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Biomedical subjects

M Arndt

Publications and source records attributed to M Arndt.

120 records · Page 7Linked to original sources
PubMedDate not supplied

Autonomy and clinical practice. 3: Issues of patient consent.

In this, the last in a three-part series considering how the concepts of autonomy, privacy and informed consent are articulated in nursing and the related literature, the authors focus on the notion of consent. Definitions of consent are considered, as are the legal elements of valid consent. Obtaining a patient's consent to treatment has several important functions. This article looks at some of these functions, such as safeguarding patient autonomy and encouraging patient participation in health care. Finally, a number of the difficulties in obtaining an informed consent from patients are considered. Some empirical studies which consider patients' understanding of the information and consent process are also discussed. From a review of the literature it appears that the issue of informed consent is very much tied up with the perceived power struggle between doctors and nurses and doctors and their patients.

Humans↗
PubMedDate not supplied

Autonomy and clinical practice. 1: Identifying areas of concern.

This article, the first of three parts, presents an analysis of the use of the concept of autonomy in the nursing and healthcare ethics literature in the UK. It commences by considering some definitions of autonomy as they appear in the literature. Some of the confusions with the use of autonomy in the nursing literature are also identified and discussed, e.g. the frequent lack of clarity regarding how closely the concept is tied to notions of freedom. In addition, it also examines the lack of any indications in the nursing literature and that when one is considering the notion of autonomy it is also useful to consider the idea of constraining factors. In the nursing literature, discussions of autonomy largely appear to centre around the power imbalance between nurses and doctors. Issues of patient autonomy thus appear to be often of only secondary concern.

Ethics, Nursing↗
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Autonomy and clinical practice. 2: Patient privacy and nursing practice.

This article, the second in a series of three considering issues of autonomy, privacy and informed consent in nurse/patient interactions, focuses on the wider conceptions of patient privacy and confidentiality. Given that patients in institutional care are likely to suffer intrusions into their privacy which would be considered unusual in normal social interaction, it is interesting to note the dearth of literature in this area. Some definitions of privacy are considered in an attempt to begin to raise readers' awareness of the complexity of this notion. It can be argued that privacy is a pertinent notion to consider, both in order to gain a greater understanding of what is meant by the term and in terms of the implications of this understanding for clinical practice.

Confidentiality↗
PubMedDate not supplied

Autonomy, privacy and informed consent 1: concepts and definitions.

This article is the first in a four-part series that explores the concepts of patient autonomy, privacy and informed consent in the context of the provision of nursing care. In this first article an overview of the concepts is provided, and some of the difficulties with definitions of these concepts are considered. The dearth of empirical exploration of the operationalization of the concepts of patient autonomy, privacy and informed consent within nursing practice is highlighted. The second, third and fourth articles report a series of empirical studies carried out with patients and staff in postnatal care, in continuing care of elderly people and in acute surgical care within Scottish NHS settings. These studies are part of a concerted effort to address the lack of empirical investigation of the ethical dimension of nursing care provision and clinical nursing practice.

Humans↗
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Autonomy, privacy and informed consent 2: postnatal perspective.

The nursing and healthcare ethics literature over the past 10 years has focused on issues of patient autonomy and patient rights. Despite the growing volume of literature exploring such topics, there is little empirical work investigating what is actually happening in clinical nursing or midwifery practice in relation to patient autonomy, privacy or informed consent, from the perspective of either patients or staff. This four-part series reports the results of a Scottish study that formed part of a multisite comparative research project funded by the European Commission, investigating issues of patient autonomy, privacy and informed consent. This article, the second of four, explores the issues of autonomy, privacy and informed consent in maternity care. The research questions asked were: (1) What is the perception of mothers' autonomy, privacy and informed consent in Scottish NHS hospitals, from the point of view of both mothers and midwives? (2) Are there differences in the perceptions of mothers and midwives on these issues? Data were collected by a self-completion questionnaire for mothers (n = 243) and staff (n = 170) on postnatal units in both district general and university teaching hospital. Results indicated that there are differences between the perceptions of mothers and midwives in relation to mothers' autonomy, privacy and informed consent. Most differences were found in the information-giving and decision-making elements of autonomy.

Decision Making↗
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Autonomy, privacy and informed consent 3: elderly care perspective.

Despite the growing interest in clinical healthcare ethics, there is a dearth of empirical studies investigating the ethical elements of day-to-day clinical practice from the perspective of either patients or staff. This article, the third in a four-part series, reports the results of a Scottish Study that formed part of a multi-site comparative study funded by the European Commission. It explores patient autonomy, privacy and informed consent in the care of elderly people in long-stay care facilities (i.e. nursing homes and continuing care units). A convenience sample of 101 elderly residents and their nurses (n = 160) participated in the study. Data were collected by means of a self-completion questionnaire for staff and a structured interview schedule for elderly residents. Results indicate marked differences between staff's and residents' responses on three of the four dimensions explored: information-giving, and opportunity to participate in decision-making about care and consent. There was much closer agreement between staff's and residents' responses regarding protection of patient privacy. From the results of this study there is indication of a clear need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day nursing care of older people. Findings to date suggest there is still a significant need to educate staff concerning ethical awareness and sensitivity to the dignity and rights of patients.

Aged↗
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Autonomy, privacy and informed consent 4: surgical perspective.

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n = 282) and their nurses (n = 260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked difference in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.

Humans↗
PubMedDate not supplied

In their own words: how hospitals present corporate restructuring in their annual reports.

Hospitals operate in an environment with strong institutional pressures, in which legitimacy is critical to an organization's access to resources. In such an environment, organizations can increase their legitimacy by engaging in activities or discussing them in a manner that signals that the organization adheres to values held by its costituents. One important symbol of organizational actions or intentions is the formal organizational structure. When hospitals began to adopt a corporate structure in the early eighties, the way in which they presented this decision to the public was as important as the technical merits of the decision itself. This study investigates, through an analysis of annual reports, what hospitals signaled about their adoption of a corporate structure. The findings suggest that through restructuring, hospitals signaled that they were in line with practices advocated in the industry and literature (e.g., adhering to business values, protection of assets, or increasing patient services). By presenting multiple reasons for restructuring, hospitals could signal their attention to the needs of various constituents, and by touching only briefly on each reason, they could ignore the potential conflict between demands such as lower hospital cost and increased services. The findings also suggest that the first hospitals to adopt a corporate structure sought to educate constituents about restructuring by devoting a greater share of their annual report to the topic than later adopters and by enumerating a larger number of anticipated benefits from the structure, which would have enhanced the innovation's legitimacy in the early years.

Annual Reports as Topic↗
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Medication errors. Research in practice: how drug mistakes affect self-esteem.

In this study a critical topic is introduced: Medication errors have worried almost every nurse and so how they are experienced, how they are dealt with and what their occurrence means at individual, institutional and professional levels, are discussed in this article. The tool of discourse analysis is outlined as the interpretive instrument of analysis. Of the analytic results from the study, five themes are introduced and shown in terms of their relevance to everyday nursing practice.

Humans↗
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Surgeon volume and hospital resource utilization.

This study examines whether surgeons who perform a particular procedure more often incur lower hospital charges and shorter lengths of stay than surgeons with less volume. The 43 Pennsylvania hospitals included in the 1991 MedisGroups Comparative Hospital Database form the study hospitals. The analysis looks at four frequently occurring surgical procedures: cholecystectomy, prostatectomy, hysterectomy, and intervertebral disc excision. Regression models are estimated separately for total charges, ancillary charges, and length of stay for each surgical procedure. The explanatory variable of interest is surgeon volume for the specific procedure. Control variables include patient age, sex, admission severity of illness, insurance plan, and hospital. For cholecystectomy, prostatectomy, and intervertebral disc surgery, we find a significant negative association between surgeon volume and both hospital charges and length of stay. We find no such volume effect for hysterectomy. The paper discusses management and policy implications of these findings.

Ancillary Services, Hospital↗