Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed June 30, 2007). Includes bibliographical references (p. 86-90).

Globally there has been a reported increase in consumerism as a main driver of de-professionalization in the practice of medicine with a corresponding increase in cases of self-reported breaches of professionalism and ethical misconduct by students. This trend has necessitated a renewed focus on the experiences of professionalism among students in health care practice. Aim: The aim was to assess the Bachelor of Clinical Medical Practice (BCMP) students’ experiences and perceptions of professionalism during clinical rotations with a view to making recommendations designed to enhance congruency between the teaching and practice of professionalism as exhibited during clinical rotations. Methods: Following five-week attachments at purposefully selected clinical departments in designated District Education Campuses (DECs), final-year BCMP students were asked to reflect on Hatem’s definition of professionalism. Students reflected on their time in three of the five rotations, namely: Paediatrics (Paeds), Emergency Medicine (EM) and Adult in-Patient wards (AIPW). The research involved a collective case study of the three settings and took the form of a retrospective, descriptive, analytical and review-based design of 71 student portfolios. Qualitative methods were used to assess in the first instance the BCMP students’ ability to reflect critically and independently on moral and ethical issues (personal attributes). Secondly, quantitative elements were incorporated to evaluate the students’ ability to reflect on the core values of professionalism (contextual attributes) as determined by the Health Professions Council of South Africa. Results: With regards to personal attributes, the majority of BCMP students (n=54) reflected on the determinants of accountable and responsible practice. As they encountered a range of ethical issues/challenges, the most critical finding was the internalization of the Oath directly linked to students showing empathy to their patients. Many of the students (n=51) were motivated to exhibit model behaviour, and recognised the value of constant reflection as a skill. Just over a third of the students (n=25) reflected on feeling like “guinea pigs” going through a period of uncertainty to becoming “teachable learners” who accepted the responsibility of becoming future role models as members of their profession. Because of the shortage of health care workers and an increasing burden of disease, the BCMP students felt pressured into “pushing the line”. Professionalism with regard to contextual attributes was presented as positive experiences (53.8%) with the BCMP students developing a good work ethic as they were mentored, observed role modelling and functioned as part of a team. Comparatively, negative experiences of professionalism (46.2%) were context-specific as students had to navigate parents’ or family interests; as well as traditional and cultural practices. The unprofessional behaviour of a few individuals resulted in access to health care being compromised, inadequate or in extreme cases denied, with student learning compromised. Conclusions: Portfolios provided a medium through which the voices of the BCMP students could be heard. The internalization of the Oath could possibly be attributed to an integrated curriculum and early exposure to the clinical training environment. Students were drawn to health care workers who embodied a good work ethic and expressed a desire to emulate such behaviours. The role of clinical teachers is critical in graduating a morally competent, ethically reflective and professional health care worker.

Thesis (M.S.)--University of Wisconsin--Madison, 1987. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 61-65).

O autor realizou um levantamento sobre as condições do exercício da Odontologia, na cidade de Manaus AM, entre 175 cirurgiões-dentistas, residentes no município de Manaus, inscritos no Conselho Regional de Odontologia Seção do Amazonas, e com clínica particular que compõem o setor privado não organizado de prestação de assistência odontológica. O método adotado foi a utilização de um formulário, preenchido pelos profissionais em atividade em Manaus, em julho de 1984, tomando-se como base as atividades realizadas na última semana, considerando-se última semana aquela em que o profissional não se afastou nenhum dia do consultório, isto é, trabalhou todos os dias da semana. Os dados obtidos foram tabulados e analisados, tendo sido pos sível, pelos resultados, conhecer os aspectos pessoais, familiares, educativos, profissionais e econômicos dos profissionais investigados. / The author has carried out a survey on the conditions presented by the practice of dentistry in Amazonas city, State of Amazonas, Brazil, among 175 dentists living in Manaus-AM, enrolled at the Regional Council of Odontology - Amazonas sector -, as well as those having private clinics, the latter comprising the non-organized private sector of the dental profession. It has been used the form methodology, being the forms filled in by the professionals who were in activity in Manaus-AM, in july 1984, taking as a basis the activities carried out on the last week, being the last week that in which the professional was not absent from his office, that is, he worked all weekdays through. Data collected were computed and analysed what made possible the knowledge of the personal, family, educational, professional and, economical aspects of the professionals under research.

This thesis seeks to elaborate the inner qualities of integrity and presence in professional practice. It is offered as a contribution to the growing body of literature that shifts the emphasis in professional development from the transfer of skills and knowledge to the transformation of practice. Professional education has been viewed as the acquisition of the knowledge and skills required to address the presenting problems of daily practice. It has been assumed that the answers to these problems can be identified, codified and passed on to others, resulting in a kind of professionalism by protocol. But, as Dreyfus & Dreyfus (2005) have pointed out, there is a qualitative shift in the practice of experts when compared to novices and beginners. The expert evidences a deliberative skill that does not rely on the application of protocols but on extensive case by case experience. Indeed professionalism may be understood as the quality of practice that is evident at the very moment when protocols no longer apply (Coles 2002).Professional practice is not a simple concept as Kemmis (2006) has shown. The thesis contributes to this field by suggesting that professionalism is acquired through prolonged inquiry into the contingencies of quotidian practice and that this shapes the inner qualities the practitioner brings to their practice. It is offered as a first person inquiry (Reason 2001) that probes fractals of my own professional practice over a five year period. In telling my personal story, I give an account of an emergent methodology that engages with action research and narrative inquiry. A narrative mode of knowing (Bruner 1986) notices the complex, many sided and sometimes conflicting stories of professional life resulting, not in a set of propositional claims, but in an account that provides the reader with the imaginal space to enter the process and participate, with me, in making sense of professional practice.

O autor realizou um levantamento sobre as condições do exercício da Odontologia, na cidade de Manaus AM, entre 175 cirurgiões-dentistas, residentes no município de Manaus, inscritos no Conselho Regional de Odontologia Seção do Amazonas, e com clínica particular que compõem o setor privado não organizado de prestação de assistência odontológica. O método adotado foi a utilização de um formulário, preenchido pelos profissionais em atividade em Manaus, em julho de 1984, tomando-se como base as atividades realizadas na última semana, considerando-se última semana aquela em que o profissional não se afastou nenhum dia do consultório, isto é, trabalhou todos os dias da semana. Os dados obtidos foram tabulados e analisados, tendo sido pos sível, pelos resultados, conhecer os aspectos pessoais, familiares, educativos, profissionais e econômicos dos profissionais investigados. / The author has carried out a survey on the conditions presented by the practice of dentistry in Amazonas city, State of Amazonas, Brazil, among 175 dentists living in Manaus-AM, enrolled at the Regional Council of Odontology - Amazonas sector -, as well as those having private clinics, the latter comprising the non-organized private sector of the dental profession. It has been used the form methodology, being the forms filled in by the professionals who were in activity in Manaus-AM, in july 1984, taking as a basis the activities carried out on the last week, being the last week that in which the professional was not absent from his office, that is, he worked all weekdays through. Data collected were computed and analysed what made possible the knowledge of the personal, family, educational, professional and, economical aspects of the professionals under research.

Academic interest in the professional practice of sport psychology has meant a proliferation in models, theories, and guides to successful service provision, from gaining entry into practice to the evaluation and/or termination of service. However, there is an absence of research that examines the stage before practice can begin, and in particular, the formal employment interview. In order to address this gap in the literature, this thesis developed an understanding of the skills necessary to navigate the employment interview as a sport psychology consultant (SPC). The first study identified the features of experience that influenced gatekeepers to sport psychology s previous hiring decisions (study one). Assuming an interpretative phenomenological approach, data were collected through interviews with seven gatekeepers in positions directly responsible for hiring SPCs within United Kingdom elite sport organisations. The participants experiences were interpreted to be influenced by four key features of the sport psychologists; (a) consultant affability, (b) consultant confidence versus arrogance, (c) consultant collaboration, and (d) presentation of consultant competencies. These features of experience were then used to create two short video vignettes simulating the employment interview between gatekeeper and practitioner (study two). Utilising these vignettes to stimulate discussion, Trainee Sport Psychologists were interviewed (n=31) concerning their ability to identify interview skills, their perception of their own skills, the sources of such skills and how they could be developed. Findings revealed that despite possessing desirable levels of both affability and collaboration skills, participants reported low levels of confidence in sport psychology and the ability to present their competencies. Parent and peer attachment, educational background and specific experiential features were proposed as sources of these skills. In an attempt to further examine the potential interactions between these proposed sources of interview skills, currently accredited, practicing Sport Psychologists and those undertaking practical training routes (n=214) were surveyed (study three). The findings of this study indicated that a SPC s peer attachment, educational background, applied experience, and interview experience variably relate to self-perceived levels of consultant affability, confidence in sport psychology, collaboration, and presentation of competencies. However, there was no significant effect observed for parent attachment, as suggested within study two. Together, the studies within this thesis provide the first examination of the features of experience that have influenced historic consumer decisions within the hiring of SPCs, the skills which SPCs should possess in order to gain entry through an employment interview, and the sources from which these skills may be derived.

In the current context of health care, the registered nurses’ perception and enactment of accountability may be constrained by many factors out of their control. The purpose of this research was to examine how registered nurses perceive accountability and translate this to professional practice. A Grounded Theory approach was adopted to explore 11 registered nurses’ understanding and experiences enacting accountability in clinical practice. Data were obtained through semi structured interviews. The theory that emerged provides a detailed portrait of the process of enacting and/or retreating from accountability. The process encompasses 4 stages where the registered nurses: develop personal understanding, then gain professional knowledge, find their way in the complex healthcare system and concludes with becoming professionally confident. The development of the stages exposed a multitude of challenges faced by the registered nurses in fulfilling accountability expectations. Importantly, the registered nurses’ expended significant effort in finding a balance between their individual accountability and the collaborative accountability of the healthcare team and organization which contributed to retreating from accountability. The contextual factors of financial and human resources, institutional culture and healthcare system processes were found to contribute to the registered nurses enacting and/or retreating from accountability. The study findings illustrate the importance of ongoing reflective practice, mentorship and continuing education, all of which have implications for nursing educators and healthcare executives in preparing and supporting registered nurses’ in practice. Further research on the concepts of this theory of accountability is needed to obtain a greater understanding of how the concepts can be operationalized within the context of current healthcare systems.

An aging workforce and stressful work environments are major issues potentially impacting the health, and in particular the cardiovascular health of Canadian hospital nurses. No study, to date, has examined the independent and combined effects between the work environment and indicators of cardiovascular risk among female Canadian nurses. The primary goal of this study was to determine if selected work characteristics influences cardiovascular risk profiles. One hundred and forty four nurses from two hospitals participated in a cross-sectional study. Participants completed a questionnaire containing validated measures of job characteristics as measured by the Job Content Questionnaire and the professional practice work environment as measured by the Nursing Work Index (Revised). Indicators of cardiovascular risk were obtained by anthropometric measures, clinical exam and serum sampling. The prevalence of metabolic syndrome, as classified by the NCEP ATP III Panel, was 7.7 % (n = 11) with 31.9 % having waist circumferences > 88 cm; 22% having a systolic blood pressure ≥ 130 mmHG and 15.2% having a diastolic blood pressure ≥ 80 mmHG. There was no statistically significant association between traditional measures of job strain and cardiovascular risk. In stepwise backward regression analyses, higher age, lower perception of autonomy and higher family income accounted for 22% of the variance in waist circumference (p < .001). Higher age and higher physical job demands accounted for 17% of the variance in systolic blood pressure, and 16% of the variance in diastolic blood pressure. Similar to other female studies, there was no significant relationship between psychosocial job strain characteristics, as measured with traditional job strain measurements, and cardiovascular risk. The findings from this study suggest that female nurses are at risk for cardiovascular disease, and that both physical and organizational characteristics of the work environment influence these associations. One may argue that traditional job strain is not unexpected in nursing practice is perhaps less stressful than dealing with high patient acuity, moral distress and hierarchical healthcare organizations. / Thesis (Master, Nursing) -- Queen's University, 2008-07-14 14:09:00.389

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