Do we know where we are heading?

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of long-term workforce planning, focusing on England.

Professional practices of dentists and unscheduled dental care in Nouvelle-Aquitaine (France)

In a context of saturation of private dental practices and medical demography issues, responses to requests for emergency dental care are a poorly documented problem. In partnership with the Observatoire Regional de la Santé, the URPS Chirurgiens-Dentistes Nouvelle-Aquitaine, a union, conducted a survey of private dentists in May and June 2022. The objective was to estimate the volume of requests for unscheduled dental care and to describe the responses provided by professionals. More than eight out of ten professionals said they were often called upon for unscheduled care and more than four out of ten set aside specific time slots to provide it. More than a quarter of them said they provided care in 90 percent of cases, in response to requests of this type, and 40 percent provided care in at least half of the cases. For most professionals, the average waiting time for patients requesting unscheduled care was less than 24 hours. Respondents cited patient education as a general avenue for improvement, in addition to the creation of a specific pricing structure for unscheduled care. This survey provides a better understanding of the difficulties faced by professionals on a subject not yet investigated by the dental profession. It documents the acceptability of possible responses in terms of improving professional practices and institutional organizations.

Still a long way to go on patient safety

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, looks at the findings of a parliamentary review into progress on safety proposals and encourages nurses to be part of the culture change.

The European PRM position (UEMS PRM Section)

INTRODUCTION

The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.

AIM

The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.

METHODS

To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

RESULTS

The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.

CONCLUSIONS

It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

Genetic counselors' utilization of ChatGPT in professional practice: A cross-sectional study

PURPOSE

The precision medicine era has seen increased utilization of artificial intelligence (AI) in the field of genetics. We sought to explore the ways that genetic counselors (GCs) currently use the publicly accessible AI tool Chat Generative Pre-trained Transformer (ChatGPT) in their work.

METHODS

GCs in North America were surveyed about how ChatGPT is used in different aspects of their work. Descriptive statistics were reported through frequencies and means.

RESULTS

Of 118 GCs who completed the survey, 33.8% (40) reported using ChatGPT in their work; 47.5% (19) use it in clinical practice, 35% (14) use it in education, and 32.5% (13) use it in research. Most GCs (62.7%; 74) felt that it saves time on administrative tasks but the majority (82.2%; 97) felt that a paramount challenge was the risk of obtaining incorrect information. The majority of GCs not using ChatGPT (58.9%; 46) felt it was not necessary for their work.

CONCLUSION

A considerable number of GCs in the field are using ChatGPT in different ways, but it is primarily helpful with tasks that involve writing. It has potential to streamline workflow issues encountered in clinical genetics, but practitioners need to be informed and uniformly trained about its limitations.

Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis

BACKGROUND

Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk.

METHODS

Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method.

RESULTS

CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely.

CONCLUSIONS

CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces.

The needs of newly qualified nurses

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the importance of providing the right support to nurses who are new to the register.

Scoping review of the second victim syndrome among surgeons: Understanding the impact, responses, and support systems

BACKGROUND

It is thought that 50% of healthcare providers experience Second Victim Syndrome (SVS) in the course of their practice. The manifestations of SVS varies between individuals, with potential long-lasting emotional effects that impact both the personal lives and professional clinical practice of affected persons. Although surgeons are known to face challenging and high-stress situations in their profession, which can increase their vulnerability to SVS, majority of studies and reviews have focused squarely on nonsurgical physicians.

METHODS

This scoping review aimed to consolidate existing studies pertaining to a surgeon's experience with SVS, by broadly examining the prevalence and impact, identifying the types of responses, and evaluating factors that could influence these responses. The scoping review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Three databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception till March 19, 2023.

RESULTS

A total of 13 articles were eligible for thematic analysis based on pre-defined inclusion criteria. Effects of SVS were categorized into Psychological, Physical and Professional impacts, of which Psychological and Professional impacts were particularly significant. Factors affecting the response were categorized into complication type, surgeon factors and support systems.

CONCLUSION

SVS adds immense psychological, emotional and physical burden to the individual surgeon. There are key personal, interpersonal and environmental factors that can mitigate or exacerbate the effects of SVS, and greater emphasis needs to be placed on improving availability and access to services to help surgeons at risk of SVS.

Failing professional practice placements in allied health: What do we understand about the student experience? A scoping review

Professional practice placements are an essential component of allied health and nursing programs. Whilst most students pass these placements, a small percentage of students will fail or be at risk of failing. Supporting students undergoing a failing experience is a time critical, time consuming, emotional and resource-heavy task which is often undertaken by key university staff and impacts all stakeholders. Whilst several studies have provided insight into this experience from the educator and/or university perspective, this scoping review aimed to identify the students' experience of failing or nearly failing a professional practice experience. Following Arskey and O'Malley's framework for scoping reviews, 24 papers were included in this review. This review generated six themes including the reasons for failure, how failure looks and feels, how supports, service and strategies influence the student experience of failure, the importance of communication, relationships and organisational culture, the impact infrastructure and policies have, and the consequences of failure. The outcomes of this scoping review highlighted three key characteristics of the research to date: (a) the student voice is still largely missing; (b) the student perspective is distinctly different to that of other stakeholders; and (c) the interventions used appear not to be student-informed or student-led. Better understanding this experience from the student's perspective could create a more sustainable practice education environment by designing and implementing more effective supports, services or strategies that reduce the overall impact a failing experience has on students and key stakeholders.

New dental graduates transition into UK professional practice; a longitudinal study of changes in perceptions and behaviours through the lens of evidence-based dentistry

BACKGROUND

This longitudinal study using qualitative methodology aims to investigate the perceptions, and implementation, of evidence-based guidelines into practice among new dental graduates (NDGs) during their transition from university into professional practice, by identifying factors that influence the adoption of evidence-based practice (EBP) in dental practice.

METHODS

The study invited NDGs from one UK dental school (N = 66) and employed longitudinal, multiple qualitative methodologies for data collection, throughout the participants' Vocational Dental Training (VDT) year. Initial interviews (Interview 1) conducted upon graduation and follow-up interviews (Interview 2) carried out between six and nine months into professional practice were combined with participants longitudinal audio diaries (LADs) recorded between the interviews.

THE STUDY

RESULTS

A total of 12 NDGs agreed to participate. For Interview 1, twelve participants were interviewed, seven of whom agreed to participate in Interview 2 and six recorded the LADs. Interview 1 exposed diverse views among NDGs about EBP, acknowledging its significance but facing obstacles in implementation due to time and financial constraints. They intended to use evidence selectively, often aligning with trainers' or NHS treatment options, while hesitating to fully embrace EBP in a busy dental practice. During VDT, LAD entries showed initial enthusiasm for EBP, but integrating evidence-based guidelines within the NHS system led to pragmatic treatment decisions, balancing gold-standard and cost-effective options. Over time, NDGs became more comfortable with alternative treatments, considering patients' financial constraints, yet they expressed frustration with external pressures limiting their clinical decision-making autonomy. In Interview 2, after six to nine months in practice, NDGs exhibited mixed attitudes towards EBP. Some actively used dental guidelines like SDCEP, others associated EBP with hi-tech or expensive materials, while others would thought to rely on colleagues' recommendations. None consistently sought direct evidence for treatment decisions.

CONCLUSION

NDGs' attitudes towards EBP changed and became more negative over their first year in professional practice, leading to challenges in their applying it. It questions the assumption that teaching EBP during undergraduate education ensures its implementation. Further understanding the influences on the development of attitudinal challenges will help to devise effective strategies for fostering lifelong learning and supporting evidence-based practice in dentistry.

Nurse autonomy expressed in Portuguese and Brazilian professional legislation: a documentary study (1986-2022)

OBJECTIVE

To analyze the convergence of nurse's autonomy expressed in Brazilian and Portuguese professional practice legislation.

METHOD

Qualitative, social-historical documentary study on the normalization of Brazilian and Portuguese professional standards for nursing practice, materials socialized in the digital collection of the profession's organizational and disciplinary entities. Qualitative analysis from the perspective of Eliot Freidson's sociology of professions.

RESULTS

Ten standards were analyzed, five from each country, which establish legislation for the nurses' professional practice. The following categories emerged: autonomy of knowledge and specific competence of the profession, in the ethical limits of the multi-professional relationship and in the disciplining of training for professional practice.

CONCLUSION

The professional autonomy under analysis implies providing access to services and to multi-professionality for the availability of health to society.

A longitudinal qualitative multi-methods study of new dental graduates' transition journey from undergraduate studies to professional practice

INTRODUCTION

New dental graduates' (NDGs) transition to professional practice is an important landmark and developmental stage in their career and in the UK it is supported by a formal educational transition process through a one-year salaried practice-based programme. However, little is known about graduates' experiences during this period. As part of a larger mixed-methods project, this study aimed to explore NDGs' experiences during their transition to professional practice, represented by Vocational Dental Practice.

MATERIALS AND METHODS

Sixty-six NDGs from one dental school were invited to participate. Two rounds of in-depth interviews were conducted: Interview 1 upon NDGs' graduation and then Interview 2 was a follow-up interview after they had spent six-nine months in vocational dental training (VDT). At Interview 1, a subset of participants agreed to record longitudinal audio-diaries (LADs) and continued these for 6-9 months into VDT. Data from the interviews and LADs were analysed together using a thematic analysis approach.

RESULTS

Eleven of the 66 invited NDGs agreed to be interviewed at Interview 1 (16.6%), seven at Interview2 (10.6%), and six (9.2%) recorded LADs. Four topic summaries were developed around NDGs transition experiences: (1) conceptualisation of the process; (2) responses to the transition, (3) challenges and support and (4) relationships with stakeholders.

CONCLUSION

NDGs' transition to professional practice was perceived as exciting and rewarding on personal and professional levels but carried challenges. VDT and related stakeholders play a vital role of supporting NDGs into their new professional life.

What do we mean by accountability?

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the concepts and principles of professional accountability.

Why we all need to speak up

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the Freedom to Speak Up report and its importance in ensuring patient and staff safety.

Building and Leveraging Soft Skills in Professional Practice

In this edition of the journal, we see reports that discuss various examples of projects that very much relate to the human care aspects of senior care pharmacy.

Quantifying and Qualifying Nursing Professional Development Practitioner Workload

Nursing professional development practitioners are integral leaders who continue to seek tangible ways to show their value. A tool was designed to capture workload based upon the scope and standards of nursing professional development practice and successfully captured the workload of over 200 practitioners. The measures used in this project can serve as a guide for others to describe nursing professional development practitioner workload.

Barriers and facilitators to the involvement of general practitioners in the prescription of buprenorphine

INTRODUCTION

France has one of the highest opioid agonist treatment (OAT) coverage rates in the world. French general practitioners (GPs) are providing the majority of prescriptions. However, a fall in the number of GPs initiating buprenorphine has been observed over the last decade.

METHODS

The objective of this study was to explore the obstacles and facilitators to the involvement of GPs in the prescription of buprenorphine. A qualitative study comprising 14 individual interviews and a focus group bringing together 5 GPs was conducted among GPs based in France between June 2021 and March 2022. We performed data analysis using a grounded theory methodology.

RESULTS

The interviews showed a great diversity in the level of involvement of GPs, depending on their experience, their representations of patients with OUD, their mode of exercise, and their personal preferences. The negative representations of the patients associated with the feeling of physical and ethical endangerment, the feeling of powerlessness, the fear of a disruption of the practice and the feeling of incompetence appeared at the forefront of the difficulties stated. Conversely, the strengthening of initial training and the facilitation of access to self-training tools and multidisciplinarity, the consideration of opioid use disorder (OUD) as a chronic illness with the application of a patient-centered motivational approach, as well as the defining and respecting one's own limits when prescribing buprenorphine seem to be the keys to a balanced and fulfilling practice.

CONCLUSION

Raising awareness of the frequency of OUD appeared to be an additional lever to enhance the interest of the GPs concerned. Additional studies focusing on the evolution of professional practices would be necessary to extend these findings.

Embedding Physical Activity Guidance During Pregnancy and in Postpartum Care: 'This Mum Moves' Enhances Professional Practice of Midwives and Health Visitors

INTRODUCTION

The benefits of physical activity during pregnancy and after childbirth are well established, yet many health care professionals do not feel well equipped to provide physical activity guidance to these populations. As such, the objectives of this study were to explore the immediate and longer term effects of training on health care professionals' ability to provide physical activity guidance to pregnant women and new mothers (mums).

METHODS

Midwives and health visitors from 5 locations in the United Kingdom were provided with training on the Chief Medical Officers' physical activity guidelines for pregnancy and after childbirth (n = 393). Midwives and health visitors attended training to become This Mum Moves Ambassadors, then disseminated education to colleagues through a cascade training model. Changes in knowledge, confidence, and professional practice were assessed by survey before and immediately after training (n = 247), and follow-up surveys were completed 3 (n = 35) and 6 (n = 34) months posttraining.

RESULTS

At all posttraining time points, health care professionals reported a significant increase in their confidence to communicate about physical activity (P < .001). The reported frequency of having conversations about physical activity increased significantly 3 and 6 months following training compared with baseline (pregnant women, P = .017; new mums, P = .005). There were changes in the types of advice and resources offered by health care professionals and an overall increase in health care professionals' own reported physical activity levels.

DISCUSSION

The This Mum Moves cascade approach to delivering training in physical activity guidelines improved reported knowledge, confidence and professional practice of midwives and health visitors, both immediately following and 3 and 6 months after training.

Evaluating Skill-Mix Models of Care: A Rapid Scoping Review of Measures and Outcomes

OBJECTIVE

To synthesize the literature on measures and outcomes for skill-mix models of care.

BACKGROUND

To address the human health resource crisis, changes to skill mix within models of care are being implemented emphasizing the need to synthesize evaluation methods for skill-mix models in the future.

METHODS

A scoping review of the literature using a rigorous search strategy and selection process was completed to identify articles that examined skill-mix models in an effort to identify related concepts.

RESULTS

Ten studies examined skill-mix models. Areas of measurement in assessing the impact of skill-mix models included patient outcomes, patient satisfaction, nurse satisfaction, cost, and nurse perceptions of role changes, model effectiveness, and quality of care. Studies examining nurse satisfaction, patient satisfaction, and/or cost generally reported improvements upon skill-mix model implementation. Studies examining patient outcomes related to skill mix were inconsistent.

CONCLUSIONS

Factors for consideration upon implementation of a skill-mix change include education of role clarity, the number of unregulated staff who require supervision, and professional practice support.

The Joint Commission's Ongoing Professional Practice Evaluation Process: Costly, Ineffective, and Potentially Harmful to Safety Culture

OBJECTIVE

To evaluate the estimated labor costs and effectiveness of Ongoing Professional Practice Evaluation (OPPE) processes at identifying outlier performers in a large sample of providers across multiple health care systems and to extrapolate costs and effectiveness nationally.

METHODS

Six hospital systems partnered to evaluate their labor expenses related to conducting OPPE. Estimates for mean labor hours and wages were created for the following: data analysts, medical staff office professionals, department physician leaders, and administrative assistants. The total number of outlier performers who were identified by OPPE metrics alone and that resulted in lack of renewal, limitation, or revoking of hospital privileges during the past annual OPPE cycle (2022) was recorded. National costs of OPPE were extrapolated. Literature review of the effect of OPPE on safety culture in radiology was performed.

RESULTS

The evaluated systems had 12,854 privileged providers evaluated by OPPE. The total estimated annual recurring labor cost per provider was $50.20. Zero of 12,854 providers evaluated were identified as outlier performers solely through the OPPE process. The total estimated annual recurring cost of administering OPPE nationally was $78.54 million. In radiology over the past 15 years, the use of error rates based on score-based peer review as an OPPE metric has been perceived as punitive and had an adverse effect on safety culture.

CONCLUSION

OPPE is expensive to administer, inefficient at identifying outlier performers, diverts human resources away from potentially more effective improvement work, and has been associated with an adverse impact on safety culture in radiology.

The perceived impact of being a chaplain-researcher on professional practice

As research has become part of chaplaincy, many chaplains become involved in research, often in the double-role of chaplain-researcher. Despite the increase of involvement in research, how conducting research benefits chaplains' professional care for clients has not been studied. The present study aimed to describe how chaplains perceive the impact of participation in the Dutch Case Studies Project (CSP) on their professional expertise and positioning in the institution. A survey was distributed among participants of the CSP (N = 50) and was completed by 48 participants. We found that participation in research contributed to the expertise of chaplains (e.g., its goal-orientation, the use of theory and method) and their positioning as they try to legitimate their profession. This study thus substantiates the presumption that chaplains' engaging in research as chaplain-researcher contributes to the perceived improvement of the quality of chaplaincy care and its legitimation.

Academic self-efficacy, personal responsibility, and readiness for professional practice in nursing students: A descriptive and correlational design

BACKGROUND

The academic self-efficacy, personal responsibility, and readiness for professional practice of nursing students are important factors for academic achievement, quality of nursing care, and the transition process of new graduate nurses into the profession.

OBJECTIVE

This research was conducted to determine whether sociodemographic variables on their own or in combination with one another have an effect on the academic self-efficacy, personal responsibility, and readiness for professional practice among nursing students.

DESIGN

A descriptive and correlational design.

SETTING

The study was conducted in the nursing department of a state university in Ankara, Turkey.

PARTICIPANTS

The sample consisted of 832 nursing students.

METHODS

The data were collected via the Casey-Fink Readiness for Practice Survey, the Academic Nurse Self-Efficacy Scale, and the Student Personal Responsibility Scale -10. The data were analyzed using descriptive statistics, Multivariate Analysis of Variance, and the Tukey Honesty Significant Difference test.

RESULTS

Nursing students who engaged in clinical practice, developed care plans, and participated in case discussions had higher levels of academic self-efficacy, personal responsibility, and readiness for professional practice. Nursing students who were satisfied with studying nursing and desired to work as a nurse after graduation had higher levels of academic self-efficacy, personal responsibility, and readiness for professional practice. First-year students had lower levels of readiness for professional practice, while fourth-year students had significantly higher levels of academic self-efficacy and personal responsibility compared to students in other years.

CONCLUSION

This study demonstrated that variables such as academic level, gender, practical applications for readiness to practice, satisfaction with studying nursing, and desire to work as a nurse after graduation significantly influenced the levels of academic self-efficacy, personal responsibility, and readiness for professional practice.

Practice hours: examining the evidence

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the challenges the NHS Long Term Workforce Plan brings to the question of the number of student practice learning hours.

Characterizing the Complexity of Senior Care Pharmacy

Professional practice in any complex health care delivery can proceed at a hectic pace. There are often competing demands for the allocation of time and expertise. Senior care pharmacists are among several subsets within the pharmacy profession who shoulder the responsibility to provide care for and to protect older people who can be at grave risk for health problems from a variety of sources, in particular: medication-related problems. This was elegantly elaborated by influential pharmacy practitioners in practice and academia a little more than 30 years ago.

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada

RATIONALE

Primary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system-level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges.

AIMS AND OBJECTIVES

This study investigates the medical education experiences that influence FP's decisions about practice locations in Canada.

METHODS

We conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach.

RESULTS

FPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions.

CONCLUSION

Medical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.

Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section)

Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.

Striking the right balance

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, reflects on the need to consider the impact on the wellbeing of professionals of fitness-to-practise processes.

US Medical Student Plans to Practice in Underserved Areas

This study explores US medical students’ intent to practice in underserved areas, analyzed by demographic characteristics.

Defining the scope of advanced practice

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the issue of defining and regulating the scope of advanced nursing practice.

Ramifications of the COVID-19 Pandemic on Nursing Students' Transition to Practice

As the COVID-19 pandemic altered the course of nursing education worldwide, it disrupted efforts to transition nursing students to professional practice. The investigators examined clinical nursing faculty members' assessment of senior students' practice strengths and challenges compared to graduates of prior years. Findings demonstrated COVID-19's wide-ranging impacts on nursing students' transition to practice and offered suggestions about the implications for nursing professional development practitioners.

Training the ageing bodies: New knowledge paradigms and professional practices in elderly care

In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3-year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal-oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide.

We need to support those who speak up, for everyone's safety

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, reflects on the need to support those who speak up.

Rejuvenating Meaningful Recognition Through Shared Governance

As majority stakeholders in healthcare systems, direct care clinical nurses are accountable for professional practice, including meaningful recognition. A sustainable recognition program can be established through structural empowerment and shared decision-making within a healthy, clinical nurse-led governance structure. This article describes the journey of rejuvenating meaningful recognition across 27 hospitals and more than 500 sites of care, with the aim of positively impacting nurses and strengthening connection to purpose.

Preceptor Course Structures and Processes Contributing to Newly Licensed Nurse Outcomes

BACKGROUND

This article describes a preceptor program implemented across a health care system with standardized structures and processes that contribute to newly licensed nurse outcomes, including role satisfaction and retention.

METHOD

A quantitative design used two psychometrically tested instruments with data collected through Internet-based surveys.

RESULTS

Newly licensed nurses' perceptions of their preceptors were consistently favorable. Newly licensed nurse retention from 2019 through 2022 was 93% at 1 year.

CONCLUSION

Preceptor programs are a critical element in facilitating the transition of newly licensed nurses to professional practice. The success of the program is dependent on the quality of preceptors, who must be carefully selected, educated, and evaluated for the role. [J Contin Educ Nurs. 2023;54(10):448-453.].

Factors influencing engagement in online dual practice by public hospital doctors in three large cities: A mixed-methods study in China

Background

In the digital age, a rising number of public sector doctors are providing private telemedicine and telehealth services on online health care platforms. This novel practice pattern - termed online dual practice - may profoundly impact health system performance in both developed and developing countries. This study aims to understand the factors influencing doctors' engagement in online dual practice.

Methods

Using a mixed-methods design, this study concurrently collects quantitative demographic and practice data (n = 71 944) and semi-structured interview data (n = 32) on secondary and tertiary public hospital doctors in three large Chinese cities: Beijing, Shanghai and Guangzhou. We use the quantitative data to examine the prevalence of the online dual practice and its associated factors via the binary logit regression model. The qualitative data are used to further explore associated factors of online dual practice via thematic analysis. The findings about associated factors from the two parts were merged using the categories of personal, professional, and organisational characteristics.

Results

Our quantitative analysis shows that at least 47.1% of public hospital doctors are involved in online dual practice. The shares in Beijing, Shanghai, and Guangzhou are 43.7%, 53.1%, and 44.8%, respectively. This practice is more prevalent among doctors who are male, senior, and non-managerial. Different specialties, hospital ownership, hospital levels, and locations are also significantly associated with this practice. The qualitative analysis further suggests that financial returns, perceived effectiveness of telemedicine, and hospital directors' attitude towards telemedicine may affect doctors' engagement with online dual practice.

Conclusions

Online dual practice is prevalent among doctors at tertiary and secondary public hospitals in Beijing, Shanghai, and Guangzhou. Personal, professional, and organisational characteristics are all associated with doctors' choice to engage in online dual practice. The findings in this study provide implications for promoting telemedicine adoption and developing relevant regulatory policies in China and other countries.

Raising the profile of nurse leadership

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, reflects on the findings of a study that examined the attributes required of, and the challenges faced by, nurse directors.

Standards of Care in Social Work: Ethical and Risk Management Implications

Social workers are sometimes named as defendants in malpractice lawsuits. These lawsuits allege negligence, specifically that social work defendants owed a duty to the plaintiff, breached this duty, and the defendant's actions caused harm. Plaintiffs in litigation cases typically allege that social workers violated or failed to meet prevailing standards of care in the profession. It is essential that social workers understand the legal concept of standard of care and its implications for professional practice. This article reviews the concept of standard of care; discusses the ways in which social work ethics standards, federal and state laws, national practice standards, expert witness testimony, and professional literature determine the standard of care; and presents practical steps social workers can take to comply with prevailing standards of care, protect clients, and protect themselves. The author focuses especially on complex cases where social workers may not agree on relevant standards of care.

A global approach to workforce issues

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers how World Health Organization documents can point the way to improving nursing and midwifery education.

Nurses Improving Care for Health Systems Elders (NICHE): An evidence-based professional practice model for an aging nation

Nurses Improving Care for Healthsystems Elders (NICHE), one of the original geriatric care models, enhances the overall quality and safety of nursing care provided to older adults in hospital and post-acute care settings. NICHE is a relatively low-cost, high-impact investment in the nursing workforce to improve performance on the nurse-sensitive quality indicators including falls, pressure injuries, medication safety, urinary incontinence, restraint reduction, delirium identification and management, reducing preventable readmissions, among others. NICHE also serves as a foundation to enhance nursing care to achieve national accreditation standards for a number of geriatric and nursing quality programs.

The Value of Magnet® Recognition Through the DNP Student Lens

The Magnet Recognition Program® provides an international criterion standard around which organizations can challenge themselves to become innovative models of care. Through the Magnet® components of transformational leadership, structural empowerment, exemplary professional practice, knowledge and innovation, and empirical quality results, healthcare organizations are leaders and exemplars in addressing the global issues that impact the nursing and healthcare professional fields. Through education and training, the DNP-prepared nurse has the potential to be at the forefront of these initiatives.

Perceptions of Radiation Safety Culture Among Radiography, Computed Tomography, And Mammography Technologists

PURPOSE

To investigate determinants of radiation safety culture among radiologic technologists to determine whether factors related to the primary imaging modality affect the perception of workplace radiation safety.

METHODS

A secondary analysis was performed on deidentified data from 425 radiologic technologists collected with the Radiation Actions and Dimensions of Radiation Safety (RADS) questionnaire, a 35-item survey with valid and reliable psychometric properties. The data included radiologic technologists working in radiography, computed tomography (CT), and mammography. Descriptive statistics were used to report RADS determinant outcomes by imaging discipline, and 1-way analysis of variance and Games-Howell post hoc tests were conducted to analyze the hypothesis.

RESULTS

Mean differences in the radiologic technologists' perceptions of teamwork across imaging stakeholders pertaining to radiation safety were found (P < .001). Mammographers had the most favorable perceptions of teamwork compared with radiographers and CT technologists.

DISCUSSION

Collaboration in mammography between imaging stakeholders is dictated by professional practice standards and federal law. The resultant engagement might influence mammographers' perceptions of radiation safety. Additional research is warranted to determine if perception differences exist among technologists in other modalities and whether intentional collaboration drives improved perceptions of radiation safety culture.

CONCLUSION

An analysis of the collaborative actions in the mammography department is needed, and the findings could be applied in radiography and CT to improve perceptions of radiation safety-related teamwork.

REIN: a tool to evaluate pratices

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of its role in practices evaluation, the following key messages were retained. The evaluation of our practices allows improving them as proposed by the concept of the Edward Deming wheel (Plan, Do, Check, Act). Measurement also allows setting goals and targets. Where there are recommendations available, the REIN indicators allow comparison with the identified targets. The REIN registry is an interesting tool to observe the deployment and impact of the recommendations in dialysis units and to evaluate the professional practices taking into account the patients’ characteristics and the changes in the recommendations. Finally, the treatment indicators analysed using REIN data show the great diversity of practices from one region to another, the result of habits, training of nephrologists, the history of the care offered and sometimes the geography of the region and its population.

Becoming a podiatrist: an exploration of the practices and processes which underpin the acquisition of a professional identity

BACKGROUND

Undergraduate podiatry degrees are designed to enable students to become professional podiatrists. To be successful students must manage academic and practical activity to ultimately acquire a professional identity. Little is known about the practices and processes which underpin the acquisition of a professional podiatry identity. It is the aim of this paper to begin to address this absence of knowledge. Community of Practice theory, arguably the dominant contemporary learning theory, represents identity shift as an interaction of imagination, engagement and alignment which enables students to successfully participate in higher education, and ultimately, the professional context. This success is underpinned through assisting students to develop an enabling identity in their learning and doing.

METHODS

Here we present findings that emerged from a yearlong ethnography in a successful higher education podiatry department. The project followed students and staff in the classroom and the clinic and explored their experiences through interviews.

RESULTS

The findings suggest that the journey to professional identity is facilitated through meaningful learning relationships between staff and students and clarity around professional practices. Here we discuss how those relationships form and enable undergraduates to become podiatrists.

CONCLUSIONS

Our findings offer a model for the transition from student to professional and highlight the importance of relationship and experience in becoming a podiatrist. There is a paucity of research around not only podiatry but also other allied health professions around this topic and given the increasing emphasis around employability skills in HE, more research in a range of contexts is needed.