patients presented for discussion. Results also suggest less formalized processes for MCC in provinces without practice standards. ConclusionsResponse differences between Ontario and elsewhere suggest that standards for MCC and supports for their implementation make a positive difference in their operation. However, ongoing operational challenges and issues with attendance exist for all sites and suggest that along with development of practice standards, incentives for participation and further education on benefits and function of MCC may support uptake of MCCs in clinical practice.

Working Towards Developing Practice Standards For the National Association of Therapeutic Schools and Programs

This study utilized qualitative methods to analyze 11 case studies published in a recent Special Issue of the Journal of Therapeutic Schools and Programs. The students featured in the case studies ranged in age from 14-19 years and were clients in established residential and wilderness programs that were members of the National Association of Therapeutic Schools and Programs (NATSAP). Several themes emerged and were aggregated into eight categories of therapeutic challenges: family dysfunction, anxiety and mood disorders, academic struggles, identity formation and self-esteem, unresolved trauma, difficulty with transitions, disruptive behavior, confrontational attitudes, and resistance to treatment. Based on the analyses, themes were proposed to guide the development of practice standards and research for NATSAP.

Nursing Students’ Opinions towards Nursing Diagnoses

Background: Nursing diagnosis is a consistent language that offers the foundation to select nursing interventions. Which conveyed nursing a position as a distinctive health discipline in giving care to patient. Aim: The aim of this study was to determine nursing students’ opinions towards nursing diagnoses. Methodology: A descriptive / exploratory design was used to conduct the current study. A 14-items (two constructs measuring students’ opinions about nursing diagnoses and the advantages of using nursing diagnoses) self-administered questionnaire was administered to a non-probability convenience sample of one hundred and sixty seven female nursing students. Informed written consent was obtained from all students who agreed to participate in the study. Results: The majority of the participated nursing students agreed that nursing diagnoses are a priority subject in nursing and necessary to use in the hospital wards. Moreover, most of the students agreed on the nursing diagnoses’ advantages as the development of practice standards in nursing care and improving the use of the nursing process. Conclusion: Nursing students had a good insight about the importance and advantages of using nursing diagnoses in clinical practice. To increase students’ knowledge and experience, more consistency in the value of nursing diagnoses needs to exist between educators and nursing students.

The transition from active treatment to initiation of end-of-life care within the intensive care unit: A clinician's perspective

Introduction: To achieve optimal patient outcomes, nurses working in critical care should hold a specialty qualification. Currently no uniform practice outcomes for critical care programs exist. Varying interpretations of a “critical care qualification” have been used as there are no agreed practice standards to measure outcomes. Additionally there have been no reported attempts to include health service consumer input into the development of practice standards. Study objectives: To develop national practice standards for graduates of critical care nurse education and a clinical assessment tool (SPECT) to measure practice. Methods:Amulti-step,mixedmethod design including a literature review, analysisof existingprograms (n=22)and identification of health consumer views via individual and group interviews (n=17). The findings informed a Delphi study of 105 nurse stakeholders to determine critical care graduate practice standards. The SPECT was based upon the Delphi results and pilot-tested. Results: The literature review, analysis of courses and health consumers viewswere used to develop 99 draft practice standards. The Delphi study resulted in 98 agreed standards (organised in 6 domains) that describe newly graduated critical care nurses should be able to manage the care of critically ill patients in most complex situations. They should not be expected to perform leadership roles. The standards were further arranged into a practical tool to measure graduate practice. This involved elimination of some duplication and re-grouping of some statements as elements. The SPECT contained 86 statements – initial testing revealed strong content validity, good internal consistency, test–retest and intrarater agreement, with at least moderate agreement for 94% of statements. The majority of panel responses (66%) were ranked as clinically feasible. Conclusion: For the first time health consumers have contributed to the components of critical care nurse graduate practice. The standards and SPECT provide the means to clearly define the expected practice level for graduates of critical care education programs. Acknowledgements: Thank you to: Australian College of Critical Care Nurses, Department of Health Western Australia, Helen Bailey Scholarship 2011, the participants for each phase of the study.

Practice expectations for graduates of Australian critical care nurse education: Development of the standard of practice and evaluation of critical-care-nursing tool (SPECT)

Introduction: To achieve optimal patient outcomes, nurses working in critical care should hold a specialty qualification. Currently no uniform practice outcomes for critical care programs exist. Varying interpretations of a “critical care qualification” have been used as there are no agreed practice standards to measure outcomes. Additionally there have been no reported attempts to include health service consumer input into the development of practice standards. Study objectives: To develop national practice standards for graduates of critical care nurse education and a clinical assessment tool (SPECT) to measure practice. Methods:Amulti-step,mixedmethod design including a literature review, analysisof existingprograms (n=22)and identification of health consumer views via individual and group interviews (n=17). The findings informed a Delphi study of 105 nurse stakeholders to determine critical care graduate practice standards. The SPECT was based upon the Delphi results and pilot-tested. Results: The literature review, analysis of courses and health consumers viewswere used to develop 99 draft practice standards. The Delphi study resulted in 98 agreed standards (organised in 6 domains) that describe newly graduated critical care nurses should be able to manage the care of critically ill patients in most complex situations. They should not be expected to perform leadership roles. The standards were further arranged into a practical tool to measure graduate practice. This involved elimination of some duplication and re-grouping of some statements as elements. The SPECT contained 86 statements – initial testing revealed strong content validity, good internal consistency, test–retest and intrarater agreement, with at least moderate agreement for 94% of statements. The majority of panel responses (66%) were ranked as clinically feasible. Conclusion: For the first time health consumers have contributed to the components of critical care nurse graduate practice. The standards and SPECT provide the means to clearly define the expected practice level for graduates of critical care education programs. Acknowledgements: Thank you to: Australian College of Critical Care Nurses, Department of Health Western Australia, Helen Bailey Scholarship 2011, the participants for each phase of the study.

Charting our course for a better CUA

The new year offers us the opportunity to reflect on the past year and to chart our course for the future. This past year was an important one for the Association. We started implementing the recommendations from our Strategic Plan, which was unanimously accepted by members at the CUA 2009 meeting in Toronto. The Executive has responded by embracing an aspirational and inspirational vision, as illustrated by the CUA’s mission statement: “The CUA exists to promote the highest standard of urologic care for Canadians and the advancement of the art and science of urology.” A clear statement of the business of the Association has also been developed, as follows: The CUA is a national member-based organization dedicated to enabling the profession to provide the highest possible standards of urologic care by collaboratively: Fostering, promoting and monitoring excellence in urologic practice through education, research and practice support tools Providing leadership in promoting evidence based clinical practice through the development of practice standards and guidelines Fostering and promoting life-long learning by Canadian urologists through continuous professional development Supporting the CUA Scholarship fund, which plays a major role in supporting research activities by Canadian urologists. Providing leadership in public education for urologic diseases Representing Canadian urology in developing and fostering partnerships while maintaining the highest educational and ethical standards Representing the Canadian urologic community in relationships with governments as well as national and international medical societies. We will continue to do our best to serve our members. We have also administered a survey to assess members’ benefits. The results are being analyzed and will be published soon. Two years ago a dispute arose between the Canadian Urological Association Journal and the Canadian Journal of Urology. We are pleased to inform the urological community the court case that followed the dispute has been amicably settled out of court, to the satisfaction of both parties. Consequently, both journals will continue to be published under their current names. 2010 is also the year of our first ever Annual Meeting in Prince Edward Island! We invite you to attend this unique CUA meeting! CUA committees and affiliated meetings are scheduled for Saturday. The Scientific Program will start on Sunday morning and will last for 3 full days. The meeting will be held in the elegant Delta Prince Edward Hotel. Dr. Michael Mulligan and Ian Reid, along with the rest of the local organizing committee, have been working hard to make sure that every attendee will enjoy the social programme planned. CUA and affiliated meetings are scheduled for Sunday morning before the Opening Brunch, after which the scientific programme will begin. The scientific program, chaired by Dr. Ricardo Rendon, will feature state-of the-art lectures from key opinion leaders in urology, educational fora addressing a wide spectrum of the most compelling issues and controversies in urology, and abstract-driven session showcasing the most cutting-edge research being done in Canada today. Sunday night is the Welcome reception. Held at the Confederation Centre of the Arts/Memorial Hall, this will be a good time to mingle with colleagues, friends and our industry partners. On Monday, after sessions, unwind at the CUA Fun Night at the Founders Hall and Seaport Centre. This Fun Night will not disappoint – join us and TV Chef Michael Smith for a lobster dinner like no other! Music courtesy of East Coast Music Award winners Rawlins Cross will move you to dance! On Tuesday evening, I invite you to join me for the traditional President’s Banquet at the Ballroom of the Delta Hotel. Bring your family. Stay a while! With so many historical, cultural, and outdoor attractions, it is clear that while PEI may be small in size, it is big in adventures for you and your family.

Grassroots Origins, National Engagement: Exploring the Professionalization of Practicing Healthcare Ethicists in Canada

Canadian ethicists have a long legacy of leadership in advocating for standards and quality in healthcare ethics. Continuing this tradition, a grassroots organization of practicing healthcare ethicists (PHEs) concerned about the lack of standardization in the field recently formed to explore potential options related to professionalization. This group calls itself "practicing healthcare ethicists exploring professionalization" (PHEEP). This paper provides a description of the process by which PHEEP has begun to engage the Canadian PHE community in the development of practice standards and related projects. By making our process and its ethical and cultural underpinnings transparent, we hope to prompt PHEs around the world to reflect on the importance of context, process and principles (not just outcomes) in the exploration of and possible movement towards professionalization. By sharing some of our key successes and challenges, we also hope to inspire our colleagues to recognize the value in developing practice standards and to contribute to this endeavor.

Getting Engaged: Exploring Professionalization in Canada

Whether from a practice, academic and/or personal perspective, the topic of professionalization tends to raise many questions, sometimes leading to vigorous debate, for those engaged in health care ethics. As part of exploring professionalization from a Canadian perspective, the papers in this issue tackle some of these questions, offering up reflections for the reader’s consideration. Other papers address conceptual and practical approaches for further work in this area, including the possible development of practice standards, while still others provide relevant historical and contextual (i.e., Canadian) details. The papers range from being more descriptive and formal in style to more conversational and personal, to a translated (French to English) talk. These different ‘‘voices’’, I believe, add to the appreciation of the personal and practice aspects of what we do in health care ethics. Indeed, a quick scan of the paper titles in this issue indicates that there are many ‘‘threads’’ to follow related to exploring professionalization. In our discussions about professionalization and in preparation for a national symposium (see Frolic and Practicing Healthcare Ethicists Exploring Professionalization 2012 for a full description), the members of Practicing Healthcare Ethicists Exploring Professionalization (PHEEP) could not help but appreciate that we were all drawn to this work for sometimes distinct, sometimes overlapping, reasons. These reasons fundamentally shaped how we wanted to approach considerations of professionalization, contributing to interest in a number of related avenues of inquiry about ‘‘what we do’’. Whether we are influenced by our experiences in the practice of healthcare ethics or our education and training, each of us could identify important projects to explore. It was also recognized (which comes as no surprise) that there are several descriptors and references used to denote those who are in healthcare ethics

The Question of Professionalization: A Narrative

For quite some time now, there have been discussions and debates in North America in the field of ethics concerning professionalization. From a talk given to graduate and undergraduate university students, the author tells the personal journey of an ethicist in the province of Quebec, Canada, and offers a narrative to illustrate some of the issues she faced since starting her work in the field of ethics at the end of the 1990s. Instead of taking the usual "for" and "against" positions, the author addresses the issue of professionalization of healthcare ethics from her own point of view. Referring to her experience with ethics committees and research ethics boards and to the works of George A. Legault in Crise d'identité professionnelle et Professionnalisme (Presses de l'Université du Québec, Sainte-Foy, 2003), she pleads for the development of practice standards and the creation of a deliberative process (see Kirby and Simpson in this issue of HEC Forum 2012), a dialogical space for assuring professionalism in healthcare ethics interventions, not solely the act of becoming a profession.

Multidisciplinary cancer conferences: A systematic review and development of practice standards

Background Multidisciplinary cancer conferences (MCCs) are a forum for health care providers to discuss diagnostic and treatment aspects of a cancer patient’s care. In Ontario, we have found that very few hospitals have developed cancer conferences or forums for the prospective discussion of patient cancer care. In this paper, we describe the process of creating a province-wide standards document for MCCs. Methods A systematic review and environmental scan were conducted to evaluate the literature regarding the impact of MCCs on physician practice patterns and patient outcomes, using the methodology of the Practice Guidelines Development Cycle. An Expert Panel was created to develop draft MCC standards. Ontario administrators and practitioners were surveyed to elicit feedback regarding the standards document. The findings were collated, and practice standards were developed. Results Multidisciplinary care, predominantly in the form of multidisciplinary clinics, has been shown to improve patient outcomes. While only limited evidence suggested a benefit for MCCs, they have been documented as influential in changing patient management plans. MCCs were also found to be part of standard cancer care on an international level. Ontario practitioners surveyed generally supported MCC implementation. Discussion We have described the process of creating an Ontario MCC standards document, including a literature review and an examination of the attitudes of Ontario practitioners and hospital administrators regarding the development and implementation of a MCC Standards document.

Neural commitment of cord blood stem cells (HUCB-NSC/NP): Therapeutic perspectives

Human umbilical cord blood (HUCB) is considered a promising source of neural progenitors capable of being used for cellular therapies in neurological disorders. Here we review briefly our work on the elucidation of mechanisms and development of practical standards as regards the selection, maintenance and use of cord blood derivatives for such purposes. Our results join those of other recent studies in suggesting strongly that, the generation of neural-like cells from tissue belonging to a different germ layer (such as a cord blood is) is most probably explained by reference to a discrete subpopulation of embryonic-like stem cells of pluripotent characteristics. Such cells identified in cord blood through their expression of specific genetic and protein markers can be expanded in vitro and directed toward neurally-committed progenitors differentiating further into more mature neuron-like or macroglia-like cell phenotypes. From this HUCB-derived neural progenitor fraction a novel neural-like stem cell line (HUCB-NSC) has been developed, and characterized in respect of in vitro and in vivo (posttransplantation) properties.Correspondence should be addressed to K. Domanska-Janik Email: kd-j@cmdik.pan.pl

Writing Résumés

Writing Résumés

Training, management, and credentialing for CRRT in the ICU

Continuous renal replacement therapy (CRRT) in the intensive care unit (ICU) requires a dedicated training and educational process that includes both theoretical and practical approaches. Important goals for this process include achieving an acceptable circuit life without patient complications and providing a high percentage of staff with bedside expertise. Lectures or didactic sessions must link into bedside instruction and simulations or mock patient/circuit setup. An annual seminar may be useful for all clinicians to share and gain knowledge. Managers require a system of staff review to ensure expertise levels are maintained. Policy development, quality assurance, and complication monitoring systems provide useful information for managers and educators in this field. Credentialing may be useful to confirm the goals of CRRT, but it requires further development of practice standards before adoption.

Enhancing nursing competence with substance abusing clients.

Alcohol and other drug abuse, major threats to health, pose challenges for nurses in virtually every practice setting. Progress toward increasing nursing competence in the addictions field is being made through the development of practice standards and model curricula and through federal initiatives to increase faculty expertise in this field. The next critical step is to forge creative collaborative links with practice settings, links that assure that requisite learning is reality-based and in step with the future of health care. This article outlines progress toward improving nursing competence in substance abuse and suggests reality-based learning strategies as a future direction for this important goal for nursing education. Two successful models of collaboration between education and practice, designed to augment basic curriculum and improve nursing knowledge, skills and attitudes related to substance abuse, are described.

Mirror to ASHP: 1942–1992

Highlights from the history of ASHP are presented on the occasion of the Society's 50th anniversary. Efforts to organize a formal group representing hospital pharmacists, begun in the 1920s, resulted in the formation of a subsection on hospital pharmacy of the American Pharmaceutical Association in 1936. In 1942, ASHP became a distinct organization affiliated with APhA. The body's goals were to establish minimum standards for pharmaceutical services, ensure a supply of well-qualified hospital pharmacists by providing hospital internships, facilitate information exchange, and foster cost-effective use of medicines. The development of practice standards and periodic surveys of hospital pharmaceutical services, educational efforts and accreditation programs, publications, and ASHP's role in the development of principles for hospital formulary systems are described. ASHP's endorsement of unit dose drug distribution and systems for preparation of intravenous admixtures is discussed. The evolution of pharmacists' clinical roles, their increased involvement in drug therapy decisions and the provision of drug information to patients, and the expanded responsibility implicit in the pharmaceutical care concept are traced. Today's ASHP members can build on the work of yesterday's members to provide better pharmaceutical care.

Practice Standards: Implications for the Internist

Pressure for national standards of medical practice is increasing from cost control initiatives, medical malpractice liability, and the desire to simplify complex practice problems. Good standards need to be academically sound, focused enough to be clinically useful, yet flexible enough to allow for the realities of practice. Standards have already been created by several professional societies, including anesthesiology and cardiology in internal medicine. Although physician education is primary, controlling the use of expensive new technologies is an unwritten but important secondary goal. While standards have reduced malpractice liability in some professional groups, some clinicians are concerned that standards will be too academic and unrealistic. Currently, third-party payers are watching the development of practice standards but are hesitant to use them as criteria for determination of reimbursement. The federal government has a major interest in practice standards as a means of both monitoring quality of care and controlling costs. A number of agencies are studying the development of standards and their implications for use. Recent articles questioning the usefulness of common diagnostic tests and even the routine physical examination have raised concern among internists that restriction of practice and reimbursement will follow. Some evolving standards, such as screening for breast cancer, seem to ignore the realities of clinical practice and may generate more cost than they save. Internists need to provide input as standards are developed to guarantee appropriateness and feasibility.

Training needs of the infection control practitioner: Development of practice standards and internship programs

The main mission of the Association for Practitioners in Infection Control (APIC) is to help its practitioners develop and improve the practice of infection control through education, communication, research, standardization, and professional relations (APIC bylaws, 1985). In only 13 years, most of these objectives have been realized. Although educational standards have been clearly defined and a certification process has been established for the infection control practitioner (ICP), infection control practice lacks standards. In the face of increasing .expectations for ICPs, the need intensifies to define what the entry-level ICP should be able to do, what the prospective employer should look for in hiring an ICP, and what standards, in both preparation and demonstrated competence, can help to assure that these expectations are met. Infection control practice standards should enable ICPs to determine the essential elements of an effective infection control program by providing a systematic and organized approach to consistent practice regardless of the setting in which they practice. The purpose of this commentary is to challenge our profession and APIC to develop practice standards and, more important, to devise a practical and accessible mechanism to implement them. Virtually all ICPs have been asked by both the lay public and various health professionals the following questions: (1) What is an epidemiologist? (2) What do you do in your day-today activities? (3) How do you become an ICP?