Scope Of Practice Research Articles

Barriers in achieving quality valuations: the New Zealand perspective

PurposeTo inform ways of improving valuation quality, this study seeks to understand the lived experiences of practising valuers regarding the challenges of conducting quality valuations.Design/methodology/approachThis study adopts a qualitative strategy involving 19 semi-structured interviews with valuers in New Zealand. The interview data were analysed using progressive comparative analysis and the constant comparative method, which yielded comprehensive and well-founded conclusions.FindingsThe data analysis revealed several challenges that hinder the improvement and maintenance of valuation quality. These challenges were categorised into nine key areas, covering a wide range of issues, including a wide scope of practice, lack of experienced valuers, inappropriate use of graduate valuers, stakeholder expectations, access to relevant information, differing approaches, valuer attitudes and dissatisfaction with compensation.Practical implicationsThe findings of this study have the potential to inform the valuation profession and other stakeholders about the challenges that practising valuers face in conducting quality valuations, which can ultimately lead to improvements in the valuation process.Originality/valueThis study contributes to the valuation literature, by highlighting the lived experiences of valuers in terms of the potential and challenges pertaining to valuation quality improvement. This has been an area that has received limited attention in the past, and an understanding of these issues has the potential to approach valuation quality in new and innovative ways.

Evaluating ExpandED: Evaluating the effectiveness of a serious game expansion pack in teaching health professional students about interprofessional care.

The emergency department (ED) is a challenging fast-paced environment with high-acuity, undifferentiated patients who often require extensive interdisciplinary care. This paper introduces ExpandED, an expansion pack to the serious board game GridlockED, designed to enhance players' understanding of interprofessional collaboration in the ED and the diverse scope of practice of different ED professionals including physicians, residents, registered nurses, registered practical nurses, social workers, occupational therapists, and physiotherapists. This investigation evaluates the effectiveness of ExpandED as a teaching tool for medical and allied health professions students about interprofessional collaboration in the ED. A program evaluation harnessing a playtest framework was employed. Participants completed pre- and postgame surveys including quantitative measures (e.g., Likert scales) and qualitative free-text feedback that focused on participant familiarity with ED functioning, valuation of interprofessional collaboration before and after playing, and feedback on game usability and effectiveness. Recruitment was open to students in all health care and allied health professional programs at the institution. Forty-five participants were recruited from medical doctor, nursing, physiotherapy, and speech language pathology programs. ExpandED enhances participants' understanding of ED workflow (p < 0.001) and provides an enjoyable playing experience. However, participants' valuation of interdisciplinary teamwork did not change significantly before and after game play (p = 0.17). Participants expressed satisfaction with the game's accuracy in simulating the ED environment and appreciated the opportunity to collaborate with peers from different disciplines. Challenges reported included some tension among players, potential biases, and limitations of fidelity to a real-life ED. While this study has limitations regarding participant sampling and duration of gameplay sessions, it highlights the potential of ExpandED for teaching interprofessional collaboration in the ED. These findings will guide further development to optimize the expansion pack's effectiveness and its implementation into health care curricula.

A Global Review of Advanced Practice Nursing in the Emergency Department.

As demands in the way of healthcare delivery increase, nurse practitioners have become essential components in optimizing access to healthcare and improving outcomes around the globe. The authors recognize the vital role nurse practitioners play globally and that education, practice, and credentialing differ significantly across countries. Many countries have a wide variation in educational requirements, resulting in a lack of adequate advanced practice nursing training and regulation of practice. Additionally, many countries are experiencing increased demands in the form of emergency services, with long waiting times and severe crowding in emergency departments. Worldwide, many programs are being developed to educate advanced practice nurses on improving emergency medical care, but developing such programs is a complex process This article aims to discuss the scope of practice and roles of advanced practice nurses globally. We will also attempt to clarify and improve these global standards and discuss competencies in this role.

Designing state-level policies to support independent pharmacies in providing specialty care services in rural regions

This review paper explores the critical role of independent pharmacies in rural regions, emphasizing their potential to deliver specialty care services despite facing significant challenges. These challenges include financial constraints, regulatory barriers, and limited specialized training and resource access. The paper argues that comprehensive state-level policies are necessary to support these pharmacies, enabling them to overcome these obstacles and enhance healthcare access in rural areas. Key policy recommendations include providing financial incentives such as grants and subsidies, regulatory reforms to streamline licensing processes and expand the scope of practice for pharmacists, and promoting partnerships between pharmacies, healthcare providers, and telehealth services. The paper also highlights the importance of integrating independent pharmacies into state health programs and adopting advanced technologies like telepharmacy and electronic health records. Future research directions are suggested, focusing on the impact of digital health technologies and evolving healthcare payment models on independent pharmacies in rural regions. The paper concludes by underscoring the need for targeted policy interventions to strengthen the role of independent pharmacies in rural healthcare, thereby improving health outcomes and quality of life for rural populations.

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach.

Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center. We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting. The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level. Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

EVALUATION DE COMPORTEMENTS A RISQUE CHEZ LES OPERATEURS DU CENTRE DEMPLISSAGE DE GAZ SKHIRAT

Nowadays, the current trend in Prevention (health, safety at work) consists of the operators behavior as much as a concrete factor invoked as cause of an accident. Indeed, to control risks and accidents, the emphasis must not only be placed on the technique but also on the operators attitudes towards risks and safety at work and especially on his perception of the risk, in fact it is he who will decide and act. It is he who will adopt so-called risky behaviors if he disregards safety measures, neglects his protective equipment, and thus puts himself and sometimes his colleague in danger. This research was there fore particularly interested in the different explanatory factors that predispose the workers of the Salam Gaz company to be less careful based on the perceptive biases that they translate the causes of non-compliance with certain safety rules. The practical scope of this work is to identify the principles of action to develop and channel the safety behaviors of operators in the context of industrial safety.

Gender differences in factors associated with rural health care practice in Minnesota.

To understand gender differences in factors affecting rural health care workforce to inform the development of effective policies and recruitment strategies to address rural health care workforce shortages. A cross-sectional survey of health care professionals (including Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs)) in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022, during their professional license renewal. The main outcome was whether or not the respondent was practicing in a rural area. The effects of factors associated with rural practice were estimated using binary logistic regression models, and subsequently subgroup analysis was conducted by gender across the four health care professions. Results show that although there were significant gender differences in some factors (growing up in a rural area and family considerations were more likely to influence women's decisions than men's, whereas men were more likely to be influenced by the prospect of having autonomy and broad scope of practice than women), these differences became insignificant when the four health care professionals were analyzed separately suggesting that overall gender differences observed were almost entirely explained by profession differences. Gender differences do not significantly influence the factors impacting rural practice. However, being raised in a rural environment emerges as the most influential predictor of rural practice underscoring the importance of involving rural residents of all genders in health care practice.

Analysis of the Current Situation of Service Capacity of Medical Social Workers in Shanxi Province and the Conception of Cultivation Pathway

Objective: This study aims to analyze the current status of service competence of medical social workers in Shanxi Province and to conceptualize the cultivation path. Methods: A questionnaire survey was conducted among 88 staff members and 120 residents of eight community health service centers in Shanxi Province to understand the population’s knowledge of the connotation of medical social workers and their needs. Results: Currently, the staff and residents of the community health service centers in Shanxi Province have a low level of knowledge and a high demand for medical social workers. It is recommended to expand the scope of practice of medical school students and design a series of training programs for medical social workers to better meet the needs of community healthcare and promote the implementation of the Healthy China Strategy.

Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013–2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders.

Infectious Diseases Fellowship Training in Caring for People Who Use Drugs: A National Assessment of an Emerging Training Need.

Infectious complications of substance use are increasingly encountered in infectious diseases (ID) clinical care. In this study, we surveyed ID fellows in the United States to assess training experiences, clinical practices, and perspectives in caring for people who use drugs (PWUD). An 18-item survey was distributed to ID fellows via email and social media platforms. Four focus groups were conducted with a subset of participants to elucidate themes in fellowship experiences and training needs. Among 196 survey respondents (estimated 24% response rate), all reported caring for PWUD in ID fellowship. Forty-nine percent received some formal fellowship-based didactics around care of PWUD, and 64% worked with faculty seen as advocates for PWUD. Integrated care practices for PWUD were infrequently employed: 50% offered risk reduction counseling, and 33% discussed medications for opioid use disorders, naloxone, or HIV preexposure prophylaxis. Risk reduction counseling was felt to be "extremely" within scope of ID practice (69%), although comfort level with this skill was low; fellows' likelihood of offering counseling was significantly associated with their comfort (P ≤ .0001). Common themes in caring for PWUD included an expanded role for ID consultants, a lack of formalized training, and benefits of developing dedicated opportunities in this field. ID fellows frequently care for PWUD but may have gaps in knowledge or comfort that affect care practices. Increased fellowship training in the care of PWUD has potential to improve clinical practices and support growing interest in this field among current and prospective ID fellows.

Interprofessional Coproduction of Diagnosis with Medical and Pharmacy Students: An Interactive Case-Based Workshop.

The Institute of Medicine and national competencies emphasize the importance of interprofessional education to reduce diagnostic error. Clinical pharmacists are increasingly integrated into clinical teams and participate in the diagnostic process. However, few educational resources explicitly teach medical and pharmacy students to collaborate on the production of diagnoses. We implemented a 2-hour, online, case-based workshop with 154 second-year medical students and third-year pharmacy students. After brief didactics on the diagnostic process and scope of practice of pharmacists, small groups of eight to 12 medical and pharmacy students with faculty facilitators worked through a case unfolding in two aliquots. Students were provided different but complementary information authentic to their profession. They had to communicate with each other to develop an appropriate differential diagnosis. Students then reflected on how communicating with the other profession impacted their diagnostic reasoning. Comments were coded and counted. The majority (99%) of students identified their data gathering and differential diagnoses were impacted by working through the case together. More pharmacy students commented on how medical students broadened their differential diagnosis (71%) and added information (72%), contextualizing information, such as past history, medication indications, and physical exam data. More medical students commented on how pharmacy students helped justify (54%) and clarify (22%) the differential diagnosis, often connecting the underlying mechanism of medications with clinical findings. This interactive case-based workshop was effective in teaching medical and pharmacy students to collaborate in the coproduction of diagnosis. It is feasible with minimal resources.

Family Physician Scope of Practice

Family Physician Scope of Practice

Childbirth Doula Training and the Experiences of Those Who Train as a Childbirth Doula

Objective:The objective of this article was to gain a deeper understanding and insight into the training and characteristics of childbirth doulas on the maternity care team. The aim was to integrate knowledge obtained from two studies: an integrative review (IR) of doula education programs globally (Study 1) and the qualitative experiences of those training to become a doula (Study 2).Methods:For the IR (Study 1), the modified Whittemore and Knafl (2005) framework and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used. Five electronic databases were searched (CINAHL, ProQuest Education Databases, ERIC, MEDLINE, and Scopus) usingdoulaandeducation/trainingas key terms. Nineteen papers were included in the review. For the qualitative study (Study 2), semi-structured interviews with 10 student doulas were analyzed using inductive thematic analysis.Results:The results highlighted ambiguity around the education (review) and scope of practice (qualitative) of a childbirth doula. The review showed a variety in duration, content, learning, certificate/accreditation, and educator qualifications in doula training programs, globally. The variety in student doulas’ understanding of their role in the maternity care context emerged from the key themes: (a) what influenced the decision to become a doula, (b) personal attributes perceived as essential to be a doula, and (c) what constitutes the role of a childbirth doula.Conclusions:This article highlights a variability in doula training legislation and accreditation, as well as program content and length. This variation may be reflected in student doulas’ understanding of their role in the maternity context. A better understanding of doula training and a defined scope of practice can fill the current gap in continuity of care and improve communication within the maternity care health team.

Addressing Health Care Access Disparities Through a Public Health Approach to Physical Therapist Practice.

As the field evolves as a doctoring profession, the role and scope of physical therapist practice must also grow to meet important and urgent public health needs. Scalable, population-level interventions must be prioritized to the same degree as tailored, individual-level care. Drawing from public health frameworks, this perspective proposes an approach to population-level physical therapist care delivery that aims to mitigate disease and disability and improve health outcomes by expanding access, decreasing cost, and improving quality of care for those facing the greatest health disparities. Application of these frameworks prompts the development of novel approaches to rehabilitation service delivery to advance twin goals of promoting access to care and reducing health disparities. This paper describes how a population health framework and public health approach can be used to support necessary evolution and innovation within the field of physical therapy and to improve rehabilitation service delivery. Rapid developments in the digital and virtual health space have created a unique opportunity for physical therapists to lean into a new vision of their role as clinicians within the broader health ecosystem. This paper will provide clinicians with a broader perspective of physical therapist expertise and describe opportunities for the development and application of a physical therapist skill set toward driving population health outcomes. Real-world examples will guide clinicians to consider opportunities in their own practice for implementing this public health approach and potentially addressing various contributors to persistent health disparities.

Introducing an Approach for Interdisciplinary Supervision in Vocational Rehabilitation Counseling

Effective clinical supervision is a key element of professional rehabilitation counseling. While there is much overlap, the provision of clinical supervision to those with master’s degrees in rehabilitation counseling is different from supervising individuals who do not have a master’s degree in rehabilitation counseling. The passage of the Workforce Innovation and Opportunity Act (WIOA) permits individuals to work in the position of rehabilitation counselor without a master’s degree, leaving supervisors to provide clinical supervision to those with and without master’s degrees in rehabilitation counseling. The purpose of this conceptual paper is to introduce an application of explicit instruction to the supervision of non-master’s-level supervisees. The principles of explicit instruction will be applied to the supervision process within the scope of practice for rehabilitation counselors. Implications for practice and research will be provided.

The Second Endourological Society Census Report.

As part of the Endourological Society's initiative to continuously enhance the field of endourology, the second annual census was circulated after the World Congress of Endourology and Uro-Technology 2022 (WCET22). An anonymous survey was created using Qualtrics XM and was disseminated via email to all Endourological Society (ES) members (n=1,502) between October 4th, 2022, and January 26th, 2023. A total of 46 questions were included in the survey and covered different aspects including demographics, practice patterns, satisfaction, impact of COVID, WCET22 attendance, and future opportunities. A total of 404 (26.9%) ES members (91.8% male and 8.2% female), representing 63 different countries participated in the survey. Fellowship-trained endourologists constituted 58.9% of respondents, and the most common practice setting was academic (55.2%). The most common practice scope was complex retrograde endoscopy (83.4%), followed by percutaneous nephrolithotomy (79.5%) and medical management of urolithiasis (72.5%). Work schedules were variable with 51.1% working 40-60 hours/week and 35.3% working >60 hours/week. More than 80% were satisfied with their practice; however, 42.4% indicated that COVID made satisfaction worse. Of the participants, 49.5% were satisfied with their compensation, and 7.3% plan to retire within the next 5 years. When asked about the future of endourology, 92.9% had a positive outlook. Of the respondents, only 36.8% attended WCET22, with the most chosen reason for attendance being an interest in learning new research and technology. For lack of attendance, cost of travel and lodging was reported as a determining factor by 45.4%. These survey results report important trends within the field of endourology and demonstrate the robust outlook of ES members for the future. By demonstrating important practice patterns and member needs, this information can be used to improve the responsiveness of its members and to continually strengthen the ES.

Advanced Practice Providers in Burn Care, 2013-2022.

This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Advancements and Challenges in Exercise Training for Multiple Sclerosis: Comprehensive Review and Future Directions for Randomized Controlled Trials.

Exercise training represents a health behavior for the treatment and management of the multi-faceted manifestations of multiple sclerosis (MS). This paper provides a comprehensive overview of evidence from randomized controlled trials (RCTs) regarding benefits, safety, participation, and guidelines for exercise training in MS, based on systematic reviews and meta-analyses. The paper then provides our opinions based on extensive experience regarding challenges for improving and expanding future RCTs that will advance our understanding of exercise training in MS. The comprehensive review of evidence from RCTs indicates that exercise training yields substantial improvements in aerobic and muscle fitness, mobility, fatigue and depression, quality of life, and participation outcomes. There is a non-significant increase in the risk of adverse events or serious adverse events with exercise training compared with control conditions or healthy populations. Rates of adherence and compliance with exercise training (i.e., participation) approximate 80% and 70%, respectively. The current prescriptive guidelines suggest 2-3days per week of aerobic and resistance exercise training as the minimal dose for safely benefiting from exercise training in MS. We propose 10 important topics as avenues for expanding the body of research and improving its scope for evidence-based practice in MS. Overall, the research on exercise training in MS is strong, but it can get stronger. The expansion and advancement of evidence are critical for moving exercise training into the clinical armamentarium of MS disease treatment and management.

Sharing midwifery philosophy through a positive learning environment prepares students for a future providing midwifery continuity of care: A mixed method study

BackgroundGlobal and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students’ access to placements within these models in Australia. AimTo evaluate Bachelor of Midwifery students’ experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. MethodA mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. ResultsSixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated ‘work across the full scope of midwifery practice’ and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. ‘Experiences prepare me to be a change agent for maternity service reform’ rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. ConclusionA mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.

A review of commercial captive breeding of parrots as a supply-side intervention to address unsustainable trade.

The volume and scale of commercial captive breeding of parrots have grown dramatically in recent decades. Although it has been proposed, and is often assumed, that captive breeding can reduce pressure on wild populations, there has been little scrutiny of the scale, viability, or impacts of captive breeding to prevent overexploitation among parrots, compared with similar approaches in other threatened taxa, such as pangolins or tigers. We reviewed the primary and gray literature to quantitatively and qualitatively evaluate evidence concerning 5 criteria, established a priori, for commercial captive breeding of parrots as an effective supply-side intervention. We focused on a sample of 16 threatened parrot species that are heavily traded or for which unsustainable trade has been a factor in the decline of wild populations, representing a range of taxonomic groups, life histories, and native regions. We identified multiple major gaps in knowledge of the extent to which these criteria are met, including a lack of quantitative data on breeding productivity under current commercial breeding practices, the scale and scope of commercial breeding practices in growing parrot markets, particularly in the Middle East and Asia, and the lack of financial viability of captive breeding under effective regulation to prevent laundering or use of wild-sourced specimens as breeding stock. The capacity for captive breeding to displace demand for wild-sourced parrots varied between species, and complex interactions between trade in different species and contexts sometimes made consequences of commercial production difficult to predict. Decision makers and regulatory authorities should approach commercial captive breeding of parrots with caution and take into account knowledge gaps and cross-linkages between trade in different species to avoid unanticipated consequences from stimulating and facilitating unsustainable trade in wild-sourced parrots.