Medical specialization,profession, and mediating beliefs that predict stated likelihood of alcohol screening and brief intervention: Targeting educational interventions

Practitioner‐level educational approaches that promote screening and brief intervention (SBI) seldom consider providers' profession and medical specialization. Strategies that consider these variables may be better equipped to affect change in beliefs and behavior. The aim of this study was to identify beliefs that predict stated likelihood of practicing SBI by specialty and health profession in order to guide the direction of educational strategies. Physicians and nurse practitioners were studied that specialized in family, internal, obstetric gynecology (ObGyn), and pediatric medicine. The results indicated that independent of amount of previous postgraduate alcohol education and knowledge, self‐rated competence mediated between specialty and likelihood of practicing SBI. For instance, low self‐rated competence for ObGyn was a barrier that suppressed likelihood of practicing SBI. Other findings were that role legitimacy mediated the association between profession and likelihood of SBI, so that lack of role legitimacy was a barrier for physicians but not for nurse practitioners. We suggest that targeted educational strategies for ObGyn and pediatric clinicians may prove more effective than the prevalent one‐size‐fits all approaches aimed at general adult populations.     

Pharmacy competencies: their relative importance to consumers, practitioners, educators, and students

The pharmacy profession increasingly is involved in developing and maintaining competency standards as objective criteria in evaluating the educational process and in judging practitioners' continuing competence. This study compared the rankings of various pharmacy competencies among diverse populations, specifically, consumers, practicing pharmacists, pharmacy educators, and pharmacy students. The competencies were assessed through a questionnaire which required the respondents to rank 17 competency labels in order of importance. The questionnaire was completed by 104 metropolitan residents and additional samples included 450 practitioners, 39 pharmacy educators, and 217 pharmacy students. Interesting differences appear between the rankings of the competencies among the consumers, practitioners, faculty, and students. Results indicate that consumers highly ranked the traditional roles of the pharmacist as a drug distributor. Faculty tend to rank highly the clinical roles of the pharmacist. The highest rank correlations on pairs occurred between students and faculty (0.89) and between pharmacists and consumers (0.89). The lowest rank correlation occurred between faculty and consumers (0.64).     

How nurse practitioners obtained provider status: lessons for pharmacists.

The history of nurse practitioners, their efforts to achieve provider status, and lessons learned from their activism are discussed. The nurse practitioner profession arose out of a need to meet a rising demand for primary care services, especially in rural areas. Some nurses and physicians vehemently opposed the nurse practitioner model, but studies documented the value of nurse practitioner services, and the utilization of these practitioners continued to grow. Compensation was provided via salary or per-member-per-month agreements. Nurse practitioners recognized that direct federal reimbursement (provider status) was needed to recognize them as independent health care providers and assign specific monetary values to their services, so they undertook an aggressive lobbying campaign. Contacts on Capitol Hill were exploited, and nursing organizations encouraged nurse practitioners to get involved in grass-roots activism. Nurse practitioners discussed their patients during meetings with their representatives in Congress, and legislators were invited to make site visits. In 1993, the American College of Nurse Practitioners was formed to unite the profession and move the campaign forward. Ultimately, the Balanced Budget Act of 1997 granted nurse practitioners provider status and authorized them to bill Medicare directly for services furnished in any setting. The key strategies that contributed to this victory were (1) gaining recognition that nursing had the potential to expand its role, (2) documenting nurse practitioners' value, (3) establishing standards in education and credentialing, (4) using professional organizations to empower individuals, and (5) being willing to accept small, incremental gains over time. The experience of nurse practitioners in obtaining Medicare provider status offers valuable lessons for pharmacists as they pursue the same goal.     

Pharmacists’ Expectations for Entry-level Practitioner Competency

Objective. To determine if defined subgroups of pharmacists’ have variability in their expectations for competency of entry-level practitioners.Methods. Rating scale data collected from the 2009 National Pharmacy Practice Survey were analyzed to determine to what extent pharmacists'' degree, practice setting, and experience as a preceptor were associated with the ratings they assigned to 43 competency statements for entry-level practitioners. The competency statements determine the content on the North American Pharmacist Licensure Examination (NAPLEX).Results. Pharmacists with a doctor of pharmacy (PharmD) degree rated the co mpetency statements higher in terms of criticality to entry-level practice than did those with a bachelor of science (BS) degree (p< 0.05). Pharmacists working in inpatient settings gave slightly higher ratings to the competency statements than did pharmacists working in outpatient settings, pharmacists without direct patient care responsibilities, and those in academia. However, there were no significant differences among practitioner subgroups'' criticality ratings with regard to practice setting. Preceptor pharmacists'' criticality ratings of the competency statements were not significantly different from those of non-preceptor practitioners. Conclusion. Pharmacists exhibited a fair amount of agreement in their expectations for the competence of entry-level practitioners independent of their practice sites and professional roles. As the pharmacy profession embraces patient-centered clinical practice, evaluating practicing pharmacists’ expectations for entry-level practitioners will provide useful information to the practitioners and academicians involved in training future pharmacists. Stakeholders in pharmacy education and regulation have vested interests in the alignment of the education of future practitioners with the needs of the profession.     

岗位胜任力培训对提高新执业护士综合能力的影响

目的分析能力教育培训对提高新执业护士综合能力的影响。方法 2009年7月后分配到医院的新执业护士230名,均采用＂模块化、阶段化、分级管理＂的培训模式进行理论与操作培训,培训结束后进行考核及问卷调查。结果培训后,新执业护士理论知识、技能操作及综合能力评分均高于培训前,新执业护士对培训的需求度及患者满意度均高于培训前,工作中差错发生率均低于培训前,差异均有统计学意义（P〈0.05）。结论通过能力教育培训,全面提高了新执业护士的综合能力,提高了护理质量,为护理人员的规范化培训提供了参考。     

Recommendations for Aligning PGY2 Pharmacy Residency Training and Pharmacy Specialist Board Certification

With the increased focus and anticipated growth in specialty training and certification within the profession of pharmacy, it is important for the profession to step back and evaluate the manner in which its adopted education and certification systems interface. As a result of specialty practice development, significant growth is occurring in both postgraduate year two (PGY2) pharmacy residency programs and individuals seeking certification by the Board of Pharmacy Specialties. As the profession continues to evolve its specialty training and credentialing systems, it is important to consider the inherent relationship between these systems. This paper considers the current landscape of specialty training and certification, including issues related to the quality of PGY2 training, consistent application of standards across and within PGY2 programs, credentialing of preceptors and program directors, and alignment of training with specialty certification examination content domains. We outline recommendations across three areas: (1) creating consistency between specialty training and certification, (2) aligning qualifications of PGY2 residency program directors and preceptors with the designated specialty area, and (3) assessing program quality in the context of the expectations of specialists established by the profession. The goal of this paper is to stimulate professional dialogue on these issues. Establishing both formal and informal connections between specialty training and certification can serve as the foundation for a rational approach to professional development and the credentialing that will be recognized by stakeholders outside the pharmacy profession. Establishing these connections will also support and advance the profession's mission of meeting the medication needs of patients.     

Team work and collaborative practice agreements among pharmacists and nurse practitioners

Objectives

The authors share their knowledge about partnering and establishing collaborative practice agreements with nurse practitioners. State laws and regulations were reviewed that affect pharmacists' ability to fully partner with nurse practitioners.

Commitments for the future of pharmacy: a review and opinion of the Pharm.D. curricular debate

For over 30 years, the content and form of the pharmacy curriculum and the title of the degree to be awarded have been subjects of controversy among pharmacy educators and practitioners. Scores of articles have been written about a universal Pharm .D. degree, all of which present different angles and opinions. Those who favor a universal Pharm .D. desire an improved image for the profession, greater employment opportunities, preparation for future pharmacy roles, the elimination of the multi- tiered structure, and decreasing costs for services. Those who oppose the entry-level Pharm .D. degree stress a need for multiple levels of education to meet the varying demands of practice, emphasize the oversaturation of the job market and increased costs to schools to adopt the new curriculum, and protest bestowing a doctoral title for reasons of self-esteem. The authors of this article consider it timely to present and evaluate these arguments, to provide the reader with a comprehensive review of the debate, and to call for unity within the profession as it considers the future educational needs of pharmacy practitioners.     

Research--the cornerstone of pharmacy practice. Harvey A.K. Whitney lecture

Hospital pharmacy's need for a new commitment to research and the attendant sharing of responsibilities between pharmacy educators and pharmacy practitioners are described. Guided by the same philosophy of professional service that motivated early hospital pharmacists, individual pharmacists should work within their differentiated roles to advance the profession as a whole. For this advancement, research to acquire new knowledge and develop and evaluate new services is required. Research enhances the prestige and societal support of a profession. Pharmacists with differentiated skills and practice areas must support each other to advance the profession, particularly because of limited financial resources in both education and practice settings. Universities, including schools of pharmacy, have a responsibility for research as well as for the transmission of knowledge, and pharmacy faculty members should conduct research that supports the advancement of practice. To support research by faculty members, pharmacy practitioners can assume greater teaching responsibility. Schools of pharmacy and practicing pharmacists can work together to support research that will benefit the whole profession and society. Pharmacy practice faculty members who maintain a practice base and are involved in research have a critical role in this cooperative effort.     

Proposed Revision to the Existing Specialty and Specialist Certification Framework for Pharmacy Practitioners

Consistent with the American College of Clinical Pharmacy's vision that future clinical pharmacy practitioners who provide direct patient care should be board-certified specialists, a new framework for pharmacist specialty board certification is proposed. This White Paper describes the current and projected needs of the pharmacy profession regarding board certification, provides a rationale for the new framework, and discusses the potential ramifications of changes in the current board-certification process.     

How and when health-care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: a qualitative study

Introduction. Indigenous Australians experience a disproportionately high burden of alcohol‐related harm. Alcohol screening and brief intervention (SBI) offers the potential to reduce this harm if barriers to its delivery in Aboriginal Community Controlled Health Services (ACCHSs) can be optimally targeted. Aims. Examine health‐care practitioners' perceptions of, and practices in, alcohol SBI in ACCHSs. Methods. Semi‐structured group interviews with 37 purposively selected health staff across five ACCHSs. Results. Alcohol screening independent of standard health assessments was generally selective. The provision of brief intervention was dependent upon factors related to the patient. Four key factors underlying health‐care practitioners' perceptions of alcohol SBI were prominent: outcome expectancy; role congruence; utilisation of clinical systems and processes; and options for alcohol referral. Discussion. The influence of outcome expectancy and role congruence on health‐care practitioners' alcohol SBI practices has been identified previously, as has to a lesser extent, their less than optimal use of clinical systems and processes. The influence of options for alcohol referral on health‐care practitioners' willingness to deliver alcohol SBI primarily related to their misunderstanding of alcohol SBI and the lack of culturally appropriate alcohol referral options for their patients. Conclusion. An intervention combining interactive, supportive and reinforcing evidence‐based dissemination strategies is most likely required to enhance health‐care practitioners' knowledge and skills in alcohol SBI delivery, positively orientate them to their role in its delivery, and facilitate integration of evidence‐based alcohol SBI into routine clinical processes and locally available systems.[Clifford A, Shakeshaft A, Deans C. How and when health‐care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: A qualitative study. Drug Alcohol Rev 2012;31:13–19]     

Substance-Using Health Professionals: Similarities of Substance Use between Medical and Nursing Specialties

This paper reviews and compares alcohol and other drug involvement findings in two professions, medicine and nursing, by specialty. Health care providers are naturally subgrouped by specialty, as this is a major work environment factor. The evidence indicates an association exists between practicing in certain medical or nursing specialties and substance use. In addition, similarities in specialty membership and substance use across medicine and nursing suggests there may be common risk factors related to substance use that could be addressed using interdisciplinary approaches.     

Similarities of substance use between medical and nursing specialties

This paper reviews and compares alcohol and other drug involvement findings in two professions, medicine and nursing, by specialty. Health care providers are naturally subgrouped by specialty, as this is a major work environment factor. The evidence indicates an association exists between practicing in certain medical or nursing specialties and substance use. In addition, similarities in specialty membership and substance use across medicine and nursing suggests there may be common risk factors related to substance use that could be addressed using interdisciplinary approaches.     

Non-medical prescribers and pharmacovigilance: participation, competence and future needs

Objective To determine UK non-medical prescribers’ (NMPs) (supplementary or independent) current participation and self-reported competence in pharmacovigilance, and their perceptions of training and future needs. Setting Non-medical prescribers in health care in the United Kingdom. Awareness of and participation in the Yellow Card Scheme (YCS); attitudes towards ADR reporting; strategies to encourage reporting; pharmacovigilance training; and demographics. The sample comprised nurse (n = 912) and pharmacist (n = 2,439) NMPs in the UK. Main outcome measures Self-reported competence in pharmacovigilance, knowledge of and participation in the YCS, attitudes towards ADR reporting; strategies to encourage ADR reporting; pharmacovigilance training during NMP training. Results Six hundred and thirteen responses were received giving an overall response rate of 20.4 %. Response rates for nurse and pharmacist prescribers were 32.2 % (n = 293) and 13.1 % (n = 320) respectively. Three hundred and fifty-nine respondents (58.6 %) had submitted a Yellow Card. Although the majority of respondents (70.4 %) felt competent in pharmacovigilance, a third (34.2 %) said they needed further training. Respondents reported a positive attitude towards ADR reporting, yet only a minority (22.9 %) correctly answered factual questions about the YCS. Approximately a third of respondents (35.6 %) “couldn’t remember” if pharmacovigilance was covered in their prescribing training. Publicity and education were commonly suggested measures to enhance contribution to the YCS. Conclusion While NMPs report participation and competence in ADR reporting, there are several key issues to consider including the need for further training and support to optimise their role in pharmacovigilance.     

Recommendations for Training and Certification for Pharmacists Practicing,Mentoring, and Educating in Infectious Diseases Pharmacotherapy

Recently created guidelines for the development of institutional antimicrobial stewardship programs recommend that a pharmacist with infectious diseases training be included as a core member of the antimicrobial stewardship team. However, training and certification requirements for infectious diseases-trained clinical pharmacists have not been established. Although pharmacists have nurtured their interest in infectious diseases by self-directed learning or on-the-job experiences, this mode of training is not considered feasible or sufficient for reliable training of future clinical specialists in infectious diseases. This document, therefore, is forward looking and provides overarching recommendations for future training and certification of pharmacists practicing, mentoring, and educating in infectious diseases pharmacotherapy, with the recognition that full implementation may take several years. We recommend that future pharmacists wishing to obtain a clinical position as an infectious diseases-trained pharmacist should complete a postgraduate year (PGY) 1 residency and a PGY2 residency in infectious diseases, that practitioners become board-certified pharmacotherapy specialists, that a certification examination in infectious diseases be developed, that practitioners maintain a portfolio of educational experiences to maintain qualifications, that current nonaccredited training programs seek accreditation, and that employers and academicians recognize the desirability of these qualifications in hiring decisions.     

急救人员职业暴露的风险及干预策略

目的分析急救人员职业暴露危险因素,提高其防护意识。方法通过分析急救人员所面临的各种职业暴露危险因素,包括HIV、HBV、HCV等病原体,发现并制定有效的干预策略。结果急救人员对职业暴露高度重视,通过执行有效的预防措施,急救人员职业暴露明显减少。结论准确地评估和切实可行的干预策略是减少职业暴露的关键。     

小儿泌尿外科实行专科护士管理效果评价

目的 评价泌尿外科实行专科护士管理的效果.方法 将全科护士分为3个专科组,并经常进行培训学习,由专科护士实施专科护理.结果 医患满意度显著提高,护理质量明显提高.结论 实行专科护士管理有利于培养高度专业化和一专多能的现代专科护士,提高临床护理工作质量和效率.     

Considerations and controversies of pharmacologic management of the pediatric kidney transplant recipient

Pediatric kidney transplantation has experienced considerable growth and improvement in patient and allograft outcomes over the past 20 years, in part due to advancements in immunosuppressive regimens and management. Despite this progress, care for this unique population can be challenging due to limited pediatric transplant data and trials, intricacies related to differences in children and adolescents compared with their adult counterparts, and limitations to long-term survival facing all solid organ transplant populations. Immunosuppression and infection prevention practices vary from one pediatric transplant center to another and clinical controversies exist surrounding treatment and dosing. This review aims to summarize key aspects of pharmacologic management in this population and present pertinent data that describe the influence of practice to serve as a resource for practitioners caring for this unique specialty patient population. Additionally, this review highlights select controversies that exist within pediatric kidney transplantation.