Does community‐based experience alter career preference? New evidence from a prospective longitudinal cohort study of undergraduate medical students

CONTEXT: Previous studies have shown that most medical students want a hospital-based career, but the protagonists of community-based teaching predict that increased community exposure within undergraduate curricula will alter subsequent career preferences. OBJECTIVES: To evaluate the impact on career preference and other attitudes of a year with substantial community exposure, compared with a year of hospital-based learning. DESIGN: Questionnaire to student cohort before and after two consecutive levels of the course, one with, and the other prior to, substantial community placement. SETTING: Sheffield Medical School. SUBJECTS: Total of 260 students in the third and fourth year of the MBChB degree. RESULTS: There were significant differences in career preference and attitude to primary care after the year with a community placement, with more students expressing a preference for a community-based career. This was particularly true for women, and less true for non-European students. Conversely, the hospital-based students, especially men, showed a significant change toward hospital-based careers. CONCLUSION: The findings support the hypothetical advantages of shifting medical education to primary care settings, both in encouraging a career in general practice and in the retention of appropriate professional attitudes.     

A success of a genetics educational intervention for nursing and dietetic students: A model for incorporating genetics into nursing and allied health curricula

Allied health care professionals and nurses provide genetic-related client services, such as eliciting family medical history information and discussing the genetic component of health conditions. However, these professionals report a lack of confidence in their ability to perform genetic services and have little formal education in genetics. A barrier to incorporating genetics into allied health curricula includes the limited flexibility to expand curricula. This barrier was addressed by incorporating a Web-based tutorial on basic genetics and a lecture on the genetics of diabetes into preexisting undergraduate nutrition courses for nursing and dietetic students. The vast majority of students enrolled in these required courses participated in the intervention. Most participants agreed that genetics is important to their future career. Following the intervention, students' knowledge of genetics and confidence in their ability to provide genetic-related services increased significantly. Despite the short-term success and positive student evaluations, a single educational intervention does not appear to be sufficient for students to become proficient in performing the recommended genetic competencies for all health care professionals. Recommendations and resources for incorporating genetics into allied health curricula are included.     

NURSING OUTSIDE HOSPITALS: THE WORKING EXPERIENCE OF COMMUNITY NURSES. EDUCATIONAL CHARACTERISTICS AND JOB PERCEPTIONS

The community nursing practice research project reports the results of a mailed questionnaire survey of nurses employed outside hospitals and nursing homes in Victoria in 1985. Two 10 per cent random samples stratified across practice areas were selected from listings of community nurses providing detailed employment information to the Victorian Nursing Council. An 84 per cent response rate was obtained from these listings yielding 689 responses. This paper reports that part of the study relevant to job entry, job satisfaction, job mobility and perceived career options as well as educational preparation. One half of community nurses entered community nursing after five years of hospital experience. The major reasons for choosing employment in community health nursing were its conditions of work, its autonomy and a dissatisfaction with hospital nursing, rather than a specific orientation to community nursing. These can be appreciated in terms of competing demands by the nurse's family life and her sense of growing professional maturity. Job satisfaction was high, with 87 per cent of nurses in the study population being satisfied or very satisfied. Only one quarter considered opportunities for career advancement to exist in their practice area. In the event only one fifth of nurses regarded promotion as important. The high levels of job satisfaction and the low importance attached to promotion are explicable given the nature of female employment and dissatisfaction with hospital nursing. Despite this high level of job satisfaction, one third of nurses believed they would not be nursing in five years time. Less than one third of nurses felt there was adequate opportunity for advancement in their practice area. Fifty per cent of community nurses were aged over 40 (the majority of these are in the maternal and child health and medical clinic groups) and some had the non-nursing educational standards that would be expected given this age composition. Overall 61 per cent of nurses believed that their basic nursing education was an adequate preparation for community nursing at least at a beginning level. However, a perceived need for preparation beyond a beginning level existed given that 83 per cent perceived regular ongoing in-service education to be essential. No more than 29 per cent however supported either a post-basic in-service course, a Diploma in Community Health Nursing, or a Bachelor degree in Applied Science with a major in Community Health Nursing or other college program as being essential. It was considered that the non-academic nature of the educational background of the majority of nurses was the principal reason for these findings. It was concluded that planning for future development in community nursing, especially with regard to the appropriate educational preparation and career structure, should recognise the current experiences and expectations of nurses. These, however, are likely to change with the introduction of college-based nursing. They may also be affected by the current absence of an adequate career structure in most community nursing practice areas.     

Construction of a nursing care concept: contribution for undergraduate nursing education

The purpose of this research was to construct a nursing care concept, based on the understanding of nurses and students from an undergraduate course. This is a qualitative study. A focus group was used to construct a nursing care concept for use in undergraduate teaching. The research was carried out at Faculdade Católica Rainha do Sert?o in Quixadá, CE, Brazil, from August to December 2007. Three categories emerged from the process: the understanding of the care concept, nursing care and the meaning of care. The constructed concept involved attitudes of awareness, ethics, zeal, solidarity and love, which express a "know-how" based on science, art, ethics and esthetics, directed at individual, family and community needs.     

The role of specialist community public health nurses: students' perceptions

The article outlines the initial perceptions of student specialist community public health nurses (SCPHN) (health visitors, school nurses and sexual health advisers) on the role of the qualified health visitor, school nurse and sexual health advisor. It considers how students undertaking the BSc (hons)/Post Graduate Diploma specialist community public health nursing programme conceptualise their future public health role. The paper identifies themes drawn from a class-based teaching session with a large group of SCPHN students using the medium of art and student drawings. This was followed by classroom discussion and a subsequent mapping exercise. Several themes emerged with emphasis on the personal attributes and role of the public health nurse. The paper concludes that SCPHN students have a relevant knowledge base upon which to develop their future public health roles, as well as identifying clear gaps in their knowledge base at the early stage of the SCPHN programme.     

Recruitment and retention strategies for expert nurses in abortion care provision

Objective(s)The purpose of this thematic analysis is to describe recruitment, retention and career development strategies for expert nurses in abortion care provision.Study designThematic analysis influenced by grounded theory methods were used to analyze interviews, which examined cognitive, emotional, and behavioral processes associated with how nurses make decisions about participation in abortion care provision. The purposive sample consisted of 16 nurses, who were interviewed between November 2012 and August 2013, who work (or have worked) with women seeking abortions in abortion clinics, emergency departments, labor and delivery units and post anesthesia care units.ResultsSeveral themes emerged from the broad categories that contribute to successful nurse recruitment, retention, and career development in abortion care provision. All areas were significantly influenced by engagement in leadership activities and professional society membership. The most notable theme specific to recruitment was exposure to abortion through education as a student, or through an employer. Retention is most influenced by flexibility in practice, including: advocating for patients, translating one's skill set, believing that nursing is shared work, and juggling multiple roles. Lastly, providing on the job training opportunities for knowledge and skill advancement best enables career development.Conclusion(s)Clear mechanisms exist to develop expert nurses in abortion care provision.ImplicationsThe findings from our study should encourage employers to provide exposure opportunities, develop activities to recruit and retain nurses, and to support career development in abortion care provision. Additionally, future workforce development efforts should include and engage nursing education institutions and employers to design structured support for this trajectory.     

Kids Into Health Careers: A Rural Initiative

Purpose: To describe a project that introduces middle school and high school students living in Pennsylvania's rural geographic regions to nursing careers through outreach extended to students regardless of gender, ethnicity, or socioeconomic status. Method: The authors employed many strategies to inform students about careers in nursing. The methods included: working with guidance counselors, participating in community health fairs, taking part in school health career fairs, collaborating with Area Health Education Centers, serving on volunteer local education advisory boards, developing a health careers resource guide, and establishing a rural health advisory board. Findings: Developing developmentally appropriate programs may have the potential to pique interest in nursing careers in children of all ages, preschool through high school. Publicity is needed to alert the community of kids into health care career programs. Timing is essential when planning visits to discuss health care professions opportunities with middle and high school students. It is important to increase the number of high school student contacts during the fall months. Targeting high school seniors is particularly important as they begin the college applications process and determine which school will best meet their educational goals. Conclusions: Outcome measures to determine the success of health career programs for students in preschool through high school are needed. Evaluation methods will be continued over the coming years to assess effectiveness.     

Developing public health nursing: barriers perceived by community nurses

OBJECTIVES: To understand the key issues for field nursing in developing their public health role within five primary care trusts (PCTs) in Merseyside, in the North West of England. DESIGN: Qualitative study. METHODS: Fourteen school nurses and 30 health visitors participated in 11 focus groups consisting of others from their profession working within the same PCT, and 24 practitioners responded to a questionnaire. RESULTS: The findings suggest that there are a number of shared obstacles that need to be overcome before the public health approach can be fully developed within community nursing. These include: the need for facilitation to deal with organisational change, lack of clarity around the public health role, inadequate administrative support, general practitioner attachment problems, poor interprofessional partnerships, competing priorities and resistance to change. CONCLUSIONS: The development of public health nursing in England envisaged in current government policy will not occur in full unless the kind of issues identified in this study are adequately addressed. This will require participative, interprofessional approaches to redesigning services by all relevant public health practitioners.     

From being a nurse to becoming a ‘different’ doctor

Using interpretative phenomenological analysis to make meaning of the experiences of three highly qualified registered nurses who had enrolled in an undergraduate medical programme, this study provides insight into their personal journeys of wanting to become ‘different’ doctors. In so doing, they conceptualised their future selves as adding clinical reasoning and diagnostic skills to the patient-centred caring ethic of their nursing practice, becoming a multi-skilled community member or helping to fix the health care culture. By customising their identities, e.g. by splinting (aligning with their stronger nursing identity), by enriching current nursing practice with newly acquired theory as medical students or by patching a perceived deficiency (i.e. patient-centredness) in medicine, they tailored their identities. Their journeys had, however, not been the natural progression they had anticipated, threatened by perceived and/or real intrinsic (e.g. working as nurses whilst studying medicine) and extrinsic (e.g. interprofessional rivalry) factors. Rather than being accepted as legitimate newcomers to the medical profession, the women sometimes felt like intruders. Some nursing colleagues accused them of desertion. In response, they generally withheld their identities as nurses or medical students, compartmentalising their group membership. This study has highlighted the role of personal (e.g. prior experience; agency; resilience; personality) and contextual factors in ‘becoming’ a doctor. A recommendation emerging from this study is the need for interprofessional learning in the medical curriculum to cultivate a health care culture of collaboration rather than competition. Future research is required in terms of how allied health professionals transition to medicine.     

Attractiveness of people‐centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home‐care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people‐centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home‐care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people‐centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home‐care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people‐centred, integrated home care as attractive. Specific aspects that home‐care nurses find attractive are promoting the patient′s self‐reliance and having a network in the community. Hospital nurses are mainly attracted to health‐related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home‐care nurses and a minority of hospital nurses feel attracted to people‐centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home‐care organisations who aim to expand the home‐care nursing workforce.     

Using Polvika's model to create a service-learning partnership

Collaboration can maximize limited resources of universities, school systems, and public health departments by offering learning from experience. Polvika's theoretical model and principles from Community-Campus Partnerships for Health guided development of a service-learning partnership among a university, a county health department, and an alternative school in a large public school district. Of three commonly identified patterns of service-learning, this partnership demonstrated the pattern that equally emphasizes service to a community or agency, and mutual learning by all participants. All organizations in the partnership share a common goal to optimize the health of children in schools, and to provide quality learning for professional students. The partnership is in its fourth year. Formal interagency agreements now exist among all partners. Individuals continue to demonstrate flexibility and mutual awareness of strengths and limitations of respective organizations. Public school students receive more services, many high-risk children achieve better learning outcomes, school nurses offer expanded services in many schools with the help of nursing students, and undergraduate and graduate nursing students gain meaningful learning experiences. Some nursing students state that school nursing has become a career goal. The partnership continues to evolve to meet changing needs of the partners. Members remain satisfied with the collaboration.     

Assessment of HIV transmission risks in clinical situations in health care students from Germany, Lithuania and Namibia

Due to the increasing global HIV prevalence, comprehensive knowledge about clinical HIV transmission risks in health care professionals is essential. Mainly medical and nursing students are at risk, because they are working close to infected patients.By using an anonymous questionnaire, the study analysed the assessments of German medical/dental students (n = 182), Lithuanian medical students (n = 176) and Namibian student nurses (n = 135) on the risk of getting HIV infected in different clinical situations.It became obvious that the Namibian student nurses overestimated the risk of HIV transmission in several situations (eg changing dirty linen, physical examination). In comparison, the Lithuanian students showed the most realistic assessments, while the German students also tended to overestimate the risks of HIV transmission.The results indicate that assessments on the risk of HIV transmission in clinical situations are influenced by the national prevalence and daily contacts with HIV patients. Education of health care students should consider this and focus more on epidemiological aspects and infection control procedures, to avoid endangering students and patients.     

Service learning: a strategy for conducting a health needs assessment of the homeless

An agency providing health care services for homeless persons and a nursing department at a liberal arts college established a service-learning partnership to complete a health needs assessment of homeless persons. Under the guidance of agency staff and a nursing faculty member, seven nursing students surveyed shelter residents (n = 101) in four urban shelters and conducted a focus group to identify residents' perceptions of health, health care needs, and health care service delivery. The service-learning partnership expanded the agency's services by providing research consultation and data collection that resulted in recommendations to improve health care services for the homeless. The agency contributed to the education of health professionals by providing students with a meaningful community service experience.     

Increasing minority representation in the health care professions

Although race is a social construct with no scientific credibility, it is a powerful predictor of diminished health outcomes and health care delivery in the United States. Minorities who enter health professions provide a disproportionate quantity of health care services to minorities, the underserved, and poor. The goal of having a health care delivery system with similar demographics to the population it serves is seriously lacking in most health care professions. The author of this commentary proposes that health care educators should be more aggressive in admitting and recruiting students from minority communities through the use of affirmative action. The recent U.S. Supreme Court ruling, Grutter v. Bollinger, not only supports this approach but also gives guidance for implementation. Under the general category of admission strategies, two strategies are proposed: (1) a defensible structure for admission using race/ethnicity as a factor and (2) expanded criteria for student selection. Under recruitment strategies, four strategies are offered: (1) outreach to kindergarten through 12th grade, (2) better informing school career counselors, (3) advertising possibilities, and (4) community involvement through local school boards. Because affirmative action in admissions is the most controversial and complex set of strategies, this report focuses particularly on this area.     

Trainee health care professionals'' knowledge of the health risks associated with obesity

BACKGROUND: Trainee nurses, doctors and dietitians will direct the future of obesity treatment and prevention. To do so effectively, they must have sufficient knowledge regarding the health risks associated with obesity and feel that part of their professional role is to counsel obese patients regarding these risks. METHODS: An online survey collected data on professional roles, training needs and the Obesity Risk Knowledge-10 (ORK-10) scale from 38 dietetic, 88 nursing (Diploma), 74 nursing (Masters) and 389 medical students. RESULTS: Final-year dietetic students demonstrated higher ORK-10 scale scores than final-year nursing (Dip), nursing (MSc) and medical students (P < 0.001). The majority of students agreed that part of their profession's role was to counsel obese patients about the health risks associated with obesity. Dietetic students were more satisfied with the teaching they had received than each of the other student groups (P < 0.05). CONCLUSION: Future health care professionals recognize their responsibility to communicate health risk information to obese patients. Dietetic students have a sound knowledge base to support them in this. Educators of trainee nurses and doctors may like to respond to their students' lower levels of knowledge and desire for more training.     

加强对实习护生人文关怀在护理管理中的意义

现代医学模式的转变使得人文关怀的重要性更加突出,目前大量人文关怀研究与实验侧重于护士对患者的人文关怀,而护士缺乏人文关怀这一现象未得到足够的重视,特别是实习护生;因此在护理管理过程中加强对实习护生人文关怀能显著提高护理质量,让实习护生在日常护理工作中体现出其最大价值。     

Psychiatric home care of elderly persons with depression: unmet caregiver needs

The purpose of this study was to explore what nursing interventions are currently being provided to family caregivers of elderly persons with depression as a part of standard home health care; and identify unmet needs of these family caregivers. Unmet caregiver needs were examined from both the family caregiver and staff nurse perspective, using caregiver structured interviews and staff focus groups. Ten caregivers participated in structured interviews and nine staff nurses participated in three focus groups. Caregivers reported unmet needs concerning support and respite, dealing with their own feelings, learning more about care-related tasks and role changes, and stress management. Similarly, nurses speculated that nursing interventions should focus on increased counseling, family and community support, assisting caregivers with their learning needs and care-related responsibilities. These findings contribute toward a better understanding of interventions currently provided to caregivers of depressed elderly persons, as a part of standard psychiatric home care; identify unmet caregiver needs; and suggest areas for future psychiatric research in home care settings.     

What impact will an increased number of teaching general practices have on patients,doctors and medical students?

BACKGROUND: Recommendations for medical training have seen a growing drive for undergraduate teaching to take place within the community - primarily in the general practice surgery. In light of the ongoing expansion of medical student numbers, many more general practices will be required to participate in undergraduate teaching. AIM: To explore the perceptions of primary care staff on the impact that increasing student numbers will have on them, on their patients and on the students themselves. DESIGN OF STUDY: Semi-structured interviews. SETTING: Three general practices presently involved in undergraduate teaching, 3 practices about to become involved in undergraduate teaching and 1 non-teaching practice, all in the Black Country area of the West Midlands. METHODS: Semi-structured interviews with prearranged prompts were undertaken with a variety of practice staff including general practitioners (GPs), practice managers and practice nurses, as well as administrative and reception staff. RESULTS: Eleven GPs, 6 practice managers, 4 practice nurses and 6 receptionists/administrators took part in the interviews. Three main themes emerged relating to the effects on students and reflecting attitudes towards the Black Country, the experience of working among deprived populations and issues around access to the new training locations. The majority of interviewees were of the opinion that patients both enjoy taking part in undergraduate teaching and are able to benefit from the process. Positive impacts on practice infrastructure were also elicited, but when asked about the resource implications for the practice of undergraduate teaching, there was a dichotomy of opinion. CONCLUSION: For many practices, involvement in undergraduate teaching is a double-edged sword.