Modern Healthcare Settings Research Articles

The inclusion of a business management module within the master of pharmacy degree: a route to asset enrichment?

Over the past decade the profession of pharmacy has steadily evolved. The New Pharmacy Contract exposed pharmacists to a fundamental change in traditional pharmacy business models. This study will consider whether community pharmacists, pharmacy undergraduates and academic staff within the United Kingdom believe it would be beneficial to incorporate a business management module within the Master of Pharmacy (MPharm) undergraduate degree along with potential mechanisms of delivery. Further to ethical approval, the questionnaire was distributed to UK registered pharmacists (n=600), MPharm undergraduates (n=441) and academic staff at Liverpool John Moores University (n=44). The questions were formatted as multiple choice questions, Likert scales or the open answer type. On questionnaire completion and return, data were analysed using simple frequencies, cross tabulations and non-parametric techniques in the SPSS (v18). The majority of pharmacists (84.9%) confirmed that business skills affect their everyday responsibilities to a considerable extent. A high proportion of undergraduate students (92.8%) believed that business management skills will impact on their future role. In total, 64.3% of this cohort declared that if a module were introduced they would study it. The majority of staff (79%) agreed that business skills are gaining increased importance within the field of pharmacy. Data suggest that business skills are of relevance to the practice of pharmacy. Appropriate staff to deliver the taught material would include business owners / lecturers and teaching practitioners covering topics including management, leadership, interpersonal skills and regulation. We suggest the inclusion of a business module with the MPharm degree would be of great value in preparing individuals for practice within a modern day healthcare setting.

MEDICAL RITES

Patients and their families are often concerned to find a material cause for suffering rather than to accept the mystery of its ontological necessity. In modern healthcare settings, in which medicine is rightly based upon the reductionist empirical scientific method, spirituality is therefore likely to be seen as a bolt-on extra to medical care rather than as a truly alternative worldview. In this article I argue that suffering needs to be rehabilitated as an experience rather than a cosmic mistake, and that chaplains are better equipped than medical staff to offer this insight into transcendent reality.

Comparing and contrasting health profiles: one dimension of critical thinking

Background Critical thinking skills are seen as being important for health professionals to operate effectively in a modern health care setting. As a result of this, for example, an undergraduate radiography curriculum involves defining, teaching and assessing appropriate components of critical thinking skills. Contents Using the example of the radiography curriculum, the components of critical thinking skills are explained. These components include: investigation, interpretation, application, generation, evaluation and justification. Each of these components can be divided into two dimensions to encourage students to focus on a specific intellectual skill. One dimension of the investigation component is being able to compare and contrast information requiring students to understand, analyse and differentiate data from a range of sources. Since knowledge and understanding of the social context of health is important in the delivery of high quality care, the Health Profiles of England have been used to illustrate how students might go about demonstrating this skill. Conclusions The worked examples involve analysing the data from two unitary authorities in order to identify key similarities and differences in people's health in each area and with the England average. Finally, possible reasons for any variations in terms of social, environmental and lifestyle factors were explored.

Quest for timely detection and treatment of women with depression.

Women are at risk for a wide range of depressive and anxiety disorders and particularly for mood disorders associated with their menstrual cycle, with seasonality, and during the menopausal transition. To review the presentation of depression, the importance of timely and effective treatment, and some of the research surrounding increased prevalence of depression in women, and the times and conditions--such as the perimenopausal transition, pregnancy, postpartum period, and comorbidities--of this increased risk in women. Dynamic interactions of both biological and environmental factors contribute to the development of major depression. These include, but are not limited to, predisposing genetic influences, gender, environmental stressors, poor social support, childhood sexual abuse, other psychiatric illness, and trauma. Timely and effective treatment of each episode of depression to remission is critically important. Barriers to instituting collaborative care of depressive illness are numerous. The lack of adequate collaborative care along with the consequent failure to adequately diagnose and treat depression reflects some of the deficiencies in the current organization and delivery of health services. The prevalence of depression, its psychosocial and medical consequences, and the worsening course of depression without treatment highlight the public health importance of early detection and improved strategies for the treatment of depression in modern health care settings.

Exploring nursing expertise: nurses talk nursing.

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.

The phenomenological ethics of K. E. Løgstrup – a resource for health care ethics and philosophy?

Abstract This paper gives a presentation and critical assessment of the phenomenological philosophy and ethics of the Danish theologian and philosopher K. E. Løgstrup (1905–1981). It is argued that although the ethics of Løgstrup contain valuable insights, an uncritical appropriation as the main source for a health care ethics or a philosophy of caring, is problematic. Løgstrup's philosophy contains a number of internal problems, and does not adequately deal with some problems raised by work in the modern health care setting.

Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies

Interest in how best to influence the behaviour of clinicians in the interests of both clinical and cost effectiveness has rekindled concern with the social networks of health care professionals. Ever since the seminal work of Coleman et al. [Coleman, J.S., Katz, E., Menzel, H., 1966. Medical Innovation: A Diffusion Study. Bobbs-Merrill, Indianapolis.], networks have been seen as important in the process by which clinicians adopt (or fail to adopt) new innovations in clinical practice. Yet very little is actually known about the social networks of clinicians in modern health care settings. This paper describes the professional social networks of two groups of health care professionals, clinical directors of medicine and directors of nursing, in hospitals in England. We focus on network density, centrality and centralisation because these characteristics have been linked to access to information, social influence and social control processes. The results show that directors of nursing are more central to their networks than clinical directors of medicine and that their networks are more hierarchical. Clinical directors of medicine tend to be embedded in much more densely connected networks which we describe as cliques. The hypotheses that the networks of directors of nursing are better adapted to gathering and disseminating information than clinical directors of medicine, but that the latter could be more potent instruments for changing, or resisting changes, in clinical behaviour, follow from a number of sociological theories. We conclude that professional socialisation and structural location are important determinants of social networks and that these factors could usefully be considered in the design of strategies to inform and influence clinicians.

Great grand multiparity--beyond the 10th delivery.

To investigate the perinatal outcome and obstetric complications of women delivering for the 10th time or more. Four hundred twenty women of great grand multiparity were analyzed in a modern health care setting and compared with our general population of obstetric patients, with regard to past history, maternal age, gestational age, mode of delivery, fetal outcome and intercurrent medical/obstetric problems. The study group showed significantly lower rates of low birth weight infants and instrumental delivery. No significant difference was seen in the incidence of cesarean section, pathologic fetal presentation, maternal hypertension, gestational diabetes, hemorrhage, or perinatal morbidity or mortality. There was a slightly higher incidence of twin births compared with the general population. It is probable that women capable of reaching their 10th delivery are basically healthy. If offered adequate perinatal care, they are not a high-risk group during subsequent deliveries.

Perspectives in development: the problem of nurses and nursing in Zambia.

The training of indigenous women in hospital nursing is directly modelled on western services. Hence training does not address social problems attendant on implicit cultural conflict between indigenous and western healing systems and conceptualisations of illness. Because these problems are not faced in the curriculum, nurses are imperfectly socialised into the modern health care setting. They, and the public, continue to accept the efficacy of both health care systems, assuming complementarity when in fact in many respects they conflict. The involvement of young women in healing, a radical innovation, became institutionalized. Because of the high visibility of the nurse and a radical change in the role of young women as healers, and because of the vulnerability of the patients, conflict in treatment systems focused on nurses who became scapegoats in hospitals, which came to be called 'houses of death'.

Folklore, food, female reproductive cycle

It is common knowledge that food is equated with health in many cultures and that dietary patterns may change in response to illness. Food habits may also change in response to normal physiological states associated with the female reproductive cycle, and may result in impaired nutritional status. The data presented here are drawn from a study designed to gain information on the concerns, attitudes, beliefs and knowledge that women have about reproductive life. Patients in a clinic setting were questioned about the advisability of dietary changes during menstruation, pregnancy and the post‐partum period, and about their attitudes concerning clay and starch‐eating practices. Results show that a majority of respondents held one or more dietary folk beliefs linked to the various phases of the reproductive cycle and that many of these are nutritionally unsound. Some of these beliefs are culturally‐patterned and it is suggested that clinicians and nutritionists be aware that they exist in modern health care settings, and that they may affect patients’ willingness to follow prescribed dietary regimens.