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PubMed1997

Developing shared learning in multiprofessional health care education: for whose benefit?

A selection of examples from programmes of shared learning indicates that the movement towards collaboration among health care professionals is thought of as a good thing and ways and means of achieving it need to be fostered. But just who are the supposed beneficiaries of such collaboration and should more work be done in analysing the assumptions that underpin much of this work? A literature review indicates a number of threats as well as opportunities for health care professionals emanating from this work, each of which needs careful consideration by educationalists. A brief analysis of the intentions of the teachers on a BA(Hons) Health Care Studies programme indicates that their approach may be useful in respecting the professional autonomy of participants by not pressing too hard for collaboration, but allowing them as individuals to select relevant learning from and about each other for themselves. History indicates that collaboration is not new and the specific, specialized contributions of professionals have a long history in holding the organization of health care services together. The organizational skills of nurses and others should not be lost but should be fostered carefully so that they are not damaged but included in an atmosphere of non-exclusion of all interested stakeholders in the National Health Service. The authors recommend that the best practices of shared learning in multiprofessional programmes be extended to benefit consumers, administrators and politicians in joint initiative programmes which could be of benefit to all.

Cooperative Behavior↗
PubMed2005

A guide to defining the competence required of a consultant in clinical chemistry and laboratory medicine.

A definition has been agreed for the most senior professional (consultant) in clinical chemistry and laboratory medicine. A model job description for a consultant has been determined, which is intended to act as a toolkit to assist employing authorities and professional bodies to define the role of individual consultant posts. A total of 86 competences for a consultant have been designated and expressed in the form of simple generic proficiency standards. These competences have been allocated to six broad areas: clinical [13]; scientific [15]; technical [12]; communication [12]; management and leadership [20]; professional autonomy and accountability [14]. The competences are intended to be illustrative rather than definitive and to enable the duties of any consultant post to be defined. Assessment of competence is likely to entail consideration of qualifications, registration status, continuing professional development and performance review. The project is intended as a guide to European societies of clinical chemistry and laboratory medicine. The guide should be capable of local interpretation to encourage a greater degree of commonality in the role of the consultant whilst protecting national identity. The guide should stimulate international understanding and collaboration and contribute to an overall improvement in the quality of practice.

Chemistry, Clinical↗
PubMed1993

Feminist ethics and cultural ethos: revisiting a nursing debate.

In this article the author re-examines from a feminist perspective the now well-known debate between Yarling and McElmurry and Bishop and Scudder. The central point of this critique is that a feminist ethics requires we attend to the social and institutional form of life in which given practices exist. The endorsement of a single concept, even the extremely important one of care, is insufficient for a nursing ethics. Without attention to the institutional factors, which support or reform care, we have only a feminine ethics. In this author's view, nursing needs a feminist ethics.

Culture↗
PubMed1993

Towards a theory of student-centred nurse education: overcoming the constraints of a professional curriculum.

Student-centred learning is an educational philosophy which became popular during the 1960s, but which has gradually fallen from favour as the educational and political climate has changed over the years. This is particularly true of nursing, where the transition to higher education ushered in by Project 2000 has signalled a return to traditional teaching methods such as the lecture and the seminar. This paper argues that the current demands for holistic practice, professional autonomy and primary nursing can best be met by educationalists by employing a student-centred approach to learning. However, it is recognised that a radical student-centred approach will conflict with the constraints imposed on curriculum writers by a professional body, and that a modified strategy is required. The paper goes on to identify several of the more pressing constraints, and suggests some methods for overcoming these problems within a student-centred framework, while maintaining the requirements of a professional training which confers upon the students a license to practise. The paper concludes by suggesting that most problems will only be identified once courses are up and running, and that a new student-centred framework can only emerge from educational practice. Teachers and curriculum writers are therefore encouraged to come together to share ideas and experiences in order to carry forward the theory and practice of student-centred nurse education.

Curriculum↗
PubMedDate not supplied

A realistic approach to the evaluation of the quality management movement in health care systems: a comparison between European and African contexts based on Mintzberg's organizational models.

The quality movement is gaining momentum worldwide in the field of health care. Initiated in industrialized countries, it steadily grows in Africa. However, there is no evidence that approaches designed to address issues in a given organizational context have the same effect in another one where issues present differently. Along the epistemological paradigm of realistic evaluation proposed by Pawson and Tilley, we use Mintzberg's organizational models to compare the configurations of European and African health care organizations and the trends followed by the quality management movement in both contexts. We illustrate how European health systems traditionally emphasize professional autonomy while African health systems are structured as command and control hierarchical systems. We illustrate how the quality movement in Europe emphasizes standardization of procedures, a characteristic of a mechanistic organization, while excessive standardization is part of the quality problem in Africa. We suggest that instilling professionalism may be a way forward for the quality movement in Africa to improve patient focus and responsiveness of responsible professionals. We also suggest that our interpretation of broad trends and contrasts may be used as a useful departure point to study the wide contextual diversity of the African experience with quality management.

Africa↗
PubMed2005

Informal medicine: ethical analysis.

CONTEXT: Doctors have been known to treat or give consultation to patients informally, with none of the usual record keeping or follow up. They may wish to know whether this practice is ethical. OBJECTIVE: To determine whether this practice meets criteria of medical ethics. DESIGN: Informal medicine is analysed according to standard ethical principles: autonomy, beneficence and non-maleficence, distributive and procedural justice, and caring. SETTING: Hospital, medical school, and other settings where patients may turn to physicians for informal help. CONCLUSION: No generalisation can be made to the effect that informal medicine is or is not ethical. Each request for informal consultation must be considered on its own merits. GUIDELINES: Informal medicine may be ethical if no payment is involved, and when the patient is fully aware of the benefits and risks of a lack of record keeping. When an informal consultation does not entail any danger to the patient or others, the physician may agree to the request. If, however, any danger to the patient or others is foreseen, then the physician must insist on professional autonomy, and consider refusing the request and persuading the patient to accept formal consultation. If a reportable infectious disease, or other serious danger to the community, is involved, the physician should refuse informal consultation or treatment, or at least make a proper report even if the consultation was informal. If agreeing to the request will result in an unfair drain on the physician's time or energy, he or she should refuse politely.

Attitude of Health Personnel↗
PubMed1993

Pediatric psychologists' perceptions of their work settings.

Describes the results of a survey of pediatric psychologists' perceptions of their work settings. Respondents (n = 261) described heterogeneous work settings, professional activities, expectations for workload and administrative arrangements. Clinical activities were prominent, accounting for nearly half the respondents' time. Respondents generally reported high levels of overall satisfaction with their work environments. Highest ranked sources of satisfaction included professional autonomy, patient care, and relationships with colleagues. Highest ranked sources of dissatisfaction included lack of time for research, salary, and patient care workload. Pediatric psychologists in private practice reported higher work satisfaction than those in other settings. Findings have implications for the work-related functioning of pediatric psychologists that should be addressed in research and professional activity.

Adult↗
PubMed1987

The deprofessionalization of medicine. Causes, effects, and responses.

In this article, we examine the components of medical professionalism; identify the roots of the loss of professional autonomy by physicians in the United States--a process that, in effect, is leading to the deprofessionalization of American medicine; discuss why such deprofessionalization is undesirable for the society; and explore three health care delivery systems and their effects on deprofessionalization. We suggest that a system based on organizations set up and directed by physicians will be the system that best preserves medical professionalism and serves the public interest.

Foundations↗
PubMed1996

The Catholic physician and the teachings of Roman Catholicism.

The relationship between Catholic physicians and the teaching authority of the Church is inquired into through an exploration of the special relationship which exists between medicine and religion. Evolution of the relationship between Church subject and Church authority, with a view to a correct interpretation of the relationship between the Catholic physician and the Church, is characterized by the healthy, moderate autonomy recognized by the Second Vatican Council.

Catholicism↗
PubMed1991

The autonomy of nurses in high dependency care. Conflicts of loyalties and their consequences for patient care.

The aim of this study is to enquire into the kind of ethical dilemmas reported by nurses in the high dependency health care sector. Nurses from different intensive care units at one British hospital were interviewed. The interviews, which were tape recorded, show that nurses often found themselves in conflict between the patient's interests and those of other people, such as physicians, relatives, other patients, colleagues, etc. Competing loyalties and role conflicts contributed to complicate the nurses' ethical problems.

Conflict, Psychological↗
PubMed1994

Modifying autonomy--a concept grounded in nurses' experiences of moral decision-making in psychiatric practice.

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of ethical decision-making in psychiatric practice.

Beneficence↗
PubMed1990

Professional role and autonomy in physiotherapy. A study of Swedish physiotherapists.

A study of 163 physiotherapists' conception of their professional role and autonomy and the implications for their work has been completed. About half (55%) felt that physicians and other staff members primarily expected them to act as independent professionals, while about one-third (34%) felt that they were expected to undertake treatment after referral from or discussion with the physician. Most physiotherapists (86%) were firmly in control of their treatment methods, but had somewhat restricted freedom in deciding whom to treat, and when to terminate treatment. The majority (96%) regarded their professional tasks as being important for others. Few (14%) had carried out any systematic evaluation of their methods and results--hence few obtained any objective feedback from their work, which is believed to affect the quality of work, as well as work motivation and job satisfaction.

Adult↗
PubMed2004

The impact of graduation from psychoanalytic training.

To examine candidates' experience of graduation from psychoanalytic training, 1997-2001 graduates of the Columbia University Center for Psychoanalytic Training and Research were sent a confidential questionnaire about their first year after analytic training. Of this group, 72 percent (23/32) returned the survey. Questions focused on the impact of graduation on time availability, net income, professional advancement, and sense of personal and professional autonomy. Graduates from analytic training were found to have more income in their first postgraduate year, a mean increase of 30,000 dollars, and more available time, a mean increase of sixteen hours. Increased earnings came primarily from seeing more patients during the time made available with the end of classes. In addition, graduates did not terminate their control cases or stop supervision. Graduates most valued their sense of professional accomplishment and ability to spend more time with their families. Although graduates also experienced relief from evaluation pressure, they did not rank this high in importance. For candidates, graduation profoundly impacts the structure of professional and personal life, but does not mean an end to learning.

Adult↗
PubMed1983

Psychiatric hospitalization in Poland.

An overview of psychiatric hospitalization in Poland is presented in the context of Polish political and socio-cultural developments. The areas addressed include: the characteristics of the patient population; the organization of Polish mental health service; the nature of psychiatric treatment; psychiatric legislation; patients' rights; and the training and social status of the various mental health professionals. In spite of the meager resources allocated to mental health services, and the consequent staff shortages and overcrowded, drab living conditions in psychiatric facilities, the care afforded patients is generally humane and nonoppressive. Polish psychiatry has succeeded in maintaining its professional autonomy and has assumed a leadership role in the modernization of its service delivery system.

Commitment of Persons with Psychiatric Disorders↗