Development of professional competence in public health nurses]

PURPOSE: Significant changes that are occurring in the community health care system, require that public health nurses who work for local governments to not only provide direct care but also to coordinate health care teams and participate in policy making. The purpose of this study is to investigate the current system of developing professional competence in public health nurses, and to consider ways to improve it. METHOD: The subjects, randomly chosen, were 100 chief public health nurses and 298 staff nurses in Hokkaido. Sixty-four chief nurses, 44 beginner nurses, 87 proficient nurses and 88 expert nurses responded. The data were collected with a self-administered questionnaire which necessitated the subjects to make a self evaluation of their practical competence and circumstances of its development. RESULT: Self evaluated competence, in making accurate assessments of individual needs and initiating direct care, developed with their experiences in the job, and was generally high. However, the questionnaire showed that self evaluation of their work and ability to do theoretical analysis and research was low and did not progress in conjunction with the length of work experience. Policy making experience was limited and policy making competence was evaluated as low, but there was an expectation that this competence would develop in time. Almost all of the respondents expected their professional competence to progress to higher levels. In particular, beginner nurses wanted to gain practical care competence; proficient and expert nurses wanted to develop their powers of theoretical analysis and do more research, while chief nurses were keen to gain competence in the area of policy making. The respondents reported that they sometimes attended academic conferences, but hardly did any research. CONCLUSION: Low self-evaluation of public health nurses reflect a basic immaturity as a profession. They need to establish their profession and to increase their self-evaluated competencies as their careers develop. These findings showed the importance of establishing a system of continuing education that will cultivate competence in various aspects of their job and also motivate self study. These findings also reveal the importance of collaboration between the university as a vehicle for theoretical work and research and the work place as the embodiment of practical application.     

Correlates of patient satisfaction with mental health services in a health maintenance organization

To assess the level and determinants of patient satisfaction with prepaid mental health services, the authors surveyed 124 adult patients who five years earlier had been seen at least once by a mental health professional. Of the 44 percent who returned questionnaires, approximately one third reported satisfaction, one third dissatisfaction, and one third were unsure. Most patients sought help for chronic situational problems and tended to use the services repeatedly over time. Satisfaction was most strongly correlated with the patients' perceptions of their rapport with the provider and slightly less so with their perceptions of the provider's technical competence. Patient characteristics, diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM 3), and systems issues were of no predictive value. Patients who presented with symptomatic distress not clearly linked to circumstances were likely to be dissatisfied with treatment.     

Toward a public health of situations: the re-contextualization of risk

This paper reviews the role of situational variables in health risk behaviors and the literature on the impact of context and situation in public health. Three postulates for a situational model are presented: that the situation can account for additional variance in explanation of health risk behaviors; that the power of the situation is reciprocal to the degree of individual autonomy; and that the situation is definable and measurable. A situational presentation methodology is presented for measuring situations in public health with preliminary data on its efficacy in the context of sexual behavior and injecting drug use as HIV transmission risks. Interventions which maximize the use of situationally-based information are discussed. It is concluded that situational presentations may offer additional explanatory power in public health and a means for intervening at a situational level.     

The core of mentorship: medical students' experiences of one-to-one mentoring in a clinical environment

Mentoring has been used in different health care educational programmes, but the core of mentorship, i.e., facilitating the development of medical students' professional competence, has not been explored in depth in the literature. In order to create effective and meaningful mentoring programmes, there is a need for deeper knowledge of the meaning of formal mentorship and, for this, the students' experiences are important. A mentoring program was set up where all medical students were offered a mentor during their first clinical courses; years 3-4. The mentors were physicians and their role as mentors was to support the students and act as sounding-boards, not to teach or assess knowledge. This study aimed to get a deeper understanding of the meaning of mentorship seen from the perspective of undergraduate medical students. A qualitative approach with individual interviews (N = 12) and inductive content analysis was chosen to investigate and interpret the meaning of mentorship. The results comprise three overarching themes: Space, Belief in the future and Transition. Having a mentor gave a sense of security and constituted a 'free zone' alongside the undergraduate programme. It gave hope about the future and increased motivation. The students were introduced to a new community and began to identify themselves as doctors. We would argue that one-to-one mentoring can create conditions for medical students to start to develop some parts of the professional competences that are more elusive in medical education programmes, such as reflective capacity, emotional competence and the feeling of belonging to a community.     

Social,health care and rehabilitation educators' competence in professional education—Empirical testing of a model

The social and health care educator's role in educating future professionals need to be stronger emphasised and deserves international recognition. The purpose of this study was to develop and test an empirical model of social and health care educators' competence in higher and professional education. The presented research employed a cross-sectional study design. Data were collected using HeSoEduCo-instrument from 28 educational institutions in Finland. The model was empirically tested with confirmatory factor analysis through Structural Equation Modelling that applied the Full Imputation Maximum Likelihood estimator. A total of 422 social and health care educators participated in the study. The empirical model of social and health care educators including eight competence areas: leadership and management, collaboration and societal, evidence-based practice, subject and curriculum, mentoring students in professional competence development, student-centred pedagogy, digital collaborative learning, and cultural and linguistic diversity. All of the connections between concepts of the empirical model were found to be statistically significant. There were strong connections between most of the identified competence concepts; however, two weak connections were found, namely, the link between competence in evidence-based practice and competence in subject and curriculum, along with the link between competence in digital collaborative learning and competence in student-centred pedagogy. The presented empirical model can help stakeholders identify which areas of social and health care educators' curricula should be further developed. The model is also relevant for improving continuous education, allowing educators to assess their competence levels and evaluating educators' performance at the organisational level.     

Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective

Health professions education is dealing with major transformations in light of the changing nature of the health care delivery system, including the use of technology for “just in time” delivery of care, evidence-based practice, personalized medical care and learning, as health professionals strive to integrate biomedical advances and clinical practice. This has forced the medical education community to reassess the current teaching and learning practices and more importantly, the evaluation of the medical education process. There have been recent advances in cognitive and learning sciences theories, some of which can inform medical educators about best teaching and learning practices and their impact on the evaluation process. An understanding of these theories provides a sound rationale for choosing specific instructional strategies and choosing evaluation measures that assess the curricular objectives. The review begins with an overview of evaluation and assessment in education, followed by an overview of major theories from the cognitive and learning sciences. Next, the role of cognitive and learning sciences theories in informing the process of medical education evaluation is discussed, including its impact on student learning, performance and professional competence, as well as recommendations for reform of medical curricula based on such theories. The paper continues with the elaboration of current trends in health sciences education, particularly medical education, and available evidence for the impact on student learning and performance as well as areas where more research is needed.     

Critical elements of culturally competent communication in the medical encounter: A review and model

Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence ‘in action.’ First, we describe four critical elements of culturally competent communication in the medical encounter – communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.     

Continuing medical education: the question of evaluation

This paper examines the question of evaluation which has been largely neglected in the credit-based systems of continuing medical education adopted by the Medical Royal Colleges. These systems are seen to encourage a training model of continuing education and a scientific model of evaluation as measurement. By contrast, humanistic evaluation is interpretative and differs not only in its criteria and methods, but also in its underpinning curricular ideologies and values. This model has closer links with concepts of education and professional practice associated with continuing professional development. Decisions about who should conduct the evaluation, what is to be evaluated, how it should be carried out, and about the goals and purposes of evaluation are outlined, noting that they presuppose an ideological view of the relationship of professional knowledge, values and practice. In a concluding discussion of evaluation and the control of professional knowledge, it is argued that the narrow, professional control of evaluation, buttressed by the quality assurance and monitoring mechanisms of the Colleges, is inappropriate, given the increasingly diverse accountabilities which affect medical professionals.     

Identity Gaps and Level of Depression Among Korean Immigrants

Identity gaps are a new theoretical construct that provide a framework for integrating communication into the study of identity and understanding the relationship between identity and health outcomes, such as depression. Derived from the communication theory of identity, identity gaps emerge when elements of identity are inconsistent with each other. This article focuses on 2 types of identity gaps, personal–enacted and personal–relational, examining their relationships with situational variables and depression. A questionnaire was administered to a community sample of 377 Korean immigrants to test a hypothesized path model predicting that 3 situational variables (intercultural communication competence, middleperson status, and perception of racial hierarchy) would influence the identity gaps that, in turn, influence Korean immigrants' levels of depression. Results showed that all 3 situational variables predicted Korean immigrants' personal–relational identity gaps, whereas only intercultural communication competence predicted their personal–enacted identity gaps. Both types of identity gaps predicted the level of depression. The personal–relational identity gap significantly mediated the effects of all 3 situational variables on levels of depression. However, the personal–enacted identity gap mediated only the effects of intercultural communication competence on the levels of depression.     

Research and the recent evolution of primary health care

Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health.Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time research, as well as professional career models acknowledging research and teaching activities. Scientific and professional associations in primary care face the challenge of maintaning research projects, of increasing their presence among professionals, of formulating opinions regarding the problems of their sector, as well as of reinforcing their organizational and communication capabilities.     

以胜任力为导向的公共卫生硕士校外实践培养体系的构建探索

目的 探索构建以胜任力为导向的公共卫生硕士（MPH）校外实践培养体系。方法 通过文献检索,分析国内外MPH专业学位培养模式,以胜任力为导向创新设计一个全面的、可行的MPH校外实践培养体系。结果 中山大学-广州市CDC高水平公共卫生人才培养示范基地针对实践时长2年以上的MPH探索构建了“4+N+综合评价”的实践体系,“4”代表基于实践的教学、专业实践、公共卫生项目管理参与和科研训练,分别培养MPH“公共卫生科学”“操作与实践”“人群健康管理”“卓越技能”能力。“N”代表拓展实践,培养MPH“综合能力与职业精神”能力,以综合评价来评估培养效果。结论 本研究构建以胜任力为导向的MPH“4+N+综合评价”校外实践体系,培养新时期社会需求的高层次应用型公共卫生人才。     

我国社会医学学科建设的成就和挑战

在新型医学模式指导下,30年来我国社会医学学科发展经历了创始、成长和发展三个阶段。越来越多的综合性大学开设了社会医学专业,教学内容不断丰富,教学方法不断革新。社会医学研究形成了社会评价、健康评价和疾病评价等三个研究重点,国际合作研究较为频繁,大量科研成果推动学科发展。但在发展过程中,社会医学也面临着院校间发展不平衡、学科融合不足、教学内容与其他学科存在重复、研究能力有待提高、部门协作不足等很多挑战,需要积极应对。     

Interviewing and counseling skills. Techniques for their evaluation.

Assessment of knowledge and cognitive skills has been traditionally included in examinations for certification and licensure of health professionals. Evaluation techniques for assessing complex cognitive and interpersonal skills, however, have not been as widely developed or incorporated in national examination programs. Specifically, the evaluation of interviewing and counseling skills has been complicated by difficulties in: (a) defining what consititutes skillful interviewing and counseling and in specifying criteria against which performance can be assessed; (b) developing evaluation procedures to permit accurate and reliable observations of these activities; (c) solving logistic problems of standardizing the content and format of these evaluation procedures; and (d) establishing standards for identifying individuals who have not yet achieved acceptable levels of proficiency. Progress has been made in defining the criteria for evaluating the interviewing and counseling skills of several categories of health professionals. Definitions can be developed to identify specific behaviors associated with acceptable and unacceptable skills in this area of professional competence. On the basis of these definitions, interaction analysis techniques have been developed for accurate and reliable recording of behavior as it occurs in an interviewing and counseling session. Moreover, the use of actors programmed to portray the roles of patients has enabled the standardization of this evaluation procedure so that examinees can be assessed on the basis of equivalent testing conditions. A number of research studies are under way to determine whether paper-and-pencil, as well as audiovisual, simulations can be substituted for evaluation in a live, interactive setting. However, little has yet been done to identify appropriate procedures for establishing standards of proficiency. Perhaps such efforts will be more feasible when appropriate evaluation techniques are more fully developed. Of relevance in determining whether the evaluation of counseling and interviewing skills is pertinent to dietetics are questions such as: How frequently do dietitians interact with patients? In what settings and for what purposes do these interactions take place? What impact do dietitian-patient interactions have on the quality of the health care provided?     

A Comparison of Self-Reported Health Education Competencies Among Selected School Health Educators In the United States and Taiwan, R.O.C

Results from a preliminary, cross-national study examining perceived competence of school health educators in Taiwan, R.O.C., and in Florida are reported. The study used the Self-Assessment for the Health Educator instrument, developed by the National Task Force on the Preparation and Practice of Health Educators, Inc., which specifies 79 skills in seven competency areas. School health educators from Taiwan and Florida rated their own perceived competence regarding each skill, and assessed the perceived usefulness of each skill in health education practice. Responses from the two groups were similar on six of seven competency areas regarding usefulness of the items. Yet, teachers from Taiwan expressed greater perceived competence than the Florida teachers in five of seven areas. However, within both groups, teachers rated perceived usefulness higher than their own perceived level of competence. Inservice training, amount of formal training, and years of professional experience affected levels of perceived confidence in both groups. Initial results suggest the self-assessment instrument may prove useful as a tool for examining professional competence in other countries, but more extensive research is needed to determine the instrument's applicability in cross-national comparisons.     

Identity gaps and level of depression among Korean immigrants

Identity gaps are a new theoretical construct that provide a framework for integrating communication into the study of identity and understanding the relationship between identity and health outcomes, such as depression. Derived from the communication theory of identity, identity gaps emerge when elements of identity are inconsistent with each other. This article focuses on 2 types of identity gaps, personal-enacted and personal-relational, examining their relationships with situational variables and depression. A questionnaire was administered to a community sample of 377 Korean immigrants to test a hypothesized path model predicting that 3 situational variables (intercultural communication competence, middleperson status, and perception of racial hierarchy) would influence the identity gaps that, in turn, influence Korean immigrants' levels of depression. Results showed that all 3 situational variables predicted Korean immigrants' personal-relational identity gaps, whereas only intercultural communication competence predicted their personal-enacted identity gaps. Both types of identity gaps predicted the level of depression. The personal-relational identity gap significantly mediated the effects of all 3 situational variables on levels of depression. However, the personal-enacted identity gap mediated only the effects of intercultural communication competence on the levels of depression.     

Professional identities and interprofessional relations: evaluation of collaborative community schemes

Despite the widespread support for integrated community care in the U.K., interdisciplinary working between health and social service staff remains complex and tentative. This paper represents the findings of an evaluative research study of two collaborative community nursing schemes at differing stages of project development within West Yorkshire, England. The studies set out to explore in depth the ways social and health care professionals construe their identity and relationships within the changing context of collaborative projects. The research adopted a constructivist phenomenological approach, conducting focus groups with social workers and district nurses; supplemented by in-depth individual interviews. Using template analysis enabled the researchers to explore themes and issues generated from the groups and individuals. A number of areas associated with professional identity and the development of roles in response to changing situations were identified as pertinent including; role ambiguity, role erosion and extension. In cases where joint working required a reconstructing of professional identity, individuals were constrained by their personal meanings, organizational arrangements and public perceptions. Implications for research and practice are discussed.     

Cultural differences in conceptual models of depression

Members of ethnic minority groups are less likely than white middle class people to seek professional treatment for depression and other mental health problems. One explanation is that the former conceptualize depressive symptoms as social problems or emotional reactions to situations, while the latter are more apt to view depression as a disease requiring professional treatment. Though considerable evidence supports this hypothesis, it is rarely explored directly through cross-cultural comparisons. The present study compares conceptual models of depressive symptoms in two diverse cultural groups in New York City (USA): 36 South Asian (SA) immigrants and 37 European Americans (EA) were presented with a vignette describing depressive symptoms and participated in a semi-structured interview designed to elicit representational models of the symptoms. Results indicate pervasive differences in representational models across the two groups. SA participants identified the "problem" in the vignette in largely social and moral terms. Suggestions for management and health seeking in this group emphasized self-management and lay referral strategies. EAs, by contrast, often proposed alternate, sometimes contradictory, explanatory models for the depressive symptoms. One model emphasized biological explanations ranging from "hormonal imbalance" to "neurological problem." The second model resembled the "situational stress" or "life problem" model described by SAs. The implications of these findings, and directions for future research, are discussed.     

An exploration of the applicability of situational segmentation in the health care market: development of a situational taxonomy

Competition in the health care market has intensified in recent years. Health care providers are increasingly adopting innovative marketing techniques to secure their positions in the marketplace. This paper examines an innovative marketing technique, situational segmentation, and assesses its applicability to the health care market. Situational segmentation has proven useful in many consumer goods markets but has received little attention in the context of health care marketing. A two-stage research process is used to develop a taxonomy of situational factors pertinent to health care choice. In stage one, focus group interviews are used to gather information which is instrumental to questionnaire development. In stage two, the responses of 151 subjects to a 51 item questionnaire are factor analyzed. The results demonstrate that situational segmentation is a viable strategy in the health care market.     

An Exploration of the Applicability of Situational Segmentation in the Health Care Market

Competition in the health care market has intensified in recent years. Health care providers are increasingly adopting innovative marketing techniques to secure their positions in the marketplace. This paper examines an innovative marketing technique, situational segmentation, and assesses its applicability to the health care market. Situational segmentation has proven useful in many consumer goods markets but has received little attention in the context of health care marketing. A two-stage research process is used to develop a taxonomy of situational factors pertinent to health care choice. In stage one, focus group interviews are used to gather information which is instrumental to questionnaire development. In stage two, the responses of 151 subjects to a 51 item questionnaire are factor analyzed. The results demonstrate that situational segmentation is a viable strategy in the health care market.     

Professional participation in organizational decision making: Physicians in HMOs

Although it has been suggested that participation by physicians in administrative and policy decisions is linked to outcomes in health care organizations, there is little research on this subject. Using Shortell's framework this paper considers relationships between perceived participation and three intermediate organizational outcomes: physician work satisfaction, perceived staff consensus about day-to-day activities, and attitudes toward patients. Also considered are situational, professional, and personal characteristics which may be related to participation. Data were collected from four staff model health maintenance organizations (HMOs) in 1978 and 1979 through physician questionnaires, administrator interviews, and documents. Physicians who reported greater participation were more satisfied with work, perceived greater staff consensus, and had more favorable attitudes toward patients. Greater participation was associated with full-time employment status and more years in the HMO (but not with the physicians' professional or personal characteristics). Implications of these findings are discussed, and it is proposed that the findings suggest mechanisms by which participation in organizational decision making may affect ultimate outcomes of the organization.