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Results for “Professional Autonomy”

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PubMed1996

Medical futility decisions and physicians' legal defensiveness: the impact of anticipated conflict on thresholds for end-of-life treatment.

Does legal defensiveness significantly influence physicians' assessments of medical futility, in ways that may adversely affect the rights of patients and their family members to make their own health care decisions at the end of life? This exploratory study addresses that question with attitudinal data from a survey of 301 physicians practicing in academic medical centers in Texas. The majority of respondents indicated that the probability of success defining futile treatment should hypothetically be lower for patients with potential to benefit more from life-sustaining medical intervention (e.g. typically patients who are sentient), and higher for patients with less potential to benefit (e.g. patients in a persistent vegetative state). That is to say, physicians normally perceive longer odds to be worth pursuing for greater potential gain - a position that seems logically consonant with patients' rational self-interest. However, physicians with an attitude of extreme legal defensiveness did not fit this pattern. Rather, they tended to define futility in a manner that would maximize the physician's latitude to justifiably oppose patient preferences for end-of-life treatment abatement. These findings suggest that some physicians assume an adversarial position in their consideration of medical futility issues - an attitude that anticipates conflict with terminally-ill patients or their surrogates. The analysis presented here is not definitive, but at least raises the question of whether some physicians may inappropriately use their prerogative over medical futility as a means to guard their professional autonomy against perceived threats.

Adult↗
PubMedDate not supplied

Differentiated practice: the evolution of professional nursing.

Differentiated practice identifies and uses three distinct nursing roles to create a comprehensive nursing care delivery system that meets client needs across the health care continuum. Clearly defined associate degree in nursing, bachelor's of science in nursing, and master's science in nursing competencies present career opportunities for professional nurses at the bedside providing, integrating, or managing client care as well as options in management, education, and regulation. An evolutionary paradigm shift required of all nurses is the awareness that each nurse is not the whole of nursing, but rather each nurse contributes to the whole of nursing. A nursing community comprised of differentiated roles that are mutually valued and well integrated will position nursing as a powerful force in meeting the diversity and complexity of health care needs in contemporary society.

Career Choice↗
PubMedDate not supplied

A behavioral inventory for professionalism in nursing.

The purpose of this article is to describe the development of an evaluative behavioral inventory based on Miller's Model for Professionalism in Nursing and to report results of an investigation of registered nurses (RNs) in eight western states. The Professionalism in Nursing Inventory was mailed to 1,600 computer-generated randomly selected names of RNs, resulting in 515 complete and usable inventories. Results indicated that the majority of respondents demonstrated professional behaviors in continuing education activities, autonomous quality assurance participation, community service, and a theory-based nursing practice. Behaviors not considered a priority with a majority of the respondents were publication, research activities, and participation in the constituent state organizations of the American Nurses Association. Approximately 4 per cent of the respondents commented that employing agencies and administrative (nursing) personnel were concerned with output, not professional behaviors. More than 91 per cent of these respondents believed that a self-evaluative instrument for professional behaviors was necessary and that the tool should be developed by nurses.

Adult↗
PubMedDate not supplied

The evolution of a profession: where do boards of nursing fit in?

Differentiation between the structure and functions of Boards of Nursing and the professional association is important to understanding the evolution of nursing as a profession. This descriptive exploratory study revealed that Boards of Nursing usually have 5 members who are appointed by and can be removed by the governor of the state. All Boards are responsible for education and licensing at the professional entry-level but may not be responsible beyond that level. In contrast to the professional association, Boards report appreciable variability in structure and administration. Boards differ from the professional association in source of power and focus on the protection of the public rather than improvement of practice.

Data Collection↗
PubMed2006

Paramedics' perceptions of their role in providing pre-hospital thrombolytic treatment: qualitative study.

BACKGROUND: The majority of ambulance services in England provide pre-hospital thrombolysis, following publication of the National Service Framework for Coronary Heart Disease. A meta-analysis has confirmed the effectiveness of pre-hospital administration in terms of all-cause mortality reduction and time saved. Little is known however, about how paramedics perceive their role in thrombolytic administration. AIMS: To describe ambulance paramedics' perceptions of their role in delivering thrombolytic treatment in the pre-hospital setting. METHODS: Twenty paramedics, based in one rural ambulance service in the South West of England participated in focus group interviews. RESULTS: Five key themes emerged: Perceptions of drivers for change; duty of care; perceptions of professional image; role expansion; and preparedness for practice. CONCLUSION: Paramedics' perceptions of their role in pre-hospital thrombolysis were mixed, encompassing professional and political issues including lack of ownership of the emerging national strategy, desire for national certification and financial reward. For successful development and implementation of new strategies within the ambulance service early engagement of paramedics and other staff is essential.

Attitude of Health Personnel↗
PubMed2004

The responsibilities and contributions of professional educators in surgery departments.

BACKGROUND: The purpose of the study is to describe the academic preparation, scope of duties, and scholarly activity of professional educators in surgery departments. METHODS: Educators with doctoral degrees employed as full-time faculty in surgery departments were surveyed to determine terms of employment, academic preparation, scope of duties, and job satisfaction. RESULTS: Twelve of 13 educators responded and participated in the study. Educators spent, on average, 22% of their time on research activities, 33% on administrative responsibilities, 13% on teaching, 13% counseling students and residents, and 7% writing grants. They spent approximately 34% of their time with surgical faculty, 19% with residents/fellows, and 14% with medical students. Educators' contributions to surgery departments included improvements in assessment and evaluation, educational conferences, recruitment, and research productivity. CONCLUSIONS: Professional educators provide support needed to meet the growing demands and requirements of surgical education. Study findings may inform those interested in recruiting a professional educator to their faculty.

Adult↗
PubMed2006

Implementing a rapid response team: factors influencing success.

Rapid response teams (RRTs), or medical emergency teams, focus on preventing a patient crisis by addressing changes in patient status before a cardiopulmonary arrest occurs. Responding to acute changes, RRTs and medical emergency teams are similar to "code" teams. The exception, however is that they step into action before a patient arrests. Although RRTs are acknowledge as an important initiative, implementation can present many challenges. This article reports on the implementation and ongoing use of a RRT at a community health care setting, highlighting important considerations and strategies for success.

Algorithms↗
PubMed2005

Is heart failure nursing practice at the level of a clinical nurse specialist or advanced nurse practitioner? The Irish experience.

Since 2000 there has been a significant increase of Heart Failure Nursing positions in the Irish health service. The background to these positions has been based on the model established at St. Vincent's University Hospital, Dublin since 1998. Recognition of nursing practice in Ireland has also transformed with the introduction of Clinical Nurse Specialist and Advance Nurse Practitioner positions. To date Clinical Nurse Specialists coordinate and manage heart failure programmes, however it remains to be seen whether current practices are within the scope of practice of these nurses. Advanced Nurse Practitioner is a new position in Irish Nursing from examining guidelines and education this may be the way forward for Heart Failure Nursing in Ireland.

Certification↗
PubMed2004

The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams.

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role.

Attitude of Health Personnel↗
PubMedDate not supplied

The legal nurse consultant.

An abundance of new opportunities have arisen in the legal field for nurses. One such area of specialty practice involves the legal nurse consultant. This article outlines the basics of what job tasks a legal nurse consultant might undertake, the level of knowledge and skill required, and the various areas within the consultant field itself that are open.

Consultants↗
PubMed2004

No alternative? The regulation and professionalization of complementary and alternative medicine in the United Kingdom.

In conjunction with its growing popularity, complementary and alternative medicine (CAM) in the United Kingdom has witnessed increasing professionalization, partly prompted by the landmark Parliamentary Inquiry that reported in November 2000. Professionalization has become a significant strategy for practitioner associations and a key focus for the government, media, and patient groups. It is being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of CAM into publicly funded healthcare. It is, moreover, being reconfigured in explicitly national terms. This paper draws on research into practitioner associations representing nine CAM modalities in the UK-aromatherapy, Chinese herbal medicine, chiropractic, crystal healing, feng shui, 'lay' homeopathy, medical homeopathy, osteopathy, and Radionics-, examining the recent wave of professionalization in relation to Foucault's concern with 'techniques of the self.' It highlights the contrasting experience of an association of Chinese herbalists seeking statutory self-regulation (SSR) and an association of chiropractors that was instrumental in securing SSR for chiropractic.

Chiropractic↗
PubMed2004

Lessons from Korea's pharmaceutical policy reform: the separation of medical institutions and pharmacies for outpatient care.

In Korea, until recently, both physicians and pharmacists were allowed to prescribe and dispense drugs for outpatient care. Along with other deep-rooted structural problems, this worked against the quality and efficiency of the health care system. To rectify this problem, the Korean government launched a drug policy reform in July 2000. However, the drug policy reform was more drastic than initially intended--driven by political factors, the reform ended up bringing about complete separation of medical institutions and pharmacies. Also, unlike in many other countries, Korea did not take a gradual approach, but instead, it implemented the reform all at once and nation-wide. As a result, the reform has faced criticism and protests, thereby generating unprecedented social turmoil and even strikes by physicians. Still, it is not clear what benefits Korea gained from this reform, when we look at the price which has had to be paid, including greater inconvenience, worsened access to medical care, increased drug spending, increased market share for multinational drug producers, and a greater deficit in the budget of the Korea's national health insurance system. Based on Korea's costly experience, we attempt to draw some policy implications for the future development of a better health care system.

Ambulatory Care↗
PubMed2004

Be good, sweet maid, and let who can be clever: a counter reformation in English nursing education?

The bulk of nursing education in England moved gradually into higher education in the 1990s. There were debates over the wisdom of this move and in late 1998 and early 1999, it seemed that nursing education might return to the NHS. There was considerable discussion in both the nursing and the general press. In this paper I concentrate on the latter, and analyse the media discussion of nursing at that time, in particular its emphasis on bodily care and excretion, and relate this discussion to the literature on the management of pollution in nursing, the gendered nature of caring, and the division of labour in nursing.

Education, Nursing, Baccalaureate↗
PubMed2005

A follow-up study of professionals' perspectives on the development of family health nursing in Scotland: a questionnaire survey.

BACKGROUND: In 1998 the World Health Organisation Europe introduced the Family Health Nurse concept. The envisaged role of this community-based nurse was seen as multi-faceted and included helping individuals, families and communities to cope with illness and improve their health. During 2000-2002 Scotland led enactment of the concept through education and practice, and the first research study evaluating its operation and impact in remote and rural areas was published in 2003. OBJECTIVE: This study's purpose was to follow up health care professionals' perspectives on the development of family health nursing in remote and rural areas of Scotland since 2002. METHODS: The main research method used was questionnaire survey of all the established family health nurses in these areas and all other health and social care professionals with whom they had regular work-related contact. Where novel contexts or practice patterns emerged, further investigation was undertaken through telephone interviews. FINDINGS: Twenty-three family health nurses (88%) and 88 of their colleagues (52%) returned questionnaires. Eight family health nurses were interviewed. The dominant theme within the findings was the gradual, positive development of a role which tended to maintain established community nursing service provision, yet also supplement this with a limited expansion of family health services and public health activities. The flexibility and wide scope of the FHN role in terms of providing generalist community health nursing services was clearly evident. However, capacity to engage with whole families was found to vary widely in practice. CONCLUSIONS: Within remote and rural Scotland family health nursing is gradually consolidating and developing, but its particular aspiration to engage with whole families is often difficult to enact and is not a priority within mainstream UK primary care policy, planning or provision.

Attitude of Health Personnel↗
PubMed2005

Nurse Practitioner competency standards: findings from collaborative Australian and New Zealand research.

BACKGROUND: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards. OBJECTIVES: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. DESIGN: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand. SETTINGS: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. PARTICIPANTS: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities. RESULTS: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators. CONCLUSIONS: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Attitude of Health Personnel↗