Positive Changes In Practice Research Articles

Healthcare assistants’ experiences and perceptions of participating in a training course

AbstractAlthough the number of healthcare assistants (HCA) in employment has continued to increase, the provision of training and development for this role has, to date, been largely dependent upon the discretion of individual employers. In response to this, the Department of Health and Children in Ireland decided to establish a national training course for HCAs and commission its evaluation. As part of this evaluation, the views of the trainees on the national training course were explored. The behaviour, attitudes and experience of these trainees were explored, as was their perception of the relevance of the training course to their role in employment as a HCA. One‐to‐one semistructured interviews with 22 randomly selected trainees were conducted. All interview respondents felt that the training course had been beneficial. Findings indicated positive changes in practice following their training. The interview respondents indicated that they felt more confident in their ability to undertake delegated duties and believed that the skills learned on the course would be useful to them in their future work. Other issues, such as course duration, selection procedure and level of assessment, caused some dissatisfaction. The training course led to a significant improvement in the trainees’ knowledge and care skills. Suggestions for changes to the course from the trainee's perspective include amending the trainee selection procedure and improving the organization and content of the course and follow‐up support.

Exploring organizational characteristics associated with practice changes following a mentored online educational module

Studies of health professionals' perceptions of barriers to and facilitators of research utilization in clinical practices suggest that structural and resource characteristics of service provider organizations are key determinants of the capacity of individual practitioners to provide evidence-based practices. In this pilot study, we compare health professionals' self-reported practice changes with characteristics of the structures and resources available to support research use at 4 hospitals. Data on the self-reported practice changes of stroke rehabilitation professionals at Ontario hospitals were analyzed following their participation in a mentored online educational intervention, the Rehabilitation Education Program for Stroke (REPS). In-depth interviews with a purposefully drawn subsample of REPS mentors and managers of stroke rehabilitation programs examined the participating hospitals' structural and resource characteristics. The interview data on hospital characteristics were coded descriptively and thematically, quantified, and then compared with the percentage of individual REPS participants who reported positive practice changes in each hospital. Hospitals with higher percentages of participants reporting improved practices following REPS provided better computer access, paid time to participate in REPS, had established specialized units of stroke care, strong teamwork, and were previously committed to implementing best practices. They also conducted program audits or evaluations and engaged in "bottom-up" program decision making. Continuing educators should consider the capacity of hospitals to support practice changes when planning educational interventions for rehabilitation professionals. Larger studies employing objective measures are needed to examine relationships between practice improvements and organizational characteristics following educational interventions.

ELearning: A review of Internet-based continuing medical education

The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

Medico-legal aspects of pain

The pattern of clinical practice is changing in the UK in line with trends in Europe and America. The introduction of ‘clinical governance' has set a new agenda for assessing quality, performance and accountability. Britain has enjoyed a privileged position with a relatively low level of medical litigation. However, patients are more readily going to court to settle grievances or seek financial compensation. It is recognized that within the surgical disciplines, obstetrics and anaesthesia carry greater risk. Pain management is also becoming an area of concern. It is acknowledged that the establishment of a complaint procedure is a healthy sign. It encourages openness in practice, exposes shortcomings and highlights failure in service. Learning from errors can lead to improvements, if positive changes in practice are adopted. Not all complaints are valid and the majority never results in litigation. Addressing issues early and expressing honest responses will defuse most situations. Quality in medicine is a difficult measure to define and probably involves a number of key points: •best practice •critical incident reporting •analysis from confidential enquiry into perioperative death (CEPOD) •understanding of negligence •managing and learning from complaints •taking effective action. Clinical governance has a broader remit, but one core element, is that of ‘best practice'. It is within this context that one should seek to look at the medico-legal issues involved in pain management. The introduction of acute pain services and pain teams has increased awareness of what can be achieved and what should be expected in the perioperative period. Although the failure to deliver such a service has still to be tested by the courts. Chronic pain management, by contrast, has been practised for many years and there are well-developed pathways involving litigation. Consequently, claims for damage may arise out of acute or chronic pain management.

A Community‐based Programme for the Prevention of Burns and Scalds to Pre‐school Children

A New Zealand programme designed to reduce burns and scalds hazards in the home was trialled with seven groups of parents and caregivers of children under the age of five years. The programme was pictorially based and was taught by community educators in the first language of each of the groups involved. Participants were encouraged to target three safety changes to make in their homes. A self‐report pre‐post measure of the safety practices of the participants (n = 75) indicated that participants made an average of 1.35 targeted changes. A selection of participants (n = 21) were interviewed 3 months after the programme. Sixty‐eight percent of the positive practice changes made by these participants were reported to be sustained. The barriers to change that participants experienced and the strengths and problems with community‐based safety education are discussed.

Learning from errors in nursing practice.

Little attention is paid to the issue of errors in nursing practice. Staff are reluctant to discuss or publicize them. However, as clinical audit and quality management become more important and established in the health service, there is now a greater need to investigate and monitor the incidence of errors. The purpose of this study was to examine the causes and consequences of errors as well as the potential for errors to initiate changes in practice. One hundred and twenty-nine nurses answered a 22-item questionnaire relating to an error they had made. Nurses reported that the most common causes of errors were lack of knowledge or information, work overload, stressful atmosphere and lack of support from senior staff. Nurses were found to have recourse to a number of coping strategies in the aftermath of the error. Accepting responsibility and planful problem-solving were found to lead to positive changes in practice, whereas distancing and self-controlling strategies were associated with defensive changes, particularly with a tendency not to divulge the error. The findings also showed that errors had the potential to effect learning. The study suggests the need for staff to be encouraged to accept responsibility for their error within the framework of support. Strategies should be developed so that errors can be managed in a more constructive manner.

Motivational orientations of allied health care professionals participating in continuing education

The purpose of this review was to determine the motivational orientations of allied health professionals participating in continuing education (CE). It is generally accepted that, prior to learning, a prospective learner must be motivated. If participation in CE is to be viewed as a motivated behavior, the organizations who offer CE programs must ensure that motivational orientations are considered in decision making regarding program development and mandated CE. A review of the allied health literature using Medline, Cinahl, manual searches, article references, and an online public catalogue was conducted for the period 1985–1995. Inclusion criteria included survey research studies using a measurement tool from the educational field and studies involving allied health professionals. Investigators found that adults demonstrated various motivational orientations toward CE, such as individual desire to learn, professional advancement, responses to external pressures, the fostering of community, social interactions, and relief from routine or boredom. The reviewed literature consistently shows that practitioners are motivated to participate in CE by knowledge rather than potential punitive actions by authority figures. The implementation of mandated CE may be an unnecessary action since it has not been shown to produce positive practice changes and since other external influences appear to exist. Licensing bodies and CE providers should focus their efforts on identifying the proportion of individuals who are nonparticipdnts or whose primary motivation is to meet obligatory relicensure requirements.