Interim manual for clinical practice guideline development /

"May 1991."

Professional doctoral training in psychology: International comparison and commentary

The level of training required for the practice of professional psychology varies across countries, and usually evolves from a combination of input from local and national regulatory bodies, legislative requirements, academic institutions and relevant professional bodies. Here we explore the North American and Australian historical developments and future directions in levels of training required and aspired to for professional psychologists, along with a brief comparison to training for psychologists in Central and South America, Europe and Asia. The recent proliferation of professional doctorate degrees in Australian universities has added another layer to the suite of available qualifications for professional psychologists and to some degree reflects international trends in the profession. The important role of professional organisations in establishing the educational requirements for entry into professional practice is highlighted.

Room to move? Professional discretion at the frontline of welfare-to-work

Outcomes of social policies have always been mediated by the discretionary agency of front-line staff, processes which nevertheless have received insufficient attention in policy evaluation and in the social policy literature more broadly. This article takes the case example or the policy reforms associated with the Australian government's welfare-to-work agenda. Drawing on two discreet research projects undertaken at different points in the policy trajectory, the practices of social workers in Centrelink - the Commonwealth government's primary service delivery agency involved in welfare-to-work - is examined. Centrelink social workers have been and remain one of the core groups of specialist staff since the Department's inception in the late 1940s, working to improve the well being Of people in receipt of income security. Their experiences of the recent past and their expectations of the future of their professional practice as welfare reform becomes more entrenched are canvassed. In summary, the discretionary capacity of the Centrelink social workers to moderate or shape the impact of policy on income security recipients is steadily eroding as this group of professionals is increasingly captured by the emerging practices of workfare.

Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma

BACKGROUND: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. OBJECTIVE: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. METHODS: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. RESULTS: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. CONCLUSIONS: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

Proof in the pedagogic pudding? The challenges of promoting evidence-based teaching practice in a research-focused institution

Drawing upon the findings of a mixed methodological study, this paper critically analyses the cultural, pedagogical, and organisational issues encountered by academics and support staff working within a newly established Centre for Learning Innovation and Professional Practice tasked with facilitating a new teaching-focused policy in a previously research-led institution. The aim of this policy is to assure that, across the institution, teaching is given the same priority and kudos as research. Focusing specifically staff perceptions of the impact of the new policy on various aspects of academic life including, pedagogic practice, student support, staff training, and organisational management, the paper critically addresses the cultural and attitudinal challenges of change management (Kotter, 1996) within a ‘grey-brick’ university. In doing so it makes a significant contribution to current academic theory and debate in the areas of pedagogic practice and organisational management.

A matter of professionalism? Reflection and reflexivity in continuing engineering education and practice

The argument that this paper sets out to critique is that in order to promote professionalism in Engineering Education and Practice, graduate level engineering programmes need to introduce the concepts of reflection and reflexivity into the curriculum right from the onset. By focusing upon the delivery of a newly developed „Work Based‟ Master’s level programme in Professional Engineering, this paper provides an overview of the first part of an empirical study which sets out to investigate the challenges associated with embedding reflection and reflexivity into Engineering Education. The paper concludes by noting that whilst student engineers may struggle with the concepts of reflection and reflexivity, with support and encouragement such difficulties can be overcome. Moreover, by encouraging students to reflect upon their Professional Practice, the programme not only enables students to consider how they may apply what they have learnt to their Professional Practice, but also encourages them to think about how they can link their experiences as Professional Engineers to what and how they learn both whilst on the programme but also as lifelong learners.

Teachers' perceptions of the national board certification process: Developing a sense of professionalism

This study describes and explains the experiences and perceptions of six public school teachers who had undergone the National Board for Professional Teaching Standards national certification process as a vehicle for promoting a teacher's sense of professionalism. Of these six participants, two achieved National Board certification, two did not achieve National Board certification, and two are awaiting results of their certification status. The study took place over a period of eleven months and focused on the participants' perceptions regarding the National Board certification process as it affected their sense of (a) efficacy and (b) professionalism. Data for this collective case study were gathered from interviews, portfolios and videotapes, and artifacts. Using case analysis, this study's participants' responses gathered through the interview process were examined. ^ The findings indicated that participants had concerns about the National Board certification process in the following areas: process, sense of efficacy, and sense of professionalism. All participants reported the process to be overwhelmingly demanding. Analysis of the data also reveals that those who were successful in achieving National Board certification had a greater sense of efficacy than those who did not. A disappointing finding was that the National Board process impacting participants' sense of professionalism could not be sustained; however, the participants in this study suggested the process was a step towards providing opportunities for collaboration, collegiality, and reflective practice. This study raises the question as to whether or not the espoused purposes of National Board certification are achieved via the certification process. ^

The spiritual and professional impact of stillbirth

Stillbirth is without question one of the most devastating experiences of grief for parents and families. The death of a baby is also a distressing experience for healthcare professionals who share hopes of a live healthy baby at the end of pregnancy. It is a sad reality however, that in Ireland one in 238 babies will die before birth. The creation and nurture of new life in pregnancy is a spiritual experience as a new baby is at the same time experienced and anticipated. There is little in the published literature concerning the spiritual impact of stillbirth on healthcare chaplains who are the main providers of spiritual care for parents and staff colleagues in Irish maternity units. In addition there are few qualitative studies that explore the impact of stillbirth on consultant obstetricians and no published studies on the spiritual impact of stillbirth on bereaved parents. This study explored the spiritual and professional impact of stillbirth on Irish maternity healthcare chaplains, consultant obstetricians and bereaved parents. Following an overall review of spiritual care provision following stillbirth in the Irish maternity services, thematic analysis was used in the first phase of the study following in-depth interviews with maternity healthcare chaplains. Interpretative Phenomenological Analysis was used in the second and third phases with consultant obstetricians and bereaved parents respectively. The data from both maternity healthcare chaplains and consultant obstetricians revealed that stillbirth posed immense personal, spiritual and professional challenges. Chaplains expressed the spiritual and professional impact of stillbirth in terms of perception of their role, suffering, doubt and presence as they provided care for bereaved parents. A review of spiritual care provision in the Irish maternity services revealed a diversity of practice. The data from consultant obstetricians identified considerable personal, professional and spiritual impact following stillbirth that was identified in superordinate themes of human response to stillbirth, weight of professional responsibility, conflict of personal faith and incongruence between personal faith and professional practice. Data from bereaved parents revealed that stillbirth was spiritually challenging and all parents expressed that stillbirth posed considerable challenge to their faith/ belief structure. The parents of only three babies felt that their spiritual needs were adequately addressed while in hospital. The data had six superordinate themes of searching for meaning, maintaining hope, importance of personhood, protective care, questioning core beliefs and relationships. Other findings from the data from bereaved parents outlined the importance of environment of care and communication. This study has revealed the immense impact of stillbirth on healthcare chaplains, consultant obstetricians and most especially the spiritual impact for bereaved parents. Recommendations are made for improvements in clinical and spiritual care for bereaved parents following stillbirth and for staff wellbeing and support initiatives. Further research areas are recommended in the areas of spiritual care, theological reflection, bereavement care, post-mortem consent procedures and staff wellbeing.

Working with people affected by cancer – Phase 1 of a mixed methods exploration of practitioner perspectives in nutritional therapy

Introduction - Nutritional therapy (NT) is a bioscience-based branch of complementary and alternative medicine (CAM) with National Occupational Standards (NOS) and accredited training courses which include compulsory clinical training. Approximately 900 practitioners are registered with the voluntary regulator, the Complementary and Natural Healthcare Council (CNHC), but the number of unregulated practitioners is unknown. Cancer is a leading cause of death worldwide; nutrition and lifestyle factors may affect recurrence and survival rates. Many cancer patients and survivors seek individualised advice on diet and use of supplements and appropriately skilled nutritional therapy practitioners (NTP) may be well-placed to safely provide this advice. Little is known of NTPs’ perspectives on working with people affected by cancer; this study seeks to explore their views on training, use of evidence and other resources, to support the development of safe evidence-based practice in this important clinical area. Methods – An on-line anonymised questionnaire collected data from participants recruited from all UK registered NTPs. Recruitment was facilitated by the British Association for Applied Nutrition and Nutritional Therapy (BANT). Quantitative data on practitioner characteristics, years in practice, other therapies practiced and work with cancer clients were collected. Qualitative data on types of evidence used, barriers to practice and perceived training and support needs when working with clients with cancer, were collected and analysed. SPSS was used to produce descriptive statistics. Preliminary Results – 274/888 (31%) of registered NTPs participated. 61% respondents had accredited NT qualifications of which 46% were at degree or post-graduate level. 73% (202) participants indicated they also had other higher education qualifications, including 153 (56%) at degree or above. When asked to describe their position on cancer work, 17% respondents (40/238) indicated no interest, and 35% (84/238) respondents already work with cancer clients (cancer practitioners - CP). A further 48% (114/238) respondents expressed interest in starting cancer work, and typically requested specialist training and practice guidelines to support this area of clinical practice. Cancer practitioners (CP) rated searches of peer-reviewed literature as most useful for information to support practice, whereas commercial product information was rated least useful. CPs requested engagement with mainstream medicine, more access to research evidence and professional recognition to facilitate and support work with cancer clients. A need for professional networking, mentorship and/or supervision was noted by CP and non-CP respondents, which is of interest since 81% all participants worked as sole practitioners exclusively or as part of their practice, <1% worked within the NHS. Discussion & Conclusions – This is the first detailed documentation of NTP perspectives on cancer work. A number of areas have been identified for further detailed evidence to be collected using focus groups and interviews, including detailed training needs, communication with mainstream cancer professionals, access to research evidence, and professional recognition. This work will inform and support the development of professional practice guidelines for NT and inform the development of specialist training and other resources.

La carpeta de aprendizaje y la evaluación entre iguales de los estudiantes. Resultados de una innovación docente en los estudios universitarios de las artes

Students reflect more on their learning in course subjects when they participate in managing their teaching–learning environment. As a form of guided participation, peer assessment serves the following purposes: (a) it improves the student’s understanding of previously established learning objectives; (b) it is a powerful metacognitive tool; (c) it transfers to the student part of the responsibility for assessing learning, which means deciding which learning activities are important and choosing the degree of effort a course subject will require; (d) it emphasizes the collective aspect of the nature of knowledge; and (e) the educational benefits derived from peer assessment clearly justify the efforts required to implement activities. This paper reports on the relative merits of a learning portfolio compiled during fine arts-related studies in which peer assessment played an important role. The researchers analyzed the student work load and the final marks students received for compulsory art subjects. They conclude that the use of a closed learning portfolio with a well-structured, sequential and analytical design can have a positive effect on student learning and that, although implementing peer assessment may be complex and students need to become familiar with it, its use is not only feasible but recommendable.

Occupational therapists’ perceptions of occupation in practice : an exploratory study

A função da auditoria interna na Guarda Nacional Republicana: estudo de caso

Mestrado em Auditoria

Idoneidade formativa dos campos de prática clínica - caso particular de uma unidade de saúde personalizada

A Ordem dos Enfermeiros (OE) aprovou em Assembleia Geral de 2007 uma proposta de alteração estatutária em termos de regulação e desenvolvimento profissional. Surge assim o Modelo de Desenvolvimento Profissional (MDP) que traz uma nova dimensão à certificação de competências de enfermeiro e enfermeiro especialista. Se até aqui a OE certificava estas competências a partir dos documentos académicos apresentados, a partir desta alteração a certificação passa por uma prática tutelada de exercício profissional e só depois de dará a atribuição do título profissional. O Exercício Profissional Tutelado (EPT) só poderá ocorrer em serviços de saúde com idoneidade formativa acreditada pela OE. Para determinar esta idoneidade formativa dos contextos de prática clínica de enfermagem, é construído um referencial, que parte do documento “Padrões de Qualidade dos Cuidados de Enfermagem”, tendo como eixo organizador o enunciado descritivo sobre “A organização dos cuidados de enfermagem”. Este trabalho reflete o estágio realizado num contexto de prática clínica (Unidade de Cuidados de Saúde Personalizados) onde foi feita uma avaliação em termos de idoneidade formativa. De Abril a Junho de 2011 foi feita observação documental e da prática de enfermagem, aplicada uma grelha de avaliação de idoneidade formativa e entrevistado o enfermeiro chefe. Os resultados apresentados são de não evidência de idoneidade formativa, após o que se tentou estabelecer um Plano de Acção, para cumprimento dos critérios estabelecidos para a certificação. Com base no mesmo enunciado, a organização dos cuidados de enfermagem, foram delineadas algumas intervenções que, a seu tempo, poderão certificar esta unidade para a prática do exercício profissional tutelado. Destacamos o necessário envolvimento de todos os elementos de enfermagem, com uma condução de liderança forte e motivadora, no sentido criar um contexto de prática clínica congruente com as orientações da OE para a certificação e, em simultâneo, melhorar a qualidade dos cuidados de enfermagem prestados.

The role of simulation in pedagogies of higher education for the health professions: through a practice-based lens

The preparation of future professionals for practice is a key focus of higher education institutions. Among a range of approaches is the use of simulation pedagogies. While simulation is often justified as a direct bridge between higher education and professional practice, this paper questions this easy assumption. It develops a conceptually driven argument to cast new light on simulation and its unarticulated potential in professional formation. The argument unfolds in, and is illustrated via, three accounts of a simulation event in an Australian undergraduate nursing program. This begins with a familiar approach, moves to one that problematizes this through a focus on disruption, culminating in a third that draws on socio-material theorisations. Here, simulation is conceived as emergent, challenging stable notions of fidelity, common in simulation literature. New possibilities of simulation in the production of agile practitioners and learners in practice are surfaced. This paper extends and enriches thinking by providing distinctive new ways of understanding simulation and the relationship it affords between education and professional practice, and by illuminating the untapped potential of simulation for producing agile practitioners.

Training a system-literate care coordination workforce.

People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.