Author: Helen Spiby
Publisher: John Wiley & Sons
ISBN: 9781444314618
Category : Medical
Languages : en
Pages : 224
Book Description
Evidence based practice is now widely accepted as a fundamental tenet of midwifery. The importance of evidence in defining midwifery policy and practice in the UK health system, and others, is acknowledged and enduring. While the development and evaluation of research in midwifery is well charted, the question of how such evidence is incorporated into practice has, to date, received less attention and discussion in the midwifery profession. Answering this need, Evidence Based Midwifery focuses on the dissemination and use of evidence for midwifery practice, and explores midwives’ experiences in using the evidence base to inform policy and enhance clinical practice. Written by a highly-regarded and diverse group from the UK and international midwifery community, Evidence Based Midwifery addresses issues of relevance to all midwives whether clinical practitioners or educators, students or supervisors, researchers or managers. Issues that influence evidence based midwifery are discussed, and topics covered include problem based learning, implementation of evidence based guidelines and the involvement of service users. Edited by founder members of the Evidence Based Midwifery Network International collaboration with contributions from the UK, Greece, Canada and the Netherlands Primary focus on the incorporation of evidence into midwifery practice Real-life examples throughout
Evidence Based Midwifery
Author: Helen Spiby
Publisher: John Wiley & Sons
ISBN: 9781444314618
Category : Medical
Languages : en
Pages : 224
Book Description
Evidence based practice is now widely accepted as a fundamental tenet of midwifery. The importance of evidence in defining midwifery policy and practice in the UK health system, and others, is acknowledged and enduring. While the development and evaluation of research in midwifery is well charted, the question of how such evidence is incorporated into practice has, to date, received less attention and discussion in the midwifery profession. Answering this need, Evidence Based Midwifery focuses on the dissemination and use of evidence for midwifery practice, and explores midwives’ experiences in using the evidence base to inform policy and enhance clinical practice. Written by a highly-regarded and diverse group from the UK and international midwifery community, Evidence Based Midwifery addresses issues of relevance to all midwives whether clinical practitioners or educators, students or supervisors, researchers or managers. Issues that influence evidence based midwifery are discussed, and topics covered include problem based learning, implementation of evidence based guidelines and the involvement of service users. Edited by founder members of the Evidence Based Midwifery Network International collaboration with contributions from the UK, Greece, Canada and the Netherlands Primary focus on the incorporation of evidence into midwifery practice Real-life examples throughout
Publisher: John Wiley & Sons
ISBN: 9781444314618
Category : Medical
Languages : en
Pages : 224
Book Description
Evidence based practice is now widely accepted as a fundamental tenet of midwifery. The importance of evidence in defining midwifery policy and practice in the UK health system, and others, is acknowledged and enduring. While the development and evaluation of research in midwifery is well charted, the question of how such evidence is incorporated into practice has, to date, received less attention and discussion in the midwifery profession. Answering this need, Evidence Based Midwifery focuses on the dissemination and use of evidence for midwifery practice, and explores midwives’ experiences in using the evidence base to inform policy and enhance clinical practice. Written by a highly-regarded and diverse group from the UK and international midwifery community, Evidence Based Midwifery addresses issues of relevance to all midwives whether clinical practitioners or educators, students or supervisors, researchers or managers. Issues that influence evidence based midwifery are discussed, and topics covered include problem based learning, implementation of evidence based guidelines and the involvement of service users. Edited by founder members of the Evidence Based Midwifery Network International collaboration with contributions from the UK, Greece, Canada and the Netherlands Primary focus on the incorporation of evidence into midwifery practice Real-life examples throughout
Nursing and Midwifery Research
Author: Dean Whitehead
Publisher: Elsevier
ISBN: 0729587711
Category : Medical
Languages : en
Pages : 442
Book Description
Nursing and Midwifery Research is an essential guide in assisting students and practitioners develop sound research skills to enhance their knowledge and practice. Written by Dean Whitehead and Caleb Ferguson, the 6th ANZ edition includes the most recent updates and developments in Australian and New Zealand nursing and midwifery practice, with a focus on evidence-based practice, along with a range of contemporary research articles and pedagogy to support specific chapter content. Using clear language and examples, the 6th edition of Nursing and Midwifery Research provides a valuable resource to assist healthcare students and practitioners in developing strong skills in research literacy and critical appraisal, as well as the confidence to successfully conduct research and apply outcomes to practice. A focus on digital communication - includes overviews and tips on navigating professional and personal electronic media Individual and group activities throughout to encourage skill development, reflection and awareness of self and others An extensive suite of scenarios - practise and apply your communication skills using realistic situations and individuals that healthcare professionals encounter in clinical practice Additional resources on Evolve eBook on VitalSource Instructor resources: Answer guides to Tutorial Triggers PowerPoint presentations Student and Instructor resources: Answer guides to An Unexpected Hurdle Answers to Learning Activities Research Articles and Questions Answer guides to Time to Reflect Glossary New co-editor, Caleb Ferguson, from Western Sydney University Fully updated Chapter 15 'Indigenous Peoples and Research' offers leading cultural insights into Indigenous approaches to research Fully updated Chapter 20 'A Research Project Journey: from Conception to Completion' fully details the process of a mixed methods project, from beginning to dissemination, that explores the topical issue of patients and carers living with bladder cancer Updated chapters throughout reflect current nursing and midwifery perspectives to provide you with the latest data and most recent examples of evidence-based practice A stronger focus on the role of social media and bibliometrics in conducting and disseminating research outcomes ensures latest best practice guidelines Real-world examples of the research process prepare you for common experiences you can expect during your own research journey and the processes that you are likely to encounter An eBook included in all print purchases
Publisher: Elsevier
ISBN: 0729587711
Category : Medical
Languages : en
Pages : 442
Book Description
Nursing and Midwifery Research is an essential guide in assisting students and practitioners develop sound research skills to enhance their knowledge and practice. Written by Dean Whitehead and Caleb Ferguson, the 6th ANZ edition includes the most recent updates and developments in Australian and New Zealand nursing and midwifery practice, with a focus on evidence-based practice, along with a range of contemporary research articles and pedagogy to support specific chapter content. Using clear language and examples, the 6th edition of Nursing and Midwifery Research provides a valuable resource to assist healthcare students and practitioners in developing strong skills in research literacy and critical appraisal, as well as the confidence to successfully conduct research and apply outcomes to practice. A focus on digital communication - includes overviews and tips on navigating professional and personal electronic media Individual and group activities throughout to encourage skill development, reflection and awareness of self and others An extensive suite of scenarios - practise and apply your communication skills using realistic situations and individuals that healthcare professionals encounter in clinical practice Additional resources on Evolve eBook on VitalSource Instructor resources: Answer guides to Tutorial Triggers PowerPoint presentations Student and Instructor resources: Answer guides to An Unexpected Hurdle Answers to Learning Activities Research Articles and Questions Answer guides to Time to Reflect Glossary New co-editor, Caleb Ferguson, from Western Sydney University Fully updated Chapter 15 'Indigenous Peoples and Research' offers leading cultural insights into Indigenous approaches to research Fully updated Chapter 20 'A Research Project Journey: from Conception to Completion' fully details the process of a mixed methods project, from beginning to dissemination, that explores the topical issue of patients and carers living with bladder cancer Updated chapters throughout reflect current nursing and midwifery perspectives to provide you with the latest data and most recent examples of evidence-based practice A stronger focus on the role of social media and bibliometrics in conducting and disseminating research outcomes ensures latest best practice guidelines Real-world examples of the research process prepare you for common experiences you can expect during your own research journey and the processes that you are likely to encounter An eBook included in all print purchases
The Handbook of Midwifery Research
Author: Mary Steen
Publisher: John Wiley & Sons
ISBN: 140519510X
Category : Medical
Languages : en
Pages : 242
Book Description
Research is a fundamental part of midwifery practice. However, not everyone finds it easy to understand the basic principles, and particularly the language of research. This accessible handbook enables midwives and student midwives to firstly understand how to search and make sense of research evidence, how to write a research proposal and finally how to undertake a research study. The Handbook of Midwifery Research specifically focuses on the needs of midwives and students and helps increase the knowledge and understanding of midwifery research, enabling the reader to undertake research with confidence. With case studies, learning objectives and clear examples throughout, this is an essential purchase for any midwife or student wanting to understand or undertake research. This handbook includes useful tools and techniques to assist midwives and students to keep themselves up-to-date with the best available evidence, enabling them to apply this evidence to their own clinical practice. An essential resource for midwifery students as well as qualified midwives Clear, straightforward, and accessible in style Provides midwives and students with the skills to undertake research with confidence Provides examples throughout to apply research to midwifery practice Includes a glossary of research terms
Publisher: John Wiley & Sons
ISBN: 140519510X
Category : Medical
Languages : en
Pages : 242
Book Description
Research is a fundamental part of midwifery practice. However, not everyone finds it easy to understand the basic principles, and particularly the language of research. This accessible handbook enables midwives and student midwives to firstly understand how to search and make sense of research evidence, how to write a research proposal and finally how to undertake a research study. The Handbook of Midwifery Research specifically focuses on the needs of midwives and students and helps increase the knowledge and understanding of midwifery research, enabling the reader to undertake research with confidence. With case studies, learning objectives and clear examples throughout, this is an essential purchase for any midwife or student wanting to understand or undertake research. This handbook includes useful tools and techniques to assist midwives and students to keep themselves up-to-date with the best available evidence, enabling them to apply this evidence to their own clinical practice. An essential resource for midwifery students as well as qualified midwives Clear, straightforward, and accessible in style Provides midwives and students with the skills to undertake research with confidence Provides examples throughout to apply research to midwifery practice Includes a glossary of research terms
Nursing and Midwifery Research
Author: Dean Whitehead
Publisher: Elsevier Health Sciences
ISBN: 0729581373
Category : Medical
Languages : en
Pages : 463
Book Description
The new edition upholds the premise that knowledge about research process and design is mandatory in today's health care arena, and that all nurses and midwives need to understand research findings and their implication for changing practice. It is completely revised with many new chapters. The text has been restructured into three sections. Section 1 Research Awareness sets the scene for the importance of nursing and midwifery research and provides an overview of research theory and practice as processes. Chapters on searching for and reviewing the literature provide detailed advice for undergraduates and facilitate access to research articles online. One of the new chapters discusses ethical issues in Australia and New Zealand. Section 2 Appreciation and Application provides a detailed discussion of qualitative, quantitative and mixed methods research approaches with many useful examples from the clinical area. Section 3 Conducting primary research is new and is designed to accommodate both undergraduate and postgraduate students in their research effort. Writing research proposals may be a requirement for undergraduates in their research program and postgraduates will find the information useful for undertaking a higher degree or applying for university or external funding. This final Section is also useful as a guide on disseminating and publishing conducted research findings. - Combined Australian and New Zealand editorship ensures greater trans-Tasman coverage, awareness and relevance. - Contributions from international luminaries are balanced by a heightened focus on research conducted within Australia and New Zealand. - New edition conscientiously recognises midwifery research as related to but independent from nursing. - The research process-driven approach is directed towards 'consumers' of research, and the comprehensive coverage extends from undergraduate through to a postgraduate level of knowledge. - Expanded pedagogy includes Key Terms and Learning Outcomes at the beginning of each chapter; Icons throughout that direct readers to web-based material; Evidence-based Tips, Research in Brief boxes and Points to Ponder for constant reinforcement that links evidence to practice. - Integrated Tutorial Triggers with suggested answers provided and Multiple Choice Questions enable students to assess their understanding of key points. - Evolve Website provides True/False questions and access to journal articles cited in the text, with additional reflective questions. - Chapter 1: The significance of nursing research identifies the current changes in practice and future directions in Australian health care - Previous chapters 3 and 4 have been combined to become Chapter 3: Searching and reviewing the literature - A detailed discussion of qualitative, quantitative and mixed-methods research approaches - Increased Australian and New Zealand context and research examples - More accessible language throughout
Publisher: Elsevier Health Sciences
ISBN: 0729581373
Category : Medical
Languages : en
Pages : 463
Book Description
The new edition upholds the premise that knowledge about research process and design is mandatory in today's health care arena, and that all nurses and midwives need to understand research findings and their implication for changing practice. It is completely revised with many new chapters. The text has been restructured into three sections. Section 1 Research Awareness sets the scene for the importance of nursing and midwifery research and provides an overview of research theory and practice as processes. Chapters on searching for and reviewing the literature provide detailed advice for undergraduates and facilitate access to research articles online. One of the new chapters discusses ethical issues in Australia and New Zealand. Section 2 Appreciation and Application provides a detailed discussion of qualitative, quantitative and mixed methods research approaches with many useful examples from the clinical area. Section 3 Conducting primary research is new and is designed to accommodate both undergraduate and postgraduate students in their research effort. Writing research proposals may be a requirement for undergraduates in their research program and postgraduates will find the information useful for undertaking a higher degree or applying for university or external funding. This final Section is also useful as a guide on disseminating and publishing conducted research findings. - Combined Australian and New Zealand editorship ensures greater trans-Tasman coverage, awareness and relevance. - Contributions from international luminaries are balanced by a heightened focus on research conducted within Australia and New Zealand. - New edition conscientiously recognises midwifery research as related to but independent from nursing. - The research process-driven approach is directed towards 'consumers' of research, and the comprehensive coverage extends from undergraduate through to a postgraduate level of knowledge. - Expanded pedagogy includes Key Terms and Learning Outcomes at the beginning of each chapter; Icons throughout that direct readers to web-based material; Evidence-based Tips, Research in Brief boxes and Points to Ponder for constant reinforcement that links evidence to practice. - Integrated Tutorial Triggers with suggested answers provided and Multiple Choice Questions enable students to assess their understanding of key points. - Evolve Website provides True/False questions and access to journal articles cited in the text, with additional reflective questions. - Chapter 1: The significance of nursing research identifies the current changes in practice and future directions in Australian health care - Previous chapters 3 and 4 have been combined to become Chapter 3: Searching and reviewing the literature - A detailed discussion of qualitative, quantitative and mixed-methods research approaches - Increased Australian and New Zealand context and research examples - More accessible language throughout
Principles and Practice of Research in Midwifery
Author: Elizabeth R. Cluett
Publisher: Elsevier Health Sciences
ISBN: 0443101949
Category : Medical
Languages : en
Pages : 309
Book Description
This title is directed primarily towards health care professionals outside of the United States. Written by authors with clinical and research experience, this book is intended for midwives and student midwives participating in Diploma, Advanced Diploma and first level degree programmes. It aims to increase research awareness and develop the skills of critical appraisal of research evidence that are essential to evidence based practice. Key features: · Introduces research methods in midwifery · Discusses the application of research to practice and looks at the route from practice to research · Presents both quantitative and qualitative research methods · Provides a framework for the appraisal of midwifery research evidence · New chapters on evidence based research and interviewing in qualitative research · Maternity care related examples used throughout. New chapter on interviewing as a means of data collection, including information on using focus groups New chapter on evidence-based practice including issues around supervision for evidence-based projects Inclusion of new material in relation to such topics as undertaking case studies
Publisher: Elsevier Health Sciences
ISBN: 0443101949
Category : Medical
Languages : en
Pages : 309
Book Description
This title is directed primarily towards health care professionals outside of the United States. Written by authors with clinical and research experience, this book is intended for midwives and student midwives participating in Diploma, Advanced Diploma and first level degree programmes. It aims to increase research awareness and develop the skills of critical appraisal of research evidence that are essential to evidence based practice. Key features: · Introduces research methods in midwifery · Discusses the application of research to practice and looks at the route from practice to research · Presents both quantitative and qualitative research methods · Provides a framework for the appraisal of midwifery research evidence · New chapters on evidence based research and interviewing in qualitative research · Maternity care related examples used throughout. New chapter on interviewing as a means of data collection, including information on using focus groups New chapter on evidence-based practice including issues around supervision for evidence-based projects Inclusion of new material in relation to such topics as undertaking case studies
Best Practices in Midwifery
Author: Barbara A. Anderson, DrPH, CNM, FACNM, FAAN
Publisher: Springer Publishing Company
ISBN: 0826108865
Category : Medical
Languages : en
Pages : 277
Book Description
Awarded second place in the 2013 AJN Book of the Year Awards in the Maternal-Child Nursing/Childbirthing category "This book is one of those turning points that will make an enormous difference." Judith P. Rooks, CNM, MS, MPH Author of Midwifery and Childbirth in America "This book provides a well-rounded examination of the issues we face in using evidence to inform our everyday clinical decisions...The authors have gathered current evidence and created practice scenarios to help the reader visualize EBP in action." "In a country that has more independent midwives and group practices than hospital based midwives this type of book could possibly become the cornerstone in terms of the standards of midwifery care."--Nursing Times From the Foreword by Holly Powell Kennedy, CNM, PhD, FACNM, FAAN President, American College of Nurse Midwives Helen Varney Professor of Midwifery Yale University School of Nursing Nurse-midwives often find themselves in situations where current research-based treatment conflicts with established practices that may be ineffective or even harmful. This text provides a roadmap for nurse-midwives who strive to implement change through evidence-based practice by presenting the most current evidence-based research on the care of childbearing women. It is the only book about evidence-based practice for nurse-midwives that encompasses the most controversial areas of practice. The text incorporates the foundations of midwifery and the midwifery model of care throughout. The book discusses the use of electronic databases in examining evidence and identifying best practices. It considers how the current workforce environment affects the practice of nurse-midwifery, and describes evidence-based practices in the care of childbearing women. Each chapter reviews current literature, describes contemporary practices and explores whether these practices are based on scientific evidence. Case studies enhance the examination of evidence and the identification of best practices. Key Features: Focuses on scientific evidence as the framework for the practice of nurse-midwifery Incorporates the hallmarks of midwifery and the midwifery model of care Examines practices that are in conflict with scientific evidence Provides guidance for practicing nurse-midwives in implementing best practices based upon scientific evidence
Publisher: Springer Publishing Company
ISBN: 0826108865
Category : Medical
Languages : en
Pages : 277
Book Description
Awarded second place in the 2013 AJN Book of the Year Awards in the Maternal-Child Nursing/Childbirthing category "This book is one of those turning points that will make an enormous difference." Judith P. Rooks, CNM, MS, MPH Author of Midwifery and Childbirth in America "This book provides a well-rounded examination of the issues we face in using evidence to inform our everyday clinical decisions...The authors have gathered current evidence and created practice scenarios to help the reader visualize EBP in action." "In a country that has more independent midwives and group practices than hospital based midwives this type of book could possibly become the cornerstone in terms of the standards of midwifery care."--Nursing Times From the Foreword by Holly Powell Kennedy, CNM, PhD, FACNM, FAAN President, American College of Nurse Midwives Helen Varney Professor of Midwifery Yale University School of Nursing Nurse-midwives often find themselves in situations where current research-based treatment conflicts with established practices that may be ineffective or even harmful. This text provides a roadmap for nurse-midwives who strive to implement change through evidence-based practice by presenting the most current evidence-based research on the care of childbearing women. It is the only book about evidence-based practice for nurse-midwives that encompasses the most controversial areas of practice. The text incorporates the foundations of midwifery and the midwifery model of care throughout. The book discusses the use of electronic databases in examining evidence and identifying best practices. It considers how the current workforce environment affects the practice of nurse-midwifery, and describes evidence-based practices in the care of childbearing women. Each chapter reviews current literature, describes contemporary practices and explores whether these practices are based on scientific evidence. Case studies enhance the examination of evidence and the identification of best practices. Key Features: Focuses on scientific evidence as the framework for the practice of nurse-midwifery Incorporates the hallmarks of midwifery and the midwifery model of care Examines practices that are in conflict with scientific evidence Provides guidance for practicing nurse-midwives in implementing best practices based upon scientific evidence
Fundamentals of Nursing and Midwifery Research
Author: Beverley Copnell
Publisher: Routledge
ISBN: 1000249611
Category : Medical
Languages : en
Pages : 264
Book Description
Nurses and midwives have a professional responsibility to keep up-to-date with current research impacting on their clinical practice. They require the skills and knowledge to read and understand research reports, evaluate the quality of the research, synthesise different research studies, apply the most appropriate findings to their clinical practice and be able to evaluate its effectiveness. This book presents a unique approach to teaching the principles of health research using practical case studies with which students can identify and engage. The book covers core concepts and principles including: - what evidence is and why understanding research is vital - finding reliable sources of evidence - the nature of the research process - understanding quantitative and qualitative research - ethical considerations - using research to guide clinical practice. Throughout the book, activities, summaries and review questions help ground theory in real life scenarios, highlighting how evidence-based practice can be applied in every aspect of nursing care. 'The text is highly readable while achieving the aim of familiarising the reader with the language of, and process for, doing research. It is logically organised and ... guides reader learning using a variety of techniques that reinforce [the] information presented and challenge thinking.' Karen Francis, Professor of Nursing and Head of Nursing, University of Tasmania
Publisher: Routledge
ISBN: 1000249611
Category : Medical
Languages : en
Pages : 264
Book Description
Nurses and midwives have a professional responsibility to keep up-to-date with current research impacting on their clinical practice. They require the skills and knowledge to read and understand research reports, evaluate the quality of the research, synthesise different research studies, apply the most appropriate findings to their clinical practice and be able to evaluate its effectiveness. This book presents a unique approach to teaching the principles of health research using practical case studies with which students can identify and engage. The book covers core concepts and principles including: - what evidence is and why understanding research is vital - finding reliable sources of evidence - the nature of the research process - understanding quantitative and qualitative research - ethical considerations - using research to guide clinical practice. Throughout the book, activities, summaries and review questions help ground theory in real life scenarios, highlighting how evidence-based practice can be applied in every aspect of nursing care. 'The text is highly readable while achieving the aim of familiarising the reader with the language of, and process for, doing research. It is logically organised and ... guides reader learning using a variety of techniques that reinforce [the] information presented and challenge thinking.' Karen Francis, Professor of Nursing and Head of Nursing, University of Tasmania
Research Methods in Nursing and Midwifery
Author: Sansnee Jirojwong
Publisher: Oxford University Press, USA
ISBN: 9780195528510
Category : Medical
Languages : en
Pages : 0
Book Description
Introduces nursing and midwifery students to basic principles of research methods. Begins with introduction to importance of research, how it relates to evidence-based practice. Then qualitative, quantitative and mixed research design methods, sampling techniques, data collection methods and analysis procedures.
Publisher: Oxford University Press, USA
ISBN: 9780195528510
Category : Medical
Languages : en
Pages : 0
Book Description
Introduces nursing and midwifery students to basic principles of research methods. Begins with introduction to importance of research, how it relates to evidence-based practice. Then qualitative, quantitative and mixed research design methods, sampling techniques, data collection methods and analysis procedures.
Linking Research and Practice in Midwifery
Author: Sue Proctor
Publisher: Bailliere Tindall Limited
ISBN: 9780702022975
Category : Medical
Languages : en
Pages : 260
Book Description
This book explores how the links between midwifery research and practice can be strengthened in order to foster more effective care based on the best available evidence. Researchers, practitioners, and consumers describe the key challenges and discuss how they can be met.
Publisher: Bailliere Tindall Limited
ISBN: 9780702022975
Category : Medical
Languages : en
Pages : 260
Book Description
This book explores how the links between midwifery research and practice can be strengthened in order to foster more effective care based on the best available evidence. Researchers, practitioners, and consumers describe the key challenges and discuss how they can be met.
Midwifery
Author: Linda V. Walsh
Publisher:
ISBN:
Category : Family & Relationships
Languages : en
Pages : 584
Book Description
This new comprehensive text recognises the roleof the midwife or clinician practisng using a midwifery model of care as a primary provider for healthy pregnant women. The woman is the central figure in the assessment of her own health needs and the determination of the care processes that will best meet those needs. Stresses throughout, the role of the midwife is to advocate for the woman while creating a climate of care the recognises and values the healthy aspects of pregnancy. When deviation from the normal occur, the reader is led through a process that emphasises consultation, collaboration, and referral to the professionals who are most appropriately prepared to meet the women¹s needs. Current research is incorporated throughout to prepare the reader for maintaining standards of care by evidence-based practice. Current research incorporated throughout Emphasises consultation and collaboration when referring patients with specific needs deviating from the norm
Publisher:
ISBN:
Category : Family & Relationships
Languages : en
Pages : 584
Book Description
This new comprehensive text recognises the roleof the midwife or clinician practisng using a midwifery model of care as a primary provider for healthy pregnant women. The woman is the central figure in the assessment of her own health needs and the determination of the care processes that will best meet those needs. Stresses throughout, the role of the midwife is to advocate for the woman while creating a climate of care the recognises and values the healthy aspects of pregnancy. When deviation from the normal occur, the reader is led through a process that emphasises consultation, collaboration, and referral to the professionals who are most appropriately prepared to meet the women¹s needs. Current research is incorporated throughout to prepare the reader for maintaining standards of care by evidence-based practice. Current research incorporated throughout Emphasises consultation and collaboration when referring patients with specific needs deviating from the norm