Professional Practice Behaviors Research Articles

Physician-nurse collaboration in the relationship between professional autonomy and practice behaviors.

Nurses and physicians are key members of healthcare teams. While physicians are responsible for the diagnosis and treatment of patients, nurses are part of the treatment and the primary practitioners of patient care. Nurses' professional autonomy, collaboration with physicians, and practice behaviors in treatment and patient care practices are interrelated. In the present study, we examined the mediating effect of physician-nurse collaboration on the relationship between nurses' practice behaviors and their professional autonomy. The present study utilized a cross-sectional survey design following quantitative methods. This study was conducted in the Istanbul Province of Turkiye from September to October 2022. The sampling method used was a convenience sampling strategy to provide easier access to participants when selecting nurses from different health institutions. The mean age of the 295 nurses was 31.23 years, with ages ranging from 21 to 59years. The data analysis was conducted using IBM's SPSS 24.0 software package and the Process Macro 4.0 plug-in. Research ethics approval was obtained from the researcher's university. Physician-nurse collaboration is positively associated with practice behaviors and professional autonomy. Nurses' professional autonomy in practice behaviors through physician-nurse collaboration is significant (95% CI [0.043, 0.135]). Our results revealed the relationships among physician‒nurse collaboration, professional autonomy, and practice behaviors among nurses. Our results provide evidence on the underlying factors of nurses' practice behaviors in patient care and guide the development of an intervention program to enhance this collaboration. Hospital managers can contribute to a collaborative physician‒nurse working environment.

The purpose, adaptability, confidence, and engrossment model: A novel approach for supporting professional trainees’ motivation, engagement, and academic achievement

Trainees often decide to pursue a career in the professions because they see it as a means to attain their life goals: to become the kind of person they want to be, to live the kind of life they want to lead, and to make the kind of impact they want to have on the world. The life goals trainees pursue through a professional career are derived from their conception of their ideal self and are thus the most important and self-defining goals that they possess. In this article, we propose a novel approach for designing training activities to harness the motivational potential of professional trainees’ life goals, toward supporting their deep engagement in training activities. We propose that activities can be designed to help trainees make links between (1) the concepts and skills covered in an activity, (2) the professional practice behaviors that an activity prepares them to enact, and (3) the life goals that are served by enacting these professional practice behaviors. Informed by Control Theory and Self-Determination Theory, we predict that this design may promote trainees’ adoption of activity-specific goals that emphasize deep understanding, long-term retention, and transfer, and enhance their autonomous motivation to attain their goals. However, there are some situations when this design may be less effective for, or even harmful to, trainees’ motivation. Specifically, we predict that helping trainees establish a purpose for learning by linking an activity to their life goals may be most effective when they can adapt an activity to best align with their purpose, when they are confident in their ability to attain their activity-specific goal, and when they become engrossed in an activity because it affords interest- and curiosity-stimulating actions. We package our theoretical analysis into the PACE model of motivational design. When our predictions are supported by more empirical evidence, the model can help educators set the PACE for trainees, thereby motivating them to engage deeply in training activities.

Privileging for Nursing: Structural Requisites for Next-Step Professional Governance

Structuring for the profession of nursing in any practice setting is critical to the expression of professional practice behaviors. Explored here is a brief outline of what a nursing professional privileging structure might look like and how it replaces historic "job-based" approaches as a better way of addressing nurses and their practice in a professional practice environment.

Development of a Comprehensive Extracorporeal Membrane Oxygenation Program in a Cardiac Transplant Intensive Care Unit: A Quality Improvement Initiative.

A major academic medical center in the Midwest has expanded their extracorporeal membrane oxygenation (ECMO) program from 8 ECMO cases in 2014 to 97 ECMO cases in 2017. The Extracorporeal Life Support Organization states that standardized policies, procedures, and standards of care are necessary for an ECMO center to be successful. With the rapid growth of the ECMO program, this medical center has chosen to transition nurses and respiratory therapists into the role of ECMO specialist to bridge the gap in care created by the influx in patients. Currently, no specific set of policies/procedures or standards of care exist for ECMO patients. The primary objective of this study is to improve the self-efficacy of ECMO specialists and bedside nurses through the development of a comprehensive ECMO program that includes standardized policies and procedures, order sets, and evidence-based patient management guidelines. The General Self-Efficacy Survey was used to assess the self-efficacy of both the ECMO specialists and the bedside nurses before implementation of the program. An ECMO manual was created that contained education on veno-arterial and veno-venous ECMO, policies and procedures, and patient management guidelines. An EPIC order set was created to ensure the correct protocols and management guidelines were ordered for all ECMO patients. Postimplementation self-efficacy surveys, direct observations, and chart audits occurred to assess program fidelity. The self-efficacy was assessed of the ECMO specialists and beside nurses 4 months after implementation of policies, procedures, patient management guidelines, and an ECMO order set. The ECMO specialists' self-efficacy survey responses increased by 25% and the bedside nurses' self-efficacy survey responses increased by 27% after 4 months. Direct observation of ECMO specialist handoff to ensure protocol fidelity also occurred. There was a 40% increase in ECMO specialist handoff taking place and a 72% increase in ECMO circuit examination. With the significant growth of ECMO patients, policies, protocols, and management guidelines are essential to provide safe care to these patients. There was a statistically significant improvement in the self-efficacy of both the ECMO specialists and bedside nurses. This was shown to directly correlate to an improvement in professional practice behaviors and ultimately improve the quality of patient care provided to ECMO patients.

The Importance of Developing Athletic Training Leadership Behaviors

ContextHealth care professionals such as athletic trainers (ATs) and athletic training educators should embrace contemporary leadership theories and practice leadership behaviors essential to professional responsibility.ObjectiveThis commentary discusses leadership behavior trends and the need for leadership development in professional athletic training education curricula and continuing education.BackgroundTraditional leadership theories focused on trait-based and “Great Man” characteristics. These theories suggest that leaders arise only through inherent or inherited leader-like behaviors. In contrast, contemporary leadership theories suggest that leaders can be developed and better promote the collegial leader-follower exchange that is needed to motivate, encourage, and support followers as well as a profession.SynthesisContemporary leadership theories involve a leader-follower relationship that integrates a teamwork approach into the workplace setting. Athletic trainers practice leadership behaviors but are less likely to demonstrate leadership characteristics when not practicing in their AT roles. Existing evidence suggests that contemporary leadership development can be helpful in athletic training to identify and develop future leaders, to promote the profession, and to improve patient outcomes.ResultsTransformational, team-centered leadership styles provide a growing opportunity for practicing ATs and athletic training students to expand into greater organizational leadership and decision-maker roles.Recommendation(s)Athletic trainer leadership knowledge, skills, and abilities development and professional responsibility should be emphasized more in professional athletic training educational programs and continuing education.Conclusion(s)Leadership behaviors that are effectively integrated into athletic training educational programs early and often may promote the profession by concurrently improving clinical and professional practice behaviors. Athletic trainers should practice leadership behaviors with greater frequency in differing societal constructs, communities, and complex health care systems.

<p>Community Pharmacists’ Knowledge, Attitude, and Professional Practice Behaviors Towards Dietary Supplements: Results from Multi-Center Survey in Ethiopia</p>

<p>Community Pharmacists’ Knowledge, Attitude, and Professional Practice Behaviors Towards Dietary Supplements: Results from Multi-Center Survey in Ethiopia</p>

Addressing workplace violence with the Pathway to Excellence® framework.

Addressing workplace violence with the Pathway to Excellence® framework.

Pharmacy employees\u2019 involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies

BackgroundCommunity-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees’ attitudes and professional practice behaviors related to DS.MethodsWe conducted a survey in eight Norwegian municipalities of pharmacy employees involved in the sale of DS. The questionnaire covered demographics and investigated attitudes toward DS, professional practice behaviors related to the sale of DS, experiences with customers with dementia, and perceived and attributed responsibilities with regard to patient safety.ResultsOne hundred and five employees responded (response rate: 52%). Most employees regarded general practitioners (GPs) as primarily responsible for safeguarding the use of DS by persons with dementia and rated themselves less responsible. Thirty-seven percent of the employees reported personal use of DS (past or current use). Nine percent considered some of the DS to have symptomatic or prophylactic effects against dementia. Forty-eight percent confirmed that they informed customers about potential adverse events; 42% indicated that they did this sometimes. Sixteen percent checked regularly for DS-drug interactions, and two-thirds checked depending on the customers’ health, the type of drug or the type of DS. One-quarter regularly asked about the co-use of prescription drugs (PD) when selling DS, while only 2% asked about the co-use of DS when dispensing PD. Only 25% reported access to independent scientific information on all or most DS sold in their pharmacy. Eight percent had experienced unsafe use of DS by persons with dementia. Six percent had been taught about counselling persons with dementia. Education level influenced professional practice behavior to some extent.ConclusionPharmacy employees do not see themselves as primarily responsible for the safe use of DS by persons with dementia. Moreover, they have limited experience with the unsafe use of DS by these persons. There is potential for improvement regarding tools and educational interventions for pharmacy employees to provide sufficient help to persons with dementia who use DS.

Career Outcomes of Dental Hygiene Baccalaureate Education: A Study of Graduates' Professional Opportunities, Further Education, and Job Satisfaction.

There is a paucity of studies on Canadian baccalaureate dental hygienists. As discussions about the entry-level education required in dental hygiene continue on national and international platforms, examining outcomes of earning a dental hygiene baccalaureate degree is imperative. The aim of this study was to investigate the professional practice behaviors and career outcomes of graduates of the University of British Columbia (UBC), Canada, Bachelor of Dental Science in Dental Hygiene (BDSc) degree program. UBC dental hygiene entry-to-practice (ETP) and degree-completion graduates from 1994 to 2016 were invited to participate in an online survey with closed- and open-ended questions about practice behaviors and outcomes after earning the BDSc degree. Of the 365 BDSc alumni who received the email invitation, 116 responded, for a 32% response rate. The results showed that 45% of respondents worked outside of the traditional private dental practice setting, specifically in education (23%), administration (9%), public health (8%), and research (5%). Of the 77 degree-completion respondents, 75% reported that the BDSc degree had expanded their career opportunities. A greater proportion of degree-completion respondents practiced outside of the clinical setting (p<0.01) and had earned a graduate degree (p=0.04) compared with ETP respondents. Over 25% of total respondents had pursued graduate education. In comparison to results from the 2015 Canadian Dental Hygienists Association job market and employment survey, a significantly greater proportion of BDSc graduates practiced collaboratively with non-dental professionals (2.7 vs. 0.8, p<0.001), earned more than $80,000 annually (47% vs. 23%, p<0.001), and received more employment benefits (4.0 vs. 3.5, p<0.001). These results highlight the positive impact of baccalaureate education on dental hygiene practice behaviors and career outcomes.

Religion and Spirituality in Social Work Practice with Children and Adolescents: A Survey of Canadian Practitioners

Empirical evidence about the relevance of religion/spirituality for children and adolescents contrasts with the limited number of studies inquiring about the role of religion/spirituality when working with this population. In response to this lack of knowledge, this study explored the professional attitudes, experiences, and practice behaviors of social workers and social service workers working with youth and determined the predictive factors for using spiritually-derived interventions. A cross-sectional survey design, with proportionate stratified sampling, was used to gather data from 307 Canadian social workers and social service workers working with youth in Ontario (response rate was 40%, with 5.06% margin of error). Respondents reported favorable views toward the role of religion/spirituality in social work practice, in general. They also reported positive attitudes about the relevancy of religion/spirituality for this population and somewhat frequent encounters with religious/spiritual abuse and neglect. They used a wide variety of spiritually-derived interventions; however, over two-thirds (69%) reported their formal education “never” or “rarely” included content on the topic. Barriers to using spiritually-derived interventions included: lack of knowledge/experience, concern about presenting one's own bias, disapproval from caregivers, and lack of agency/supervisor support. Multiple regression analysis revealed two assessment variables, two attitudinal variables, one education/training variable, and one personal religious/spiritual variable predictive of the use of spiritually-derived interventions, accounting for 55% of the variance. Findings suggest a need for emphasizing spiritually-sensitive practice guidelines and for social work education and continuing education to include content about religious/spiritual diversity as well as content about spiritual development that includes spirituality in childhood.

The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?

IntroductionPassage of voter-driven marijuana reform laws signals a shift in public attitudes for marijuana use. For providers, legalization may necessitate practice modifications, particularly regarding patient-provider conversations about use and risk. We examined healthcare providers' knowledge of marijuana laws and health implications, professional practice behaviors, and attitudes about training. Materials and methodsWe surveyed 114 Colorado-based providers who care for children, adolescents, pregnant and breastfeeding women using a Venue-Day-Time survey methodology throughout Colorado. The survey captured providers' (e.g., physicians, nurses, medical assistants) knowledge of state marijuana laws, risk perceptions, counseling practices, and continued training needs. ResultsProviders were knowledgeable about marijuana laws, cautious supporting legalization, and perceived moderate to high risks, particularly for certain groups. About 50% of providers working with adolescents and pregnant or breastfeeding women assessed marijuana use “every” or “most” visits; 23% of those working with children reported such behavior. Conversations about specific risks varied between groups. Few providers felt completely knowledgeable about marijuana health risks and lacked confidence talking to patients about this issue. ConclusionsProviders frequently assess patients' marijuana use; however, they are uncomfortable and inconsistent talking to patients about specific marijuana health effects.Additional education is warranted, particularly as it relates to talking to patients about the danger of second hand smoke exposure, underage use, safe storage, and the over-consumption of edibles.

Developing Self-Care Practices in a Trauma Treatment Course

This article describes the development of self-care practices of social work students who were part of a larger study of students’ experiences in a graduate course on the treatment of trauma. Consensual qualitative research methods were used to analyze 17 participant journals submitted at 4 times during the course. Findings indicated that students benefited from being introduced to evidence-based practices for mediating the stress of trauma education, including journaling and mindfulness-based stress reduction. Although students reported struggling with developing effective self-care practices, they demonstrated an ability to integrate self-care into their professional practice behaviors. The authors review recommendations for research and pedagogy of self-care practices in courses on trauma treatment.

Translating knowledge in rehabilitation: systematic review.

Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.

“On the Scene”

Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.

Effects of Clinical Practice Environments on Clinical Teacher and Nursing Student Outcomes

The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.

Predictors of Professional Nursing Practice Behaviors in Hospital Settings

Many hospital nurses perform isolated, routine tasks, rather than use their professional training, because they are subject to control by organizational and medical divisions of labor. The environment may interfere with a nurse's ability to practice autonomously and according to professional standards. The purpose of the study was to explore how certain factors in the environment and personal characteristics interact to affect hospital nursing practice behaviors. The study used a nonexperimental, comparative design. Surveys were sent to a random sample of 500 nurses throughout the state of Michigan. Three instruments,measuring structural empowerment, self-efficacy for nursing practice, and professional practice behaviors,were included. Path analysis was used for statistical analysis. Three hundred sixty-four nurses responded (73%), of whom 251 provided usable protocols for the final analysis. Environmental factors (structural empowerment) contributed both directly to professional practice behaviors as well as indirectly through self-efficacy. Self-efficacy mainly exerted its effect as a mediator in the relationship between environmental factors and practice behaviors. Support for the proposed theoretical model was mixed, although the proposed model fit the data well (chi2 = 11.02 [(5, N = 251), p < .05, CFI = .999, NNFI = .991, RMSEA = .069]). An alternative model emerged from the data analysis. Nurses may practice more professionally when the environment provides opportunities and power through resources, support, and information. Self-efficacy may contribute to professional practice behaviors, especially in an environment that has the requisite factors that provide empowerment.

Structural Empowerment and Professional Nursing Practice Behaviors of Baccalaureate Nursing Students in Clinical Learning Environments

This study examines the associations between professional behaviors of baccalaureate nursing students and student perceptions of select factors within the clinical learning environment, including the role of clinical faculty leadership. Participants (n=243) were recruited from a randomly selected list of 1000 members of the National Student Nurses Association (NSNA) among sixteen states within the Southern region of the United States. Results revealed a direct relationship exists between student perceptions of structural empowerment in their clinical learning environment and professional nursing practice behaviors among students. Also found was that relationships between variables in the model are significantly strengthened by student perceptions of strong leadership behaviors of clinical faculty. Findings from this study may assist nurse educators by contributing knowledge relevant to support/facilitate the transition of individuals from student nurses to professional registered nurses and, thus enhance the impact of professional nurses' contributions in healthcare delivery.

How much health promotion and disease prevention is enough?: should chiropractic colleges focus on efficacy training in screening for family violence?

Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review

BackgroundAlthough dietary supplements (DS) are widely sold in pharmacies, the legal, ethical, and practice responsibilities of pharmacists with respect to these products have not been well defined. This systematic review of pharmacists' attitudes, knowledge, and professional practice behaviours toward DS is intended to inform pharmacy regulators' and educators' decision making around this topic.MethodsEligible studies were identified through a systematic database search for all available years through to March 2006. Articles were analyzed for this review if they included survey data on U.S. or Canadian pharmacists' attitudes, knowledge, or professional practice behaviors toward DS published in 1990 or later.ResultsDue to the heterogeneity of the data, it was not possible to draw a conclusion with respect to pharmacists' general attitudes toward DS. Approximately equal numbers of pharmacists report positive as well as negative attitudes about the safety and efficacy of DS. There is strong agreement among pharmacists for the need to have additional training on DS, increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners.ConclusionFurther research is needed to explore the factors that influence pharmacists' beliefs and attitudes about DS, to accurately evaluate pharmacists' knowledge of DS, and to uncover the reasons why pharmacists do not routinely document, monitor, or inquire about patients' use of DS.

The Effect of Nursing Leadership on Hospital Nurses?? Professional Practice Behaviors

To understand the effect of unit-level nursing leadership on the relationship of structural empowerment and nursing self-efficacy to professional nursing practice behaviors. Nursing leadership at both organizational and unit levels is a major influence on professional nursing practice. The interaction between environmental factors, such as structural empowerment and unit-based nursing leadership, and self-efficacy for nursing practice may determine whether a nurse's practice behaviors are either professional or more task-focused. A nonexperimental, comparative survey design was used. Instruments included the Conditions for Work Effectiveness-II, Caring Efficacy Scale, Manager's Activities Scale, and Nurse Activity Scale. Multigroup path analysis demonstrated the effects of strong and weak nursing leadership on variables of interest. Nursing leadership contributed to the effects of empowerment and self-efficacy on practice behaviors. Strong nursing leadership also contributed to an additional relationship between empowerment and self-efficacy. Nursing leadership helped to explain 46% of the variance in nursing practice behaviors overall. Nurses may be able to practice more professionally when they perceive strong nursing leadership. By providing more access to structural empowerment factors for staff, strong unit-level nursing leadership may also influence nurses' self-efficacy, which in turn leads to more professional practice behaviors.