PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. Professional Standards: How To Stay Current in This Fast-Paced Health Care Environment by Barbara Acello, M.S., RN A profession is an occupation or career, such as law, medicine, or engineering, that requires considerable training and specialized study. The term professional is an adjective that describes individuals who are engaged in certain activities or careers, such as lawyers, doctors, nurses, and other professional people. Individuals who conform to the standards of a profession exhibit professional behavior. The term professional can also be used as a noun. In this context, it means an individual who earns a living in a given or implied occupation. This individual is considered a skilled practitioner or expert. All professions have standards and practices for their members. The “standard of care” is the degree of care or competence that one is expected to exercise in a particular circumstance or role. The standard of care is what the reasonable, prudent professional would do based on their education, experience, institutional policies and procedures, standards set by their professional organization(s), textbooks, research, and professional literature. The standard of care is not what the best professional in the field would do, but rather what any reasonable professional would do in the same or similar circumstances. Technology and practices change rapidly in health care. Research and evidence-based practices supersede agency policies and procedures if those policies are outdated. If a professional holds certifications and advanced education, he or she is held to the same standard as other professional individuals with like qualifications. Negligence is failure to exercise the degree of care considered reasonable under the circumstances, resulting in an unintended injury to another party. In other words, failure to meet the standard of care for the profession. Malpractice constitutes mistakes or negligent conduct by a professional that results in damage or harm to others. To complicate matters, the care of each patient involves numerous standards of care. No single standard encompasses all professionals caring for the individual. Many standards apply to each profession and each situation. Since I am not an attorney, I will stop the definitions here. Rather than trying to give you legal advice, I will emphasize the importance of adhering to professional standards of practice or standards of care. Deviating from accepted standards of care is risky business, both for the patient and the health professional. This is an area in which your knowledge must constantly be updated, particularly if you work in an area of health care that relies heavily upon technology. (And most health care professionals do work with advanced technology). Today’s healthcare system is weighed down by excess paper, including documents generated by mail, and those created by photocopying, and fax. Electronic technology is beginning to replace paper systems, improving communication and enhancing its effectiveness, as well as making it more cost effective. Published standards of practice (standards) come from many different sources, as noted above. But one important source has been omitted from the list. Many professionals do not have the most current textbooks in their field, nor do they have time to read them. Likewise, they may subscribe to professional journals, but not read them from cover to cover each month. As health care professionals, we all have a broad knowledge of many subjects. We have specific, specialized knowledge in our selected areas of expertise and practice. But knowing all we need to know about every subject is impossible. For the most part, our generalized knowledge sustains us, but there are times when we must learn more about applicable, current standards in subjects outside our specialty area. Aside from that, there are times when you will need to research standards, even if you know them cold. Some of the simplest ones may be the most difficult to find, and you may need to be somewhat resourceful. The missing source of information noted above is the Internet. Literally thousands of standards can be accessed online, quickly and painlessly, without ever leaving your home or office. Technology that didn’t seem possible five years ago is possible now. Millions of healthcare professionals throughout the world are actively using the Internet. In 1989, Lindeman published an article in Communicating Nursing Research , listing hypothetical challenges for nursing researchers at the end of the century and the beginning of the new millennium. Her ideas seemed farfetched at the time. Although not a complete listing, it is interesting to see that most of the author’s predictions have come true: • If researchers take longer than 2-3 years to complete a study, the information will be obsolete when it is published. • A national database will contain licensure and performance information for healthcare professionals. • Quality performance standards that are computer based will determine who receives treatment, and by what means. • Experts will update and design intelligent computers to be used by healthcare professionals. • Lay people will become their own primary care practitioners, using their own information and primary care system. • Automation and robotics will cause hospitals to revise their staffing patterns, bringing numbers of personnel down to less than two employees per occupied bed. • The federal government will conduct research using computer simulations and data banks that the various branches of government control. • Journals, books, and face-to-face conferences will become obsolete. These will be replaced with electronic media and teleconferencing. Most of these predictions seemed remote in 1989. Realistically, the publication process is slow. The article may well have been written in 1987 or 1988, when most of us could not envision these futuristic predictions. In the 1990's, most came to pass. As you can see, the future is limited only by your imagination. You can perform five different types of searches using a search engine: • Content-oriented searches are used to search for specific web sites. • Subject-oriented searches are used for searching for broad content, such as nursing, medicine, or specific clinical areas. • Guide-oriented searches are done to search for new sites. Netscape and other browsers provide features to assist you with this. Depending on the version you use, you may click the “What’s New” button, “What’s Cool” button, “Find Sites” button or “What’s Related” button to bring up new sites. • Location-oriented searches are done to search for sites within a specific geographical area. These are done by typing in the subject and the state. For example, you are looking for a job as a paramedic in Chicago. Type in Paramedic AND Chicago. • Wild card searches are very broad, usually retrieving hundreds or thousands of matches. For example, typing nurs* into the query box will bring up matches on nurses, nursing, nurse, nurse assistant, and so forth. Always follow the directions provided by the search engine for typing in and narrowing in the information for which you are searching. Although the method of searching is similar for all engines, each has its own idiosyncrasies. Generally, the results of your search are listed in order of relevance, from most relevant to least relevant. Some engines rate relevancy by using a percentage system. When searching for information, make sure to check several different sources. Some of the health information on the World Wide Web is inaccurate, some is dated. Confirming information with several sources will help you sort the information and sift out inaccuracies. Likewise, use more than one search engine. Each of us has a favorite. My personal favorite is Google. I have used Google since it was in the beta version, and can usually find more specialized medical information there than I can on the medical search engines. I also use the images. Google site a great deal for photos and line drawings for my various projects. However, when searching for information, make it a practice to check several engines. The information varies from one to the next, and checking several will ensure that you receive a complete listing of the data you seek. Two excellent sites that will help you evaluate health content online are: • Evaluating health information on the Internet http://mel.lib.mi.us/health/health_evaluating.html • Health On the Net Foundation http://www.hon.ch/ Searching for Standards of Care •Develop a strategy for searching •Formulate your search question •Identify concepts that are important to the search •Identify search terms related to these concepts •Identify synonyms and variations of the search terms •Select/use several search engines •Read the help page or search directions for the search engines •Format your search using boolean terms •Keep the search terms as simple as possible •Limit the number of search terms •Avoid unnecessary words, such as “the,” or “on” •Evaluate your search results •Narrow, broaden, or refine your search, if necessary •Check links and relevant documents •Search another engine, if necessary The following sites have standards of care and various other resources that you may find useful. All sites are working at the time of this writing, but each professional must evaluate the content to determine if it meets his/her needs: Agency for Healthcare Research and Quality (AHRQ) Home Page, formerly the Agency for Health Care Policy and Research http://www.ahrq.gov/ State Operations Manual http://www.hcfa.gov/pubforms/progman.htm Joint Commission on Accreditation of Healthcare Organizations http://www.jcaho.org/ National Guideline Clearinghouse http://www.guideline.gov/index.asp Primary Care Clinical Practice Guidelines http://medicine.ucsf.edu/resources/guidelines/guide.html Medscape http://www.medscape.com WWWRSW: (Word Wide Web Resources for Social Workers) Publications (papers, position statements & clinical practice guidelines) http://webdb.nyu.edu/sociallinks/menu.cgi?cid=1034 NY Emergency Room RN-nursing standards of practice http://www.nyerrn.com/nursing/nursing_standards.htm Cancer/PRACTICE GUIDELINES http://www.surgonc.org/sso/guidelines.cfm MDchoice.com/index.asp http://mdchoice.com/index.asp MERCK MANUAL, Home/Title Page http://www.merck.com/pubs/mmanual/ Neurosurgery Online http://www.neurosurgery_online.com/ NURSING REFERENCE http://www.nursingnet.org/nr.htm OrthoGuide.com http://www.orthoguide.com/ortho/result.php3 Praxis.md _ Best Practice of Medicine http://merck.praxis.md/index.asp?page=bpm ResourceNurse reference center http://www.resourcenurse.com/RN/refcenter Wheeless' Textbook of Orthopaedics http://www.medmedia.com/ Crane Memorial Library Search the Catalogue http://www.deerlodge.mb.ca/crane_library/search_catalogue.asp Risk Management Sourcebook http://www.thedoctors.com/rm/sb/index.htm Medical Reference Library ($9.95 year/subscription) https://www.medical_library.org/subscribe.html Practical Guide/Clinical Medicine http://medicine.ucsd.edu/clinicalmed/introduction.htm Gateway to Health, Nursing and Medical Resources http://library.shu.edu/health.htm The Medical Algorithms Project home page http://www.medal.org/ Algorithm Index __ American Family Physician http://www.aafp.org/afp/algorithms/ Gerontology Manual http://otpt.ups.edu/Gerontological_Resources/Gerontology_Manual/ UNC Nursing Protocol Manual http://www.med.unc.edu/nursing/manuals/00_protocol.htm AARC (American Ass’n for Respiratory Care) CPGs http://www.hsc.missouri.edu/~shrp/rtwww/rcweb/aarc/ Clinical Programs Nursing Manual http://www.uams.edu/nursingmanual/default.htm Protocol Manual http://www.med.unc.edu/nursing/manuals/00!banked!00_protocol.html Medical Directors Forum http://www.hcwp.org/meddirfm/mdpol.htm Nicholas Institute of Sports Medicine & Trauma http://www.nismat.org/index.html American Society of Healthcare Pharmacists http://www.ashp.org/ American Pharmaceutical Ass’n: http://www.aphanet.org/ National Ass’n of Vascular Access Networks http://www.navannet.org/ American Society of Consultant Pharmacists http://www.ascp.com/ CDC Guidelines & Recommendations http://www.cdc.gov/ncidod/hip/Guide/guide.htm CDC Issues in Healthcare Settings http://www.cdc.gov/ncidod/hip/DEFAULT.HTM American Geriatrics Society http://www.americangeriatrics.org/ sepsis.com http://www.sepsis.com/ APIC http://www.apic.org/ American Nurses’ Association http://www.nursingworld.org/ Another source of online standards is the many professional listservs. There are thousands of groups representing the spectrum of professional interests and practices. Sometimes your colleagues are your best resources! ### Barbara Acello, M.S., RN Science Advisory Board Steering Committee Member 2001-2002 A Science Advisory Board member since September 1997 ### << Previous Next >> [ View All Perspectives ] |
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