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PubMedDate not supplied

The effects of malpractice insurance on certified nurse-midwives. The case of rural Arizona.

This study of CNMs in rural Arizona indicated malpractice insurance has had a negative effect on the practice of nurse-midwifery. In 1987 a telephone survey was conducted to assess the effects on the practice patterns of Arizona's 21 rural CNMs, four of whom had had previous experience as licensed midwives. Results indicated 24% had been refused medical back-up by a physician. Although 10% were personally responsible for paying malpractice insurance premiums, they were not able to afford the cost and were going "bare." Nearly 30% had changed their employment status from private practitioner to salaried employee, suffering a decrease in professional autonomy, flexibility of hours, quality of lifestyle, benefits, and income. Unless there are changes that result in lower malpractice insurance premiums or greater compensation and benefits, there likely will be a diminishing number of entries into an increasingly stressed profession.

Arizona↗
PubMedDate not supplied

Professional practice for the extended care environment: learning from one model and its implementation.

This article describes a model of professional nursing governance in an 800-bed long-term care facility and discusses the model's implications for nursing education. Seventy registered nurses, 330 ancillary staff, and 50 other health professionals provide care for about 100 residential, 350 intermediate, and 350 skilled nursing care patients in the facility. The governance model includes a registered nurse organization that determines all standards for nursing practice, policies governing practice, and nursing clinical programming. Each registered nurse has 24-hour, seven-days-a-week authority and accountability for a patient caseload. Average annual turnover of registered nurses is 5 per cent, and the average length of employment among the nurses is 7.5 years. Since the model was implemented, measures of patient welfare have increased. Experience with the governance model indicates that nursing education curricula need to increase students' (1) understanding of professional autonomy and accountability, (2) understanding of the role of nursing diagnoses and interventions to structure nursing knowledge, (3) skills of diagnostic and intervention reasoning, (4) consensus decision-making abilities, (5) knowledge of organizational structures and mechanisms for governance, and (6) mastery of technical intervention skills.

Humans↗
PubMed1987

Organizational characteristics that facilitate the use of nursing diagnoses.

The effective use of nursing diagnosis is facilitated by an organizational structure that accommodates nursing professional autonomy and accountability. Nurse executives who plan for the implementation of nursing diagnosis should expect nurses to develop as an autonomous and accountable collective. There should be shared leadership to achieve mutual goals, make decisions about nursing practice, socialize its members, build and maintain effective communication processes, and use the process of change to effect and maintain the model of practice. When these structures and processes compose the organizational milieu, nursing diagnoses will be used and will promote the further development of nurses as autonomous and accountable professionals who develop and use knowledge to deliver quality client care.

Communication↗
PubMed1997

In uncharted waters: confronting the culture of silence in a residential care institution.

This paper describes a study grounded in feminism, which explored the experiences of three registered nurses who were employed in a residential care institution in which they believed the standard of care to be unacceptably poor. Ultimately, the nurses became 'whistle blowers'. Data surrounding these events were gathered through serial encounters and analysed using feminist interpretive methods. Three distinct phases were revealed: (i) trepidation and optimizm; (ii) barriers and obstacles; and (iii) disillusionment and defeat. It was in this final phase that the whistle blowing occurred. For these women, whistle blowing was an intervention of last resort; a stressful and negative event that carried personal and professional cost. Issues pertaining to professional autonomy and patient advocacy are raised, together with concerns surrounding the appropriation by business people of the language and images of nursing, and the power of these people to negatively impact upon nursing practice.

Adult↗
PubMed1996

[General practitioners, community physicians and hospital physicians--how different are they?].

In 1993, 9,226 practising physicians in Norway received extensive questionnaires about their health, working and living conditions. In this article we compare municipality employed community physicians (n = 972), general practitioners in private practice (n = 869), and hospital physicians (n = 3,160) with regard to demographic variables and their experience of stress, professional autonomy and job satisfaction. General practitioners report higher job satisfaction and more autonomy than community and hospital physicians, whereas community physicians seem to have a somewhat higher stress level than the two other categories. The experience of general well being, however, is the same in the three groups. General practitioners also spend more time with patients, and are much more satisfied with their income.

Burnout, Professional↗
PubMed2001

Nurses' perceptions of physiotherapists as rehabilitation team members.

OBJECTIVE: To investigate nurses' perceptions of physiotherapists as members of the rehabilitation team. This study arose from the current emphasis that is placed on good multidisciplinary teamwork for effective rehabilitation and the awareness that different team members often have different perceptions of their respective roles within the team. DESIGN: Semi-structured interviews, the results of which were then subject to content analysis. SETTING AND SUBJECTS: Experienced rehabilitation nurses in two rehabilitation wards within a National Health Service Trust. RESULTS: Nurses perceived the role of physiotherapists as being concerned with mobility and movement, and valued the therapists' knowledge and skills in these areas. They felt, however, that physiotherapists had insufficient understanding of the demands and pressures of nursing practice and lacked recognition of the nurses' professional autonomy in decision-making in rehabilitation. Nurses viewed nursing and physiotherapy as two quite distinct and different roles within rehabilitation, despite some role overlap. Physiotherapy was perceived as specific and measurable, while nursing was perceived as generalized and undefined. These perceptions extended to their views on patient-staff interactions and organizational structures. Some of the differences, such as organizational structures, created barriers to rehabilitation. Others, such as physiotherapy expertise in mobility, were valued for their contribution to rehabilitation. Areas were identified where the two professions can assist each other in professional skills. CONCLUSION: Nurses valued the role and contribution of physiotherapists, but identified areas in which barriers existed to effective interprofessional working, particularly in relation to organizational factors and interprofessional relationships.

Adult↗
PubMed2002

Policy, organisation and practice of specialist old age psychiatry in England.

OBJECTIVE: To describe and compare service arrangements in old age psychiatry across England according to three broad domains: (i) levels of professional autonomy; (ii) degree of community orientation (delivery of and links with community services) and (iii) degree of integration between health and social care provision. DESIGN: Cross sectional survey of consultants in old age psychiatry in England. Potential respondents were sourced from the Royal College of Psychiatrists and Regional Advisers in Old Age Psychiatry. MEASURES: A self-administered postal questionnaire was piloted and refined. The questionnaire domains listed above reflect core policy issues for older people's services, covering the domains above. RESULTS: There is marked variation in the deployment and use of professional staff in old age psychiatry, ranging from open access to multidisciplinary assessment to services only accessible by clinician referral. Patterns of linkage with primary care are likewise variable with only half of services providing the types of support recommended by the Audit Commission (2000). Community orientation was evident to a considerable extent in support to care homes and assessment practices. Links between health and social care appeared strongest in terms of liaison and training. There was less evidence of more formal integration through shared management of staff or for links with intensive home support for those with dementia. CONCLUSIONS: The data provide a unique picture and benchmark of the configuration of old age psychiatry, a core element of mental health care in old age, after some 25 years of development in the UK. There appears to be substantial variation on all three domains of comparison.

Aged↗
PubMed1990

The attitudes of physicians toward health care cost-containment policies.

This study analyzed physician attitudes toward a variety of health care cost-containment policies, based on a national survey of 500 practicing doctors in 1984. Reactions to 23 policies were simplified to nine common themes using factor analysis. Although there was great diversity in views, physicians generally favored policies that increased responsibilities or costs for patients and disfavored policies that decreased physicians' autonomy of practice. For most policies, practice characteristics (specialty; type of practice, e.g., solo or group, salaried or self-employed; membership in medical societies; or percent of time in direct patient care) were not significant determinants of attitudes. Physicians who were more "conservative" with respect to the health care system tended to favor policies that shifted cost to patients, while more "liberal" doctors were more supportive of using prepaid health care, reducing the intensity of care, or selecting efficient providers. Overall, this study indicates that physicians still place a high value on their professional autonomy.

Attitude of Health Personnel↗
PubMed1991

Autonomy, religious values, and refusal of lifesaving medical treatment.

The principal question of this paper is: Why are religious values special in refusal of lifesaving medical treatment? This question is approached through a critical examination of a common kind of refusal of treatment case, one involving a rational adult. The central value cited in defence of honouring such a patient's refusal is autonomy. Once autonomy is isolated from other justificatory factors, however, possible cases can be imagined which cast doubt on the great valuational weight assigned it by strong anti-paternalists. This weight is sufficient, in their estimation, to justify honouring the patient's refusal. There is thus a tension between the strong anti-paternalist's commitment to the sufficiency of autonomy and our intuitions respecting such cases. Attempts can be made to relieve this tension, such as arguing that patients aren't really rational in the circumstances envisaged, or that other values, such as privacy or bodily integrity, if added to autonomy, are sufficient to justify an anti-paternalistic stance. All such attempts fail, however. But what does not fail is the addition of religious freedom, freedom respecting a patient's religious beliefs and values. Why religious freedom reduces the tension is then explained, and the specialness of religious beliefs and values examined.

Attitude to Health↗
PubMed2002

Consent, sectionalisation and the concept of a medical procedure.

Consent transforms an otherwise illegitimate act into a legitimate one. To be valid, however, it must be adequately informed. The legal requirement is vague and provides little assistance in predicting when it will be satisfied. This is particularly so when a patient consents to a procedure and the physician subsequently varies one of the components of that procedure. Using three legal judgments and one General Medical Council (GMC) decision as a springboard, I have explored the concept of a medical procedure within the context of consent and developed a theoretical model to elucidate a more predictable and consistent informational requirement.

Decision Making↗
PubMed1991

Prescriptive authority for nurse-midwives. A historical review.

The profession of nurse-midwifery has undergone a major transformation in the struggle for professional autonomy. Inherent in this struggle is the profession's attempt to obtain the legal authority to prescribe drugs, devices, and treatments. This article traces the barriers to practice and the authority to prescribe from a historical perspective. Also explored are the problems inherent with the language and the implementation of relevant federal and state statutes.

Certification↗
PubMed1978

Evolving social work roles in health care:The case of discharge planning.

This paper examines changing definitions of social work's role in health care and the continuing struggle for professional autonomy, in the context of the profession's responsibility for discharge planning. Planning for posthospital care is seen to be a major function of social work today and of traditional importance since social work's inception in the hospital setting. Major role and value conflicts are highlighted in a review of social work's traditional ambivalence toward the role of discharge planner and current recognition of the initial contribution of the profession to the continuing care of hospitalized patients.

Hospital Administration↗
PubMed2006

The responsibilities and rights of dental professionals 3. Professional rights.

Professional status, professional autonomy, clinical freedom, self-regulation and the right to serve patients and the community seem to be the main rights of dentists. Although they simply may be seen as privileges that are related to being a dentist, these rights cannot be considered independent from dentists' roles and responsibilities. They are, in fact, valuable tools that serve dentists to meet their broad responsibilities that arise from the 'social contract' between the profession and the public.

Dentist-Patient Relations↗
PubMedDate not supplied

The moral costs of the Ontario physicians' strike.

In a strike to permit extra billing, physicians in Ontario, Canada, sought to balance their concerns for professional autonomy with their primary call to beneficence. But the right to reasonable compensation within a nationalized health care system is not on the same moral plane as the public's right to health care. Having failed to convince either the provincial government or the public of the soundness of their position, Ontario's doctors must now repair the damage done to the relationship with their patients.

Economics, Medical↗
PubMed2003

International profiles of dental hygiene 1987 to 2001: a 19-nation comparative study.

AIM: The purpose of this international longitudinal study is to examine patterns and monitor trends and changes in dental hygiene. METHOD: Information was collected from national dental hygienists' associations through surveys conducted in 1987, 1992, 1998 and 2001. Sample size increased from 13 countries in 1987 to 22 by 2001--of which 19 were included in the analysis. RESULTS: Overall, characteristics of the profession were remarkably similar; most noteworthy was the scope of dental hygiene clinical practice. Regarding historical development, educational programmes and professional organisation, the profession was more similar than dissimilar. Greater variation was evident regarding numbers, distribution, regulation, workforce behaviour, predominant work setting, and remuneration. Over the relatively short 14-year period, several observations were of particular interest: marked increase in the supply of dental hygienists, accompanied by a decline in their ratio to populations and to dentists and a high workforce participation rate; increase in baccalaureate dental hygiene programmes, with a gradual shift from the diploma as the entry-level qualification; and increase in scope of practice and professional autonomy, including for Europe and North America in particular, a decline in mandated level of work supervision and a slight but gradual increase in independent practice. CONCLUSION: By 2001, the profiles reflected the vast majority of the world's population of dental hygienists. Rate of change varied across the countries examined; however, the nature of the change overall was consistent, resulting in a continuing homogeneity in the profession worldwide. Observed trends, changes and persistent issues have implications for service accessibility and technical efficiency and should continue to be monitored.

Asia↗