Perceived barriers to the professional development of modern nursing in Italy – A discussion paper

The aim of this paper is to discuss the development of modern nursing in Italy. Specifically, the paper aims to draw attention to the fact that while nursing in Italy has mirrored developments in Europe, in many respects the advancement of the profession is much less accelerated. The paper considers the reasons for this and the contributing factors and explores possible solutions.     

Reflection,the way to professional development?

Background. Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses’ reflections, what do they reflect about, and how do they deal with their reflections? Aims and objectives. The aim of this study was to describe the RNs’ experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs’ reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development? Design and method. The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study. Results. The qualitative differences regarding the RNs’ experiences of reflection were categorized as follows: to reflect (to think back – consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development. Conclusion. By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development. Relevance to clinical practice. The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge.     

The route to success – pathway qualifications for a career in veterinary nursing

ABSTRACT:

Central Qualifications has recently announced that the newly developed pre-veterinary nursing qualifications - the Diploma for Veterinary Nursing Assistants and Diploma in Animal Nursing – are now available for delivery. The author explains the development of the Level 2 qualifications as providing a seamless pathway to veterinary nursing.     

Understanding organizational culture: the key to successful middle manager strategic involvement in health care delivery?

AIM: The aim of this study was to explore the extent to which organizational culture influenced strategic involvement. BACKGROUND: It is crucial for the strategic management of health care that the cultural dimensions affecting health service organizations are identified and understood. How culture influences middle manager strategic involvement has not been established and therefore an understanding of the power of organizational culture is important to middle managers working in not-for-profit health care organizations. CONCLUSION: It was demonstrated that strong organizational culture predicted strategic involvement, and supported the importance of middle managers remaining strategically involved in the development of new organizational strategic initiatives. Findings have implications for strategic management in health service organizations.     

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients after stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test–retest reliability. Method: TIS was translated according to international guidelines. The validity study was performed on data from 201 patients with acute stroke. Fifty patients with stroke and acquired brain injury were recruited to examine intertester and test–retest reliability. Construct validity was analyzed with exploratory and confirmatory factor analysis and item response theory, internal consistency with Cronbach’s alpha test, and intertester and test–retest reliability with kappa and intraclass correlation coefficient tests.Results: The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed. By combining items from the subscales Dynamic sitting balance and Coordination, six ordinal superitems (testlets) were constructed. The TIS-NV was renamed the modified TIS-NV (TIS-modNV). After modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. It demonstrated good construct validity, excellent internal consistency, and high intertester and test–retest reliability for the total score.Conclusions: This study supports that the TIS-modNV is a valid and reliable scale for use in clinical practice and research.

Implications for Rehabilitation

• Trunk control is an essential part of balance and postural control, thereby an important prerequisite for daily activities and function

• Impairments of trunk control is a common problem in stroke

• The TIS-modNV is a valid and reliable measure to evaluate impairments in trunk control

• The TIS-modNV containing ordinal superitems is recommended for use in clinical practice and research

     

Prediction of success in the first-year exam in the study of medicine – a prospective survey

OBJECTIVE: To identify predictors of students' success in the first-year exam in a new curriculum in the study of medicine in Vienna. DESIGN: We tested 11 topics (including socio-demographic variables, family background, school performance, economic situation, living conditions, social integration and health, learning capacity, study motivation and ability to cope with stress) for their relevance in terms of study success in a prospective study of an unselected student sample. Data were collected from questionnaires filled in by 674 first-year students (50.8% of the total number of 1327 new students) who enrolled in the academic year 2002/03. MAIN OUTCOME: Comparison of students who passed the first-year exam with students who failed identified four predictors: male sex, German mother tongue, performance in secondary school and learning capacity. CONCLUSIONS: The new curriculum exerted subliminal selectivity; the predictive powers of school marks and subjective learning capacity were confirmed; the influence of a student's sex should be investigated further; the influence of mother tongue requires modification of pre-study courses for foreign students.     

Introducing first year students to interprofessionalism: Exploring professional identity in the “enterprise culture”: A Foucauldian analysis

This view from the 'frontline' examines what is needed to underpin interprofessional collaboration in the new Health Action Zones (HAZ). Successful joint working in the Luton HAZ has required continuing commitment at all levels, time and other resources. The agencies involved need to create an environment of low-competition and high involvement, one that rewards innovation where risk-taking is supported by senior management. They seek measurable outcomes without being obsessed with attribution.     

The past tense debate: is phonological complexity the key to the puzzle?

Theorists disagree over whether our language faculty is a single system or a dual one. Those supporting the latter position believe that English regular and irregular past tense verbs reflect this duality, with some proposing that each is processed by a rule mechanism and memorised lexicon respectively. Single system proponents believe instead that all verbs are processed by the same system, differing only in their degree of reliance on phonological and semantic representations. Regular past tense verbs involve greater phonological processing partly because they are phonologically more complex than irregulars. Early neuroimaging studies showing activation differences between the two have been taken as evidence for a dual system. However, it has been proposed recently that greater activation related to regular verb inflection was instead due to the failure to match regular and irregular verbs for phonological complexity (PC). Using a 2×3 ANOVA, the current event-related fMRI study tested this idea directly by manipulating regularity (regular, irregular) and PC (low, mid,and high) in 19 English-speaking monolingual participants. We found a main effect of PC, supporting the idea that phonological complexity cannot be ignored when considering differences between regular and irregular verbs. However we also found a main effect of regularity, demonstrating that differences over and above phonological complexity exist between the two types of verb. Even with phonological complexity matched, several regions including left inferior frontal gyrus and caudate were more activated for regular verb inflection. Temporal lobe regions and left hippocampus were among regions activated relatively more for irregular verb inflection. These latter findings suggest it may be premature to rule out a dual system account.     

Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care

A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified.     

Multi-professional and multi-dimensional group education – a key to action in elderly persons

Purpose: This study was intended to evaluate a multi-professional health-promoting and disease-preventive intervention organized as multi-professional senior group meetings, which addressed home-dwelling, independently living, cognitively intact elderly persons (80±), by exploring the participants’ experiences of the intervention. Method: The focus group methodology was used to interview a total of 20 participants. The informants had participated in four multi-professional senior group meetings at which information about the ageing process and preventive strategies for enhancing health were discussed. Results: The overall finding was that the elderly persons involved in the intervention lived in the present, but that the supportive environment together with learning a preventive approach contributed to the participants’ experiencing the senior meetings as a key to action. Conclusions: Elderly persons who are independent may have difficulty accepting information about preventing risks to health. However, group education with a multi-professional approach may be a successful model for achieving an exchange of knowledge, which may possibly empower the participants, give them role models, the opportunity to learn from each other and a sense of sharing problems with people in similar circumstances.

Implications for Rehabilitation

• Since elderly persons these days are expected to live beyond their 80 s, there is still time for interventions aimed at health promotion and disease prevention to have an effect on functional status and the quality of life of their remaining years.

• Elderly persons who are independent may have difficulty accepting information about preventing risks to health.

• Multi-professional health promoting and disease-preventive senior meetings could motivate elderly persons to act on behalf of their own health.

• Multi-professional collaboration combined with the group model made the participants in our study experience the senior meeting as a key to action.

     

The role of health informatics in clinical audit: part of the problem or key to the solution?

The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of financial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care.     

Referral to the pediatric dialysis unit – The earlier the better?

Whereas recent research has demonstrated clear evidence for beneficial effects of early referral to the nephrologist in chronic renal insufficiency in adults, no such data exist for the pediatric population. In this study, we therefore correlated patient age and residual renal function at first presentation to a specialized pediatric nephrologist with the extent of secondary uremic complications and the further course of renal function. From March 2003 until March 2004, 43 children (34 boys, aged 10.1 +/- 6.3 yrs) with congenital-urologic (n = 26), congenital-nephrologic (n = 13) or acquired (n = 4) renal diseases had been followed for 3.9 yrs (14 days to 17.5 yrs) at the Kinderdialyse Wien, with a residual renal function of 35 +/- 20.5 ml/min/1.73 m(2) at first presentation. With regards to uremic secondary complications, the majority of children exhibited involvement of at least two systems at first presentation. Thereafter, children with congenital diseases who were referred to the specialized pediatric nephrology unit within the first year of live demonstrated a significantly better course of residual renal function (1.8% vs -0.7%, p = 0.034) than children who were referred later. These data confirm recent registry reports on chronic renal insufficiency in children. Only about a third of the children of our population were presented to a specialized pediatric nephrology center within their first year of life (despite a congenital disease in 90% of them). Thus, therapeutic interventions might be currently offered at a delayed time point in the majority of children.     

The relationship between nurses’ job satisfaction and continuing professional development

Objective

To identify the correlation between nurse's perception of the continuing professional development (CPD) and the satisfaction of nursing career ladder system (NCLS) implementation.