Skills Of Healthcare Professionals Research Articles

Reading with an “Inveterate Hypochondriac”

Narrative medicine, designed to develop empathic listening skills in healthcare professionals, also helps literature teachers discuss ethics without sacrificing critical rigor. Reading the distasteful narrator of Dostoevsky's challenging story as the notorious “hated patient/unreliable historian” of clinical practice, we demonstrate how students can practice reading empathically as a fundamentally ethical act.

Developing competence in cardiac care through the use of blended learning: Course members' and mentors' accounts

The use of blended learning to develop the clinical knowledge and skills of healthcare professionals is increasing. This paper reports the qualitative findings from an evaluation of a blended learning course designed to equip registered nurses with the knowledge and skills required to practice competently in cardiac nursing. The aims of the study were to explore whether a cardiac care course could be successfully delivered mainly online and it had any impact on the students' clinical practice. The sample consisted of course members and their mentors. Data were obtained through focus groups and interviews and analysed using thematic analysis. All students felt they had benefited from undertaking the course. Mentors identified higher levels of confidence and greater depth of knowledge and skills amongst their students. Areas identified for further development by both groups were firstly, the preparation of mentors for their role in supporting the students undertaking an online course and secondly, the expected level of competence that students needed to display in practice. This study indicates online learning is useful in enhancing student competence but may be wrongly seen as requiring less time commitment for both course members and mentors when compared to taught courses.

Habilidades sociales en los profesionales de urgencias y cuidados críticos de un hospital público comarcal

Objective To assess the social skills of health care professionals in the emergency and critical care units of the regional hospital Vega Baja and analyze the association between a series of sociodemographic and professionals variables and social skills. Aim A cross-sectional, descriptive study. Method Two evaluation tools were used. These included a sociodemographic and professional variables questionnaire, and the Elena Gismero's Social Skills Scale (SSS). Results A response rate of 82.6% was obtained. Considering the standards made by the author in SSS validation, it can be seen that the sample has obtained a medium-high score in each one of the aspects. Significant differences have been found when considering the sociodemographic variable gender as an independent variable with the complete score of SSS (F=6.555; p=0.013), and with the scale dimensions, self-expression in social situations (F=4.468; p=0.039) and making a demand (F=7.982; p=0.007). Conclusions In each one of the SSS dimensions, the sample has obtained a slightly higher score than the standard sample and it within the 50–69 percentile. This indicates the existence of a medium-high level of Social Skill. The doctors score higher than the nurses, although these differences are not statistically significant.

Changes and challenges in Finnish health care management

Finnish health care has been the target of continuous management reforms for decades. Most reforms have been aimed at effectiveness, enhancing quality, raising the level of management skills of health care professionals, and allowing patients greater freedom of choice. Thus, the reforms implemented in health care have been wide, many-sided and complex, and they have also overlapped each other. The main objective of this article is to analyze the current status of public health care management reforms in Finland by discussing the theoretical and practical trends used in the development of Finnish health care systems and services. The reason for choosing both the theoretical and the practical trends as the framework for this study is the hypothesis that only by combining these two issues is it possible to create a more in-depth analytical picture of the management reforms implemented in Finnish health care. This study aims to explore how health care management deals with system-wide problems, and what kinds of solutions, or even new styles of governing, have been introduced in Finland to solve these problems.

An Intensive Insulinotherapy Mobile Phone Application Built on Artificial Intelligence Techniques

Software to help control diabetes is currently an embryonic market with the main activity to date focused mainly on the development of noncomputerized solutions, such as cardboard calculators or computerized solutions that use "flat" computer models, which are applied to each person without taking into account their individual lifestyles. The development of true, mobile device-driven health applications has been hindered by the lack of tools available in the past and the sheer lack of mobile devices on the market. This has now changed, however, with the availability of pocket personal computer handsets. This article describes a solution in the form of an intelligent neural network running on mobile devices, allowing people with diabetes access to it regardless of their location. Utilizing an easy to learn and use multipanel user interface, people with diabetes can run the software in real time via an easy to use graphical user interface. The neural network consists of four neurons. The first is glucose. If the user's current glucose level is within the target range, the glucose weight is then multiplied by zero. If the glucose level is high, then there will be a positive value multiplied to the weight, resulting in a positive amount of insulin to be injected. If the user's glucose level is low, then the weights will be multiplied by a negative value, resulting in a decrease in the overall insulin dose. A minifeasibility trial was carried out at a local hospital under a consultant endocrinologist in Belfast. The short study ran for 2 weeks with six patients. The main objectives were to investigate the user interface, test the remote sending of data over a 3G network to a centralized server at the university, and record patient data for further proofing of the neural network. We also received useful feedback regarding the user interface and the feasibility of handing real-world patients a new mobile phone. Results of this short trial confirmed to a large degree that our approach (which also can be known as intensive insulinotherapy) has value and perhaps that our neural network approach has implications for future intelligent insulin pumps. Currently, there is no software available to tell people with diabetes how much insulin to inject in accordance with their lifestyle and individual inputs, which leads to adjustments in software predictions on the amount of insulin to inject. We have taken initial steps to supplement the knowledge and skills of health care professionals in controlling insulin levels on a daily basis using a mobile device for people who are less able to manage their disease, especially children and young adults.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. First Revision.

Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in biomedical and health informatics (BMHI), particularly international activities in educating BMHI specialists and the sharing of courseware. Method: An IMIA task force, nominated in 2006, worked on updating the recommendations' first version. These updates have been broadly discussed and refined by members of IMIA's National Member Societies, IMIA's Academic Institutional Members and by members of IMIA's Working Group on Health and Medical Informatics Education. Results and Conclusions: The IMIA recommendations center on educational needs for health care professionals to acquire knowledge and skills in information processing and information and communication technology. The educational needs are described as a three-dimensional framework. The dimensions are: 1) professionals in health care (e.g. physicians, nurses, BMHI professionals), 2) type of specialization in BMHI (IT users, BMHI specialists), and 3) stage of career progression (bachelor, master, doctorate). Learning outcomes are defined in terms of knowledge and practical skills for health care professionals in their role a) as IT user and b) as BMHI specialist. Recommendations are given for courses/course tracks in BMHI as part of educational programs in medicine, nursing, health care management, dentistry, pharmacy, public health, health record administration, and informatics/computer science as well as for dedicated programs in BMHI (with bachelor, master or doctor degree). To support education in BMHI, IMIA offers to award a certificate for high-quality BMHI education. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

The Quantum Leader: Applications for the New World of Work, 2nd Edition

By Kathy Malloch and Tim Porter-O’Grady Published by Jones and Bartlett Publishers, 40 Tall Pine Drive, Sudbury, MA 01776, 2009. 246 p. Price $59.95. This is a unique and practical guide to the development of advanced leadership skills in healthcare professionals. The purpose is to provide

Éducation thérapeutique des enfants et adolescents atteints de maladie chronique

The education of children with chronic diseases and of their parents is a treatment procedure that must be integrated into the management of the child's disease: it is essential for his or her physical and psychological health and quality of life. This continuous process is part of long-term follow-up and of the child's development; it is not a procedure that can be carried out once and for all. The program must include initial, follow-up, and advanced education. Treatment education for parents occurs simultaneously with the child's medical management and has the same requirements as that of the child (which means that the time spent in this education requires financial support). The role of the pediatrics departments serving these children is essential, and they must work with other participants, whose roles are not identical to they perform in education for adult patients. Pediatric patient education requires an interdisciplinary pediatric team with specific skills and appropriate liaison with those involved in other aspects of the child's life (e.g., daycare and school). The child's psychological development is central to the design and implementation of pediatric patient education programs. Knowledge of child development is critical in providing these services for children and adolescents; training in this field is required in addition to that necessary for adult patient education. Epidemiologic findings of the increased incidence of several chronic diseases in children must be considered in decisions about the resources allocated to coping with them. The particularities and requirements of adolescence and its interactions with chronic disease must also be considered in specific patient education programs for adolescents, and in the training and skills of healthcare professionals.

Virtual Reality Skills Training for Health Care Professionals in Alcohol Screening and Brief Intervention

Educating physicians and other health care professionals about the identification and treatment of patients who drink more than recommended limits is an ongoing challenge. An educational randomized controlled trial was conducted to test the ability of a stand-alone training simulation to improve the clinical skills of health care professionals in alcohol screening and intervention. The "virtual reality simulation" combined video, voice recognition, and nonbranching logic to create an interactive environment that allowed trainees to encounter complex social cues and realistic interpersonal exchanges. The simulation included 707 questions and statements and 1207 simulated patient responses. A sample of 102 health care professionals (10 physicians; 30 physician assistants or nurse practitioners; 36 medical students; 26 pharmacy, physican assistant, or nurse practitioner students) were randomly assigned to a no training group (n = 51) or a computer-based virtual reality intervention (n = 51). Professionals in both groups had similar pretest standardized patient alcohol screening skill scores: 53.2 (experimental) vs 54.4 (controls), 52.2 vs 53.7 alcohol brief intervention skills, and 42.9 vs 43.5 alcohol referral skills. After repeated practice with the simulation there were significant increases in the scores of the experimental group at 6 months after randomization compared with the control group for the screening (67.7 vs 58.1; P < .001) and brief intervention (58.3 vs 51.6; P < .04) scenarios. The technology tested in this trial is the first virtual reality simulation to demonstrate an increase in the alcohol screening and brief intervention skills of health care professionals.

The Effects of Simulation on Nursing Students' Critical Thinking Scores: A Quantitative Study

Simulation has become the innovative method of incorporating clinical and theoretical knowledge and experiences for nursing students. It is essential for educators to offer strategies that develop students' critical-thinking abilities. This experiment used the Health Sciences Reasoning Test to determine if critical-thinking scores improved in the associate degree in nursing student after exposure to multiple clinical simulation scenarios (Facione & Facione. Health Sciences Reasoning Test (HSRT): a test for critical thinking skills for health care professionals. Test manual. Millbrae, CA: The California Academic Press LLC; 2006). Participants were 53 students from the medical-surgical course of an associate degree in nursing program of a college of nursing in the Midwest. Control participants received two simulation scenarios, and experimental participants received five scenarios. As predicted, experimental participants showed a greater increase in critical-thinking scores, demonstrating that simulation can enhance the quality of nursing education providing guaranteed clinical experiences that increase critical-thinking skills, as well as providing high-tech training for nursing students. Implications for nursing education and further research are discussed.

Internet pharmacy: a web of mistrust?

Internet pharmacy: a web of mistrust?

Employee Recruitment

The labor shortage of skilled health care professionals continues to make employee recruitment and retention a challenge for health care managers. Greater accountability is being placed on health care managers to retain their employees. The urgency to retain health care professionals is largely an issue that should be considered during the initial recruitment of potential employees. Health care managers should analyze candidates rigorously to ensure that appropriate hiring decisions are made. Behavioral assessments can be used as a useful employee selection tool to assist managers in the appropriate placement and training of potential new employees. When administered appropriately, these tools can provide managers with a variety of useful information. This information can assist health care managers in demystifying the hiring process. Although there are varying organizational concerns to address when using behavioral assessments as an employee selection tool, the potential return on investment is worth the effort.

Clinical practice guidelines for communicating prognosis and end‐of‐life issues with adults in the advanced stages of a life‐limiting illness, and their caregivers

Prognostic and end-of-life communication is a vital skill for health care professionals caring for patients with progressive life-limiting illnesses, and their families. Expert opinion varies, and high-quality evidence on how best to discuss these issues with such patients and their caregivers is limited. These guidelines were developed to address these issues. The guidelines were developed through the following methods: - Systematic literature review of the best available evidence on discussion of prognosis and end-of-life issues; - Review of previous relevant guidelines and expert opinions in the literature; and - Refining of draft guidelines by an expert advisory panel. The key recommendations of these guidelines are for health professionals to consider the recommendations conveyed by the acronym PREPARED.

L’École des Hautes Études en Santé Publique (EHESP) : III. Prévention et dépistage des maladies

The ongoing epidemiological transition is characterized by the increasing predominance of degenerative diseases. New responses from the health system are thus needed, reorganizing curative services as well as preventive strategies. The latter have to target risk factors for degenerative disease in order to improve primary prevention. And for all other diseases with unknown or non-modifiable risk factors, screening (or secondary prevention) is an option to be considered as a public health response. Early diagnosis and early treatment can improve the prognosis of patients screened in defined conditions. Although medical screening is generally well accepted by health professionals, screening is rather sophisticated and encounters substantial difficulties when implemented in the real world. This article briefly presents the main theoretical and practical drawbacks of early diagnosis. Screening will substantially improve health if the knowledge and skills of healthcare professionals are substantially increased.

Teaching Cardiac Auscultation: Effectiveness of a Patient-Centered Teaching Conference on Improving Cardiac Auscultatory Skills

To assess the cardiac auscultatory skills of health care professionals before and after an actual (not simulated) patient-centered cardiac auscultation conference and to determine the effectiveness of this clinical teaching method on Improving diagnostic proficiency. Seventy-eight participants at a conference on cardiac auscultation completed preconference and postconference examinations on their ability to diagnose a wide variety of heart sounds and murmurs. Among those tested, 46 (59%) were physicians: 17 (22%) were cardiologists, 19 (24%) were medical Interns or residents, 7 (9%) were cardiology fellows, 2 (3%) were general practitioners, and 1 (1%) was a pediatrician. Thirty-two (41%) of this group of respondents were nonphysicians: 14 (18%) were nurse practitioners, 9 (12%) were nurses, 6 (8%) were physician assistants, 2 (3%) were medical students, and 1 (1%) was a nonmedical professional. All participants were tested on 14 clinically Important cardiac auscultatory events directly recorded from actual (not simulated) patients and transmitted via wireless Infrared stethophones. The auscultatory events tested were wide physiologic splitting of S2 in right bundle branch block, fixed S2 splitting and systolic murmur in atrial septal defect, midsystolic click and late systolic murmur of mitral valve prolapse, S4 gallop, S3 gallop, opening snap of mitral stenosis, innocent systolic murmur, systolic murmur of mitral regurgitation, systolic murmur of tricuspid regurgitation, systolic murmur of hypertrophic obstructive cardiomyopathy, continuous murmur of patent ductus arteriosus, pericardial friction rub, prosthetic valve sounds, and alternation of heart sounds, heart murmurs, and the S3 gallop in congestive heart failure. On the basis of the analysis of the 78 participants who completed preconference and postconference evaluations of the 14 selected cardiac auscultatory events, a preconference Identification score of 26.3% and a postconference score of 44.7% were observed. This represents a statistically significant overall Improvement in diagnostic proficiency (P < .001). Cardiac auscultatory skills among today's health care professionals are extremely poor, regardless of the level and/or type of training of the professional. An actual (not simulated) patient-centered teaching conference is an effective clinical method of improving cardiac auscultatory skills and diagnostic proficiency of health care professionals.

Commitment of project participants to developing health care services based on the Internet technology

When developing Information and Communication Technology (ICT), such as services for the decision-making process, skilled health care professionals with their comprehensive knowledge of patients/clients are essential contributors to the project. Careful evaluation is needed to assess the effectiveness of project management as well as to analyze the commitment of the personnel to goal attainment. In the course of the development of integrated maternity care services, the commitment of project participants (n=48) was evaluated. What factors enhanced or impaired their commitment to the project work? Questionnaire (n=80, response rate 60%) with quantitative analysis as well as open-ended questions with qualitative content analysis. Positive commitment was related to a confidential and open atmosphere during the project. The utilization of personal skills and experience was appreciated. Differences in the working principles and cultures between the participating organizations complicated fluent collaboration. To encourage commitment, a lot of attention should be paid to internal communication as well as the effective realization of project tasks. The strength of the project was the highly innovative and confidential atmosphere. The well-established project goals, the highly inspired project team, and the effective co-operation between the project manager and the core group helped to deepen overall commitment in the project.

Blurring the boundaries: scenario-based simulation in a clinical setting

The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings. A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques. Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive. Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Factors Influencing Minority Studentsʼ Choice of Physical Therapist Education Programs

Background and Purpose. The physical therapy profession does not reflect the racial and cultural diversity of the United States. It is necessary for education programs to focus on improving recruitment of minority applicants to address the shortage of minority physical therapists and to reap the educational benefits of a diverse student population. The purpose of this study was to analyze factors influencing minority student choice of professional (entry-level) physical therapist education programs. Subjects. The participants included students enrolled in the first professional year of an accredited physical therapist education program. Methods. A survey instrument was developed based on literature and interviews with physical therapist students and faculty members. Face and content validity were acceptable. Using a 5-point Likert scale, subjects rated the influence of 51 items on their selection of a specific physical therapist education program. Stratified random cluster sampling was applied to select 66 professional physical therapy programs from a population of 150. Results. The return rate was 66%. Results indicated subjects identifying themselves as minority ranked 3 categories higher than nonminority students when selecting a physical therapist education program: (a) cost of the program; (b) ethnic, cultural, and gender considerations; and (c) physical therapist education program faculty. Discussion and Conclusion. Factors influencing minority student program choice differ from those influencing nonminority students. Physical therapist education program administrators may use the results of the study to develop recruitment programs focusing on minority applicants. Key Words: Minority, Physical therapy, College choice. INTRODUCTION The importance of cultural diversity in education and professional practice is emphasized by various health professions, including physical therapy. Programs in medicine, nursing, and allied health strive to recruit minority students to improve workforce diversity and to more accurately reflect national racial and cultural variances.1-5 However, the majority of physical therapist students and practitioners remain disproportionately Caucasian in comparison to the population of the United States. Recruitment of minority applicants to the nation's physical therapist education programs is the first step in providing minority physical therapists to an increasingly diverse population. The purpose of this study was to analyze factors influencing choice of professional (entry-level) physical therapist education programs by minority students. The study built upon the questionnaire by Ancrum-Smalls and colleagues,6 who surveyed physical therapist students but did not report results related to minority students. The hypothesis of the current study was that factors influencing minority students differ from factors influencing nonminority students. Review of the Literature The effects of the shortage of minority health care providers are far-reaching. The limited number of skilled minority health care professionals adversely affects the quality and availability of health care in minority communities.7,8 Increasing the number of minority health care providers potentially improves access to health care in underserved areas, where certain disabilities are more prevalent among minorities.9,10 Studies show minority health care workers are more likely to provide care in underserved areas, including the inner city and rural areas, and tend to provide services to patients with racial or ethnic backgrounds similar to their own.11-15 In addition to improving access to health care, minority health care professionals have a role in improving the effectiveness of care. Minority health care professionals may be better able to communicate with other minority groups and are usually more sensitive to the needs of other cultures.11,12,16,17 Ultimately, lack of minority health care providers may hinder minority patients' adherence, participation, and cooperation in rehabilitative programs, thus reducing effectiveness of therapeutic interventions. …

Professionalism

Professionalism lies at the heart of clinical practice and this issue of Medical Education is dedicated to papers exploring aspects of the educational processes involved in learning about being a ‘good’ doctor. The ways in which doctors behave, how they think, and how they interpret the problems presented to them all reflect the standards they believe underpin their professional practice. These standards are made explicit by governing or regulating bodies such as the General Medical Council in the United Kingdom. Good doctors accept these standards and the principles they are based on and conduct their practice accordingly. Medical students learn about professional practice by seeing others do it, by reflecting on what they see, and by shaping their own behaviour to mirror the models their senior colleagues portray. The effects of this hidden or informal curriculum are powerful and long lasting and may influence the ways in which students and young doctors behave for many years. Recently, pressures from the growth of consumer awareness, from patient choice, from greater calls for professional accountability and from the increasingly important role of other highly skilled health care professionals in health care delivery, have put pressure on doctors to rethink and take stock of what being a medical professional is and what it means. Concerns about the need for change in perspective about the nature of professional practice have led many medical teachers to introduce courses or themes addressing personal and professional development. Often these courses are integrated with or derived from earlier existing courses in medical ethics. and for many schools, the rise in interest in the medical humanities reflects concerns that, whilst the medical profession may not have lost its way, there is a danger of derailment or diversion from the core business of altruistic clinical practice. The topic of professionalism is important and rightly causes concerns that are being constructively and rigorously addressed in debate and through research. This is significant and the quality of the debate can only be improved by the provision of evidence. The literature on professionalism has grown rapidly in recent years and there is a lot to read, although much of this literature consists of opinion pieces or descriptions of courses. There is now a pressing need for work that provides the evidence to support practice and teaching. Thomas Inui has suggested that the literature about professionalism is good at setting out the ideal attributes of professional practice. Where it is not so good is in taking descriptions of what actually happens in practice, and recognising and exploring the reasons for what, on occasion, may be significant gaps between the ideal and the real. Whilst the hidden curriculum shapes the behaviour of future clinicians, it also causes conflicts between what students see doctors doing and what they hear doctors tell them about the concept of professionalism.1 The processes involved, and the factors that contribute towards the construction of professional identity are largely unexplored areas in medical education. Research in these areas will pay rich rewards in helping to develop and maintain the integrity of the profession. So it is good to see a recent initiative started by Professor Carol Black, the President of the Royal College of Physicians in England, who has convened a working party to define the nature and role of medical professionalism in today's society. The working party held its first meeting in October 2004 in London, and will report in a year's time. It will take evidence from a wide range of stakeholders drawn from the professions and from the public about perspectives on the key tenets and values of professionalism in medicine. It will also explore evidence about how professional values in medicine are changing. The working party hopes to report on ways of defining medical professionalism that are important for the 21st century and is especially keen to take into account how medical professionalism may be strengthened in the service of both patients and the wider public.2 The work of this group and of others in the systematic analysis of professionalism and in charting the future course is of great interest to medical students, teachers and clinicians alike.

Information literacy—what it is about?: Literature review of the concept and the context

Objectives: The use of IT in health care has merged advanced knowledge and skills for health care professionals. Former studies indicate that basic skills in computer use are no more than comprehensive competencies to manage electronically stored information in health care. The purpose of this paper is to review the literature focusing on the concept information literacy in the field of health, nursing and medical informatics. The target is to find out how information literacy is defined, in what kind of context it is presented and who are the focus of interest. Methods: An automated literature search was performed on-line to Medline and by using the EndNote Bibliographic Software. All together the number of papers analyzed was 97 or 78% of the total literature search result. Results: The survey indicates that the concept information literacy does not exist as such in the literature, but it can be found as a synonym to ‘computer literacy’ or even more obscure concepts such as ‘informatics awareness’ or ‘computer experience’. The definitions of these concepts varied considerably. A variety of descriptions of educational programs were also found, none were based on the IMIA recommendations. Conclusions: In international cooperation such as that of IMIA WG1, a wide range of efforts still needs to be carried out to compile educational programmes in health informatics to enhance knowledge and skills in computer use among health care professionals.