Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Professional Autonomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMed1989

Limited autonomy and partnership: professional relationships in health care.

Principles of autonomy and self-determination have been upheld as vital to modern-day medical and ethical practice. However, the complexities of current health care and changes in the expectation of some patients and their families justify a review of such concepts. Their limitations and relativities may suggest that other descriptions of partnership and negotiated goal-setting, while based on respect for autonomy, reflect more modern and ideal multi-disciplinary practices. Discussion should extend beyond the 'classic' participants of patient and doctor to a more realistic picture where other health carers are included. It is therefore apposite that other professional relationships are considered as they affect areas of doctors' and patients' responsibilities. Such partnership between members of the team may not be without problems and conflict, but the principle of negotiated agreements could result in more long-term harmony, and greater patient welfare.

Allied Health Personnel↗
PubMed1999

[The phenomenon of "evidence-based medicine"].

Evidence-based medicine originates in 1992 when the proliferation of medical publications and other clinically relevant information was neither organized nor efficiently employed, aggravating concerns on the ethical duty of its incorporation to clinical decision making. Development of clinical research and its methods have changed the nature of medical knowledge, "changing the paradigm" leading to need for changing both practice organization and the contents of continuous education. This is the "objective basis" of evidence-based medicine. Since evidence-based medicine emphasizes the clinician's judgement and asses the knowledge basis of his practice, reinforces professional autonomy compared to other considerations, thus having political and ethical implications. Evidence-based medicine redefines in its own terms professional excellence.

Bioethics↗
PubMed1994

[The emergence of a professional identity among Quebec nurses, 1890-1927].

As part of an important Western trend, the professionalization of Quebec nurses was initially characterized by the enormous challenge of rallying all nurses into adhering to a single professional model. The story starts in 1895 when an elite corps of English-Protestant nurses established the Canadian Nurses Association. These graduates of the Montreal General Hospital were quite active within the English Canadian nursing movement promoting the ideal of the trained nurse, conceived by Florence Nightingale in England. They also fought for professional registration, in keeping with the American trend. The task of rallying French Catholics to the cause of registration soon proved difficult however, as disparities between schools and associations as well as between linguistic and religious groups became apparent. The 1920 Nurses Registration Bill did not put an end to the conflict, unfortunately. By an immediate and controversial alliance, French Catholic physicians and nurses attempted to contest the law which penalized them. If the alliance between them proved beneficial to French-Catholic nurses then, it cost the latter their professional autonomy.

Canada↗
PubMed1992

Physician satisfaction, professional characteristics and behavior formalization in hospitals.

In this paper, an analysis is presented of professional and bureaucratic predictors of physician satisfaction. Results from 210 physicians in 17 medical departments of university hospitals support the hypotheses that both professional attitudes and formal structuring of work activities have a positive effect on physician satisfaction. It is shown that behavior formalization, preference for professional autonomy and the time spent on patient care activities within medical departments are positive predictors of satisfaction with work environment, while 'traditional' professional attitudes like craftsmanship and client service have more impact on satisfaction with patient demand. Certification is a strong positive predictor of work load satisfaction. Satisfaction with work environment was the most important factor in explaining other satisfaction dimensions. This finding supports the hypothesized 'buffering' effect of the affective climate or 'feel' of the professional work environment in hospitals. The implication of the findings is, that in the process of bureaucratization of medical practice in hospitals, specific attention should be paid to the maintenance of professional values as guidelines for professional work and to the maintenance of a good affective work environment for professionals in order to prevent dissatisfaction with patient demand and work load.

Attitude of Health Personnel↗
PubMed2004

Good physicians from the perspective of their patients.

BACKGROUND: It is not currently known what is the patient's viewpoint of a "good" physician. We set out to define patient's priorities regarding different physician's attributes in 3 domains important in medical care. METHODS: Patients hospitalized or attending clinics at a large teaching hospital selected the 4 attributes that they considered most important out of 21 listed arbitrarily in a questionnaire. The questionnaire included 7 items each in the domains of patient autonomy, professional expertise and humanism. RESULTS: Participating patients (n = 445, mean age 57.5 +/- 16 years) selected professional expertise (50%), physician's patience and attentiveness (38% and 30%, respectively), and informing the patient, representing the patient's interests, being truthful and respecting patient's preferences (25-36% each) as the most essential attributes. Patient's selections were not significantly influenced by different demographic or clinical background. Selections of attributes in the domain of patient's autonomy were significantly more frequent and this was the preferred domain for 31% and as important as another domain for 16%--significantly more than the domain of professional expertise (P = 0.008), and much more than the domain of humanism and support (P < 0.0005). CONCLUSIONS: Patients studied want their physicians to be highly professional and expert clinicians and show humaneness and support, but their first priority is for the physician to respect their autonomy.

Adult↗
PubMed1995

[Qualitative research in health: methodological reflections on the oral report and narrative production in a study about the medical profession].

Qualitative research as applied to Public Health and Social Medicine is studied. The project is based upon research into the historical transformation of medical professional autonomy as medicine shifted from the "liberal" practice to recent "technological" medicine. Field research used unstructured recorded interviews to gather personal testimonies about the professional histories of physicians who graduated between 1930 and 1955. These testimonies are technically classified as "oral accounts" and were registered as free narratives. This study analysis how accounts can express the physicians' self-representations of their daily work and simultaneously write the history of medical practice. Further, the unstructured interview is evaluated as an instrument yielding free narratives and life accounts.

Humans↗
PubMed1988

A model for teaching about interdisciplinary practice in health care settings.

The authors describe a continuum of collaborative interdisciplinary professional practice which can be used for teaching students in health care settings. Choices about the nature of interdisciplinary practice can be made not only on the imperatives of patient care but also on the interpersonal characteristics of health care providers as well as their needs for professional autonomy. This model can enable students to make clear career decisions about the types of interdisciplinary practice best suited to their interpersonal style and professional needs.

Health Occupations↗
PubMedDate not supplied

[Deprofessionalization or reprofessionalization: a study comparing law and medicine].

The author discusses and compares the transformations in the profession of lawyers in the United States of America and the doctors in Brazil according to a theoretical analysis based upon the classical theory of the Sociology of the Professions. The discussion about the deprofessionalization of Medicine is conducted along some of the characteristics outlined by the theory. The author concludes that the challenge that faces medicine is a kind of re-organization that will change necessarily the profession as we know it today, but this change will not affect the professional autonomy or any other of its essential characteristics.

Brazil↗
PubMedDate not supplied

Shared governance. Opportunities for intravenous nurses.

Intravenous nurses must find their work both satisfying and fulfilling, emotionally and professionally. Autonomy is a vital component of long tenure and satisfaction. Nurses need to get involved in decision making, setting standards, and ensuring quality. Shared Governance, a professional nursing practice model, provides the structure for accountability for nursing practice and participation in the process. I.V. nurses have a unique opportunity to be in the leadership forefront because of their mobility and visibility within their institutions.

Decision Making, Organizational↗
PubMed1987

Incentives and obligations under prospective payment.

In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I analyze several definitions of the physician's professional obligation and discuss four conditions that morally qualify the obligation. And fourth, I explore why the views of economists and physicians differ so strikingly on the question of economic incentives. In the process of this analysis, I argue that criticisms of prospective payment systems which are premised primarily on the conflict between economic incentives to contain cost and the professional obligation of beneficence are probably as much a matter of rhetoric as serious argumentation.

Beneficence↗
PubMed1993

The attitudes of patients and physicians towards placebo treatment--a comparative study.

Placebo treatment in clinical practice can be given either in order to comply with the wishes of the patient, or with the purpose of doing good and not causing harm. In the former instance, the procedure may be in accordance with the interests of the patient, yet be in conflict with the interests of the medical profession. In the latter instance, the procedure presupposes that in most cases the patient has not been informed of the nature of the treatment; this type of procedure may jeopardize a trusting patient-doctor relationship. Therefore, it is of interest to investigate both the extent to which patients and physicians feel they can accept placebo treatment and a paternalistic attitude, and in which particular situations. In order to shed some light on this matter, we compiled a questionnaire built around three case histories which problematize placebo treatment and paternalistic acts. The questionnaire was distributed to 100 patients and 100 physicians. 83 patients and 94 physicians responded. The results show that patients and physicians do not automatically follow specific group interests. Physicians are more inclined to respect the patient's option to refuse medical treatment than the patients are inclined to respect a physician's professional autonomy. Patients appear more to be paternalistic in their judgements than physicians, but one cannot rule out the possibility that the answers of the physicians reflect the fact that placebo treatment represent a socially undesirable behaviour. We conclude that theoretical and normative analyses of the perspective of the actors ought to be supplemented by empirical research.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Observation: the original sin of mental health nursing?

The assessment and management of 'risk' has become a focal aspect of contemporary mental health practice. Given their proximal relationship with service users, nurses most often represent the 'front line' of risk management, typically expressed in hospital settings through the bureaucratic process of 'observation'. Much of the available 'evidence' is highly critical of this practice and service user researchers, in particular, have repeatedly called for alternatives. This paper reviews the historical and inter-professional dimensions of the practice of observation, contrasting this with mental health nursing's search over the past two decades, at least within the UK, for professional autonomy. Contemporary mental health nursing is trapped in an anachronistic relationship with psychiatric medicine. If nursing is to prosper, nurses must address the complex issues underlying this inter-professional relationship. The authors describe the development of 'bridging'--a radical alternative to observation practice, which represents a means of managing 'risk' and a way that nurses might develop their interpersonal relationships with people deemed to be at risk, thereby asserting the power of 'caring'.

Defensive Medicine↗
PubMedDate not supplied

Oncology nursing protocols: a step toward autonomy.

Many professional nurses see the lack of autonomy, an essential element in the definition of a professional, as a deterrent to achieving true professional status. Autonomy in nursing is seen in the context of self-governance, shared governance, and nurses' participation in the decision-making process with regard to patient care problems and/or responses to care. To promote staff nurses' decision-making participation and increase their responsibility and accountability on a 32-bed oncology unit, Oncology Nursing Protocols were developed and implemented.

Clinical Protocols↗
PubMedDate not supplied

The health and wellbeing of mental health professionals.

We examine dimensions of job satisfaction, occupational burnout and general health of a sample of 123 mental health care professionals (psychiatric nurses and nursing assistants, and smaller professional groups such as social workers, occupational and recreational therapists and psychologists) employed at a large Canadian psychiatric hospital. Psychiatric nursing assistants exhibit more of the consequences of job-related stress (less job satisfaction, greater occupational burnout, greater incidence of negative physical and psychological symptoms of stress) relative to the other professional groups in the sample. This may be linked with their position within the hospital organization (having less authority and professional autonomy relative to the other groups), affecting their ability to cope with job-related problems and stresses experienced by all direct care workers. We examine attitudes of mental health professionals towards organized support groups at the hospital, which could provide one forum for the open discussion (and potential resolution) of job-related stresses and problems experienced in hospital settings.

Adult↗
PubMed2000

Beyond a code of ethics for bioengineers: the role of ethics in an integrated compliance program.

Developing a code of ethics for biomedical engineering professionals is a very important first step in clarifying their professional obligations and in helping to establish and maintain their professional autonomy. However, it is only that--a first step. Unless ways can be found to bring the principles contained in this code to bear on the everyday decision making of these professionals, this code will have little practical influence. One effective way to bring a code of ethics to bear on decision making is to integrate it into organizational compliance programs. Such programs often have company-specific codes of ethics attached to them, and these company-specific codes can either include the principles contained in the professional code of ethics or reference the code by title. After defining what I take to be the challenge of compliance, I consider four (4) roles that codes of ethics and ethics generally can play in helping to create and sustain programs at the organizational level that integrate ethics and compliance and thereby aim to make a practical difference in the everyday decision making of bioengineering professionals. These four roles include: framing the program, grounding the standards, achieving critical distance, and creating and sustaining an ethical organizational culture.

Biomedical Engineering↗
PubMedDate not supplied

[Professional trajectory of obstetric nurses from the University of Sao Paulo College of Nursing: a focus on social phenomenology].

This study aimed at understanding the experiences of students that were enrolled in the Obstetric Nursing Program offered by the University of São Paulo College of Nursing. Data were collected through interviews with the former students, who had different life histories after their graduation. The proposal of this research was based on Alfred Schutz' Social Phenomenology framework, considering that people express, in their actions socially experienced, the meaning of these experiences. Results showed two social types: the ones who continue in the area because they like what they do and the ones who do not work in the area as they were disappointed with the lack of professional autonomy. The reasons mentioned offer important guidelines that must be analyzed by the ones who are still working in the area, by the class associations and the ones who are responsible for the capacitation of these professionals.

Obstetric Nursing↗
PubMedDate not supplied

Physician practice management companies: should physicians be scared?

Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

Contract Services↗
PubMed2002

Training doctors for professionalism: some lessons from teaching clinical medical ethics.

Medical professionalism encourages physicians to place their patients interests above self-interest. In recent years, many medical organizations, including the American Board of Internal Medicine (ABIM), Association of American Medical Colleges (AAMC), and the American Medical Association (AMA), have developed initiatives to strengthen medical professionalism. By emphasizing professionalism, supporters of these initiatives hope that medicine and physicians may recapture professional autonomy, decrease public criticism of medicine and physicians, and help physicians regain the moral high ground in the unending struggle with payers, both public and private. One crucial question facing medical educators is whether the concepts of professionalism can be taught to medical students and residents. This paper draws upon the author s thirty years of experience in teaching clinical medical ethics to provide guidance on how to teach the concepts of professionalism to students and residents.

Ethics, Clinical↗