Placing principle before expediency: the Shipman Inquiry.
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Family Practice↗
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Results for “Professional Autonomy”
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Optometrist prescribing of therapeutic agents: findings of the AESOP survey.
Throughout the USA and in some parts of Australia and Canada, licensed optometrists may prescribe therapeutic agents for certain eye conditions. However, this role is not currently available to European optometrists. The extension of prescribing rights to new professional groups was the subject of a UK government-commissioned review, which cited optometrists as potential candidates. A recent literature review found limited evidence to assess the appropriateness of eye care delivered by different health care providers. To inform the UK decision, we therefore conducted a national postal survey to explore how optometric practice might change with the introduction of therapeutic prescribing. The Anonymous Enquiry of the Scope for Optometrist Prescribing (AESOP), was sent to a random 10% sample of registered optometrists. Over 80% of respondents indicated that optometrists should be able to train as therapeutic prescribers. Most respondents were willing to undergo training, periodic re-accreditation and continuing education, as well to participate in simple professional audit of their prescribing. Respondents anticipated that referrals to general practitioners (GPs) would be reduced by nearly 40% and to ophthalmologists via a GP by nearly 20%. Optometrist participation could increase patient access to therapeutic ocular care by between 29% and 50%. Authorising UK optometrists to prescribe therapeutically for eye diseases would appear to make good use of their existing skills and improve patient access to eye care, while relieving pressures upon other healthcare providers. Tentative economic analysis suggests that the introduction of independent optometrist prescribing may be cost neutral. However, adequate comparative research on the performance of optometrists as prescribers is needed and the issue of reimbursement will require careful consideration.
Attitude of Health Personnel↗
Every nurse needs a nurse: reconceptualizing models and methods of care.
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Humans↗
[The debate on the organization, functions and efficiency of nursing in primary care: apropos of a qualitative study].
OBJECTIVE: To show the opinions that doctors and nurses express on the organisation and competences of primary care nursing, and on inter-professional relations. DESIGN: Qualitative research study based on the group discussion technique known as Philips 66. SETTING AND PARTICIPANTS: Three discussion groups, one of nurses, one of doctors and a third mixed, with 6 components each, half from Cáceres and the rest from other provinces, and all involved in primary care health delivery. MEASUREMENTS AND MAIN RESULTS: In the discussions, the three groups coincided in the importance given to nursing clinics and home visits, in the organisational advantages that the attachment as a norm of the population to a nursing clinic would bring, in the ability of nurses to perform the techniques they have habitually used, and in defence of one sole clinical record per patient. They blamed each other mutually for making few home visits. Doctors attributed to nurses under-use of records and nurses alleged doctors took no notice of their notes. On the question of their relations, doctors thought that nurses did not take on joint responsibility for the work-loads in health centres; and nurses thought that doctors did not wish to share tasks, but rather delegate or order them. CONCLUSIONS: The attachment of the population to nursing clinics would favour the extension of care, the commitment to the population and the real delivery of services, as well as professional autonomy and recognition.
Community Health Nursing↗
Australian nurses' perception of the impact of their postgraduate studies on their patient care activities.
Postgraduate nursing education, formal or informal, has grown enormously and the benefits, to the students, their employers or their patients or its impact on clinical practice has not been well researched, particularly in Australia. The authors commenced a 10 year longitudinal study at a university in Sydney, Australia to track five cohorts of postgraduates at two yearly intervals to determine their career paths, changes in professional behaviour and the perceived impact of their postgraduate education on the care they deliver. This paper will report these five cohorts' (N=236) perceptions of the impact of their postgraduate studies on their care delivery two years after completion of their study. The results indicate that their postgraduate education had a positive to strongly positive impact on the majority of items. These as well as those items identified as not being affected will also be presented and discussed.
Adult↗
NVQs in nursing, midwifery and health visiting: a question of assessment and training.
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Education, Nursing, Continuing↗
Reflection: a flawed strategy for the nursing profession.
The meaning and process of reflection and reflective practice appear to be currently accepted and institutionalized within the nursing profession. This paper, through use of a literature review, attempts to question the value that is consequently placed on this strategy and argues that on closer examination, reflection has no clear or universal definition, an uncertain framework for implementation, and is of unproven benefit to the professional practice of nurses. Given this evidence, the author concludes that reflection is a fundamentally flawed strategy that must be of limited benefit to the nursing profession.
Education, Nursing↗
Physician satisfaction revisited.
UNLABELLED: Nineteen US physicians were interviewed in 1987 to identify how they defined and addressed the changes facing them. Attitudes and problem-solving approaches of physicians who remained satisfied were compared with those deemed dissatisfied. In this ten-year follow-up study, the original subjects were re-contacted and asked to describe changes in their practices, and other questions regarding their professional lives. They were rated by themselves and the authors for satisfaction. Eighteen responded and could be rearranged into three groups by ratings of satisfaction. Representative responses delineate each group and explore various aspects differentiating responses within the grouping. CONCLUSION: past satisfaction with medical practice is no predictor of current satisfaction. Only those who either embraced change or found a means of escape from the issues facing them earlier were judged satisfied. The majority describe strategies to reduce fatigue, and to maintain some control over their professional lives.
Attitude of Health Personnel↗
Taking responsibility for cancer treatment.
One hundred and fourteen consecutive patients with early breast cancer were entered into a study on the psychological effects of involvement in treatment choice. All women were offered counselling throughout. One group of women (n = 34), were advised to undergo mastectomy, due to the nature or position of the tumour. These women fared less well psychologically when compared on a battery of measures, before and after surgery, with women who were involved in choosing their own treatment (n = 80). The latter group itself was randomly allocated into two groups for taking explicit responsibility for treatment choice, using a double-blind procedure. These were a Patient Decision Group (n = 41) and a Surgeon Decision Group (n = 39). Results support the hypothesis that over and above the benefits of receiving their preferred treatment, women can further benefit from taking explicit responsibility for their treatment choice.
Adult↗
A question of place: medical power in rural Australia.
In Australia, like many countries, government, medicine and the community have maintained an interdependent and symbiotic relationship based on mutual resource dependency and reciprocity. The services of medicine have been indispensable to government and the community and in return medicine has achieved power, elitism and financial gain. Traditionally, doctors have controlled and directed medical knowledge in an absolute manner and this has been the basis of increasing power and dominance. There are, however, claims that medicine's power and dominance over the health care system is being eroded by the emergence of major social trends. The corporatization of medicine, manageralism and proletarianization are touted as factors that are increasingly countervailing medical dominance and power. Whilst it could be suggested that as these trends become more firmly established government and the community gain greater discretionary control over how the resources of medicine can be allocated and utilized, this article argues that the geographic and social dimensions of the community in which doctors practice must be considered. Using a qualitative descriptive approach research was conducted in rural Victoria, Australia. The overall aim of the study was to identify the issues that impact upon service delivery in rural hospitals. The most significant issue that emerged related to medical relationships. The results of this research indicate that in this rural area the power of medicine is strengthened and institutionalized by geographically determined resource control. The sustainability of rural communities is linked to the ability of the town to attract and retain the services of a doctor. Crucial shortages of rural doctors provide medicine with a mandate to dictate the way in which medical resources will be allocated and used by hospitals and the community. Organizations that control critical resources are in an extremely powerful position to control others. Doctors in rural Victoria maintain a position of strength and use their power to exert control over the state, the community and the hospital. Although medical power and dominance may be declining in some areas, in rural Victoria it remains firmly entrenched.
Community Participation↗
Modernized education of traditional medicine in Korea: is it contributing to the same type of professionalization seen in Western medicine?
In Korea, the teaching of traditional medicine (TM) has been institutionalized for more than five decades, and accordingly the formulated educational system has a structure similar to that of Western medicine (WM). The authors therefore assumed that TM and WM students would share similar attitudes and values regarding professionalism. To test this hypothesis, we administered a questionnaire to TM students nationwide, and compared the results with those of WM students. We found that, despite the large differences in philosophy, concepts, and clinical content between the medical disciplines, the professional socializations of TM and WM students were progressing in a similar way.
Attitude of Health Personnel↗
The end of professionalism?
Increasingly questions are being raised about the ability of many current health reforms to address the challenges that are facing health systems. We investigate this situation by exploring the role of professionalism in the delivery of health services. In contrast to the dominant approach of considering professionalism as a social phenomenon, professionalism is considered as primarily a task-related phenomenon. The characteristics of the task are identified as being high levels of uncertainty and complexity. These characteristics are shown to lead naturally to the key social features that typify professionalism. Hence, the close link between professionalism and the nature of the task is argued. However, health reforms threaten professionalism. They have been based on considerable dissatisfaction with the performance of professionals as well as the emergence of a number of new challenges. In addition, the reforms have been developed without significant consideration of the central role that professionalism has played, and reformers have adopted a simplified view of the task. Thus, the centrality of professionalism has intrinsically been downgraded. However, this simplification can be shown to be inconsistent with the realities and complexities of health service provision, and thus the downgrading of professionalism is unwarranted. This inconsistency generates many of the conflicts and contradictions being reported. The future of health service reform depends on an effective understanding of the nature of the task, recognition of the central role of professionalism and the development of professional and organisational structures that support each other.
Health Care Reform↗
Traditional medicine, professional monopoly and structural interests: a Korean case.
Oriental medicine (OM) is a widely practised traditional healing modality across the East Asian countries. The typical operating mode of traditional medicine in the region is characterized by a relatively stable, though asymmetrical, relationship with the biomedically-oriented health care system with a varying degree of collaboration. The present paper looks at the major conflict between OM and pharmacy in South Korea in the 1990s. Most of the discussions over the so-called 'Hanyak Punjaeng'(OM vs pharmacy dispute) have so far been carried out in the perspective of interest/pressure group politics. But this paper presents an alternative analysis about the genesis, process and resolution of the dispute. It is argued that Robert Alford's 'structural interests' model, rather than the conventional pluralist perspective, offers the most plausible explanation of the conflict. Three key findings are ascertained. First, a sectional, inter-professional conflict can erupt into a major social cataclysm beyond the confines of health care services, an unlikely incident of a 'low politics' case becoming a 'high politics' affair. Second, a bipartite professional monopoly based on the principle of professional credentialism came to be established. Third, the dispute brought about a notable change in the structural power distribution between the corporate rationalizer and professional monopolist.
Competitive Behavior↗
Professional commitment among US physician executives in managed care.
This paper examines professional commitment among physician executives working in managed care settings in the United States. The rise of an 'administrative elite' in medicine is central to the notion that physicians preserve their professional dominance despite changes in their prestige, work and employment status. Implicit in the notion of Freidson's restructuring perspective, physician executives presumably remain dedicated to professional interests in their management roles. The findings of a national survey support this assumption. Physician executives maintain meaningful, stable levels of professional commitment over time in management and the organization. This commitment is positively related to work-related characteristics involving favorable perceptions of the management job and physical and mental 'connection' to the practice of medicine. Belief in one's ability to successfully deliver appropriate clinical care, however, moderates the positive association between involvement in the management job and professional commitment. The findings provide a rationale for the maintenance of professional loyalty among physicians in management rooted in the work-related perceptions and activities of the individual physician executive.
Attitude of Health Personnel↗
Medical end-of-life decisions in Norway.
AIM: Previous studies indicate that Norwegian physicians hold conservative attitudes towards ethically controversial end-of-life decisions. The present study was undertaken to explore whether in Norway euthanasia may be hidden under labels such as death after analgesic injections and withholding or withdrawing treatment. METHODS: A postal questionnaire containing 76 questions on ethical, collegial and professional autonomy issues was sent to a representative sample of 1616 active physicians in Norway in 2000. RESULTS: 83% responded. A total of 8.1% had terminated life-prolonging treatment based on the resource situation, while 53.5 and 40.1% respectively had stopped life prolonging treatment due to the wish of the patient and the wish of the patient's relatives. Although not significantly, anaesthesiologists more often reported to have stopped treatment due to resource considerations. One percent of the physicians reported to have shortened a patient's life intentionally (other than stopping futile treatment). All of these were men. Logistic regression showed no effect when gender, age and specialty were analysed simultaneously. 10.6%, and male more often than female physicians, had had experience of unintentional patient death in relation to pain treatment. Anaesthesiologists had had experiences of death following an analgesic injection no more than other specialists. CONCLUSIONS: Only a small minority of Norwegian physicians has committed euthanasia. However, patient death has occurred following ethically questionable decisions such as withdrawal of treatment based on resource considerations and requests from the family.
Adult↗
First-line managers: scope of responsibility in a time of fiscal restraint.
Fiscal restraint and government cost control have contributed to the downsizing and restructuring of Canadian health care organizations. As key players in the hospital sector, the role and responsibilities of first-line nurse managers have been significantly affected by these changes. This paper presents data from a survey of 200 first-line nurse managers in British Columbia which investigated the current scope of the first-line manager's role, the number of hierarchical levels within nursing departments, and views on managerial union membership.
British Columbia↗
Removing barriers to partnerships.
One of the six corollaries to high quality healthcare identified in a 1987 study indicated that a team approach is required, although it challenges the notion of the professional autonomy of the medical staff. There are both individual and delivery system barriers to formation of partnerships and resistance to the change process. Combined with different views between physicians and executives, partnership building is a complicated process, and a number of recommendations are suggested to promote better relationships.
Attitude of Health Personnel↗
Constraints to advanced psychiatric-mental health nursing practice.
Constraints and barriers to advanced practice psychiatric nursing were reported by respondents of the Primary Mental Health and Advanced Practice Psychiatric Nursing survey of certified psychiatric clinical nurse specialists. Primary data (N = 507) were the qualitative responses to a survey item about constraints and secondary data were the literature and theoretical memos. Methodology was based on principles of qualitative data analysis and procedures for manifest and latent content analysis. Findings resulted in eight themes that explained both constraints and barriers to advanced practice: (1) reimbursement, (2) prescriptive authority, (3) admitting privileges, (4) bureaucracy, (5) practice environment, (6) colleagues, (7) image, and (8) personal. Themes were interpreted within the context of regulatory, market-based, and inter/intraprofessional constraints and barriers that led to suggestions for organizational and individual strategies for action. The survey was funded by the Society for Education and Research in Psychiatric-Mental Health Nursing with technical support from the Center for Mental Health Services.
Attitude to Health↗