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PubMed2006

Impact of cost containment measures on medical liability.

RATIONALE: Owing to the growing health care expenditure and the need to improve efficiency, public authorities have since the 1980s changed their policy with respect to health care. Financial pressures encouraged them to investigate methods to control health care costs. One recent method is the enactment of cost containment measures based on clinical practice guidelines (CPGs) that provide financial or administrative sanctions. AIMS AND OBJECTIVES: This article describes the legal value of CPGs, the evolution towards cost containment measures based on CPGs, and finally the legal value of these new cost containment measures. It questions whether these measures may have an impact on the medical liability rules and it wants to open the debate on the legal value of these measures based vis-à-vis the professional autonomy of the physician and patients' rights on quality care. METHODS: The research for this article is based on a comparative analysis of the legal literature and jurisprudence of a number of legal systems. RESULTS AND CONCLUSIONS: The article concludes that, as a result of the rising costs, it becomes increasingly difficult for a physician to balance his duty to take care on the one hand and his duty to control costs on the other. Maintaining a high standard of care towards patients becomes difficult. Consequently, one wonders whether the law should then allow the standard of care to be adjusted according to the available means. Until now, courts in a fault based system have not been willing to accept such an adjustment of the standard of care, but it might well be possible that this attitude will change in case of no-fault compensation systems.

Belgium↗
PubMed2004

Leadership behaviours that foster nursing group power.

Today's health care environment presents many challenges to nursing groups as they seek to achieve their goals. All resources must be recognized and effectively utilized. Power, defined as the capacity to achieve goals (Sieloff 1995), is a valuable resource that can assist nursing groups in the achievement of their goals. The leader of a nursing group can make a significant difference in a group's ability to actualize their power capacity. The purpose of this article is to identify and discuss the use of a tool (Sieloff-King Assessment of Group Power within Organizations) to identify the nurse leader/group power variables that can be used to improve a nursing group's power as a resource in the achievement of its goals. Using behaviours related to a Nurse Leader's Power Competency and Power Perspective variables, identified in the Theory of Group Power within Organizations (Sieloff 1999), a nurse leader can foster a nursing group's power.

Attitude of Health Personnel↗
PubMed2004

Political leadership and the politics of nursing.

This article provides a critical examination of the concept of political leadership as it has recently developed in the field of nursing, arguing that despite its undoubted usefulness, there are important issues that it obscures. Using five guiding questions, it is proposed that a focus on political leadership is inward-looking and individualizing. It encourages a view of the profession as immature and it emphasizes separation instead of alliance formation. An alternative perspective starting from an assumption that nursing operates in a position of cultural and structural disadvantage is proposed. A close analysis of the government's strategy for nursing in England confirms the continuing cultural ambiguity that surrounds nursing. This enables a number of questions to be posed concerning where nursing fits in relation to current health policy on workforce change and raises doubts about just how far the historical neglect of nursing in policy arenas has been overcome.

Attitude to Health↗
PubMed2004

Political leadership in action.

This paper explores the author's personal experience of working in positions of leadership in a variety of National Health Service roles. In particular how in these roles was it possible to influence policy and if not, why not, what the challenges are for leading in a political environment, and what competencies are needed to succeed. Readers will draw their own conclusions about how they approach their work and what might be done differently on reflection.

Adaptation, Psychological↗
PubMed2006

So what exactly is a nurse?

The problematic nature of defining nursing is examined. Contrasts are set out in respect of the work of different grades of practitioner and how these do or do not constitute nursing care. A concept of caring and caring profession is utilized as a backdrop by which it is argued that caring can be defended as an ethical position independently of its objects of care. The paper asserts the existence of different perspectives within mental health nursing and demonstrates how these are influenced by extraneous forces. It concludes by (1) defending universal moral rules that operate independently of situations or the objects to which they apply and (2) that the usefulness of invoking a nursing identity may be less rather than more illuminative in exposing what mental health (psychiatric) 'nursing' is.

Attitude of Health Personnel↗
PubMed2006

The slow death of psychiatric nursing: what next?

Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.

Attitude to Health↗
PubMed2005

Professionalism.

Explore the source record for details and available documents.

Curriculum↗
PubMed2005

The nature of qualitative comments in evaluating professionalism.

INTRODUCTION: We analysed written comments on clerkship evaluation forms to determine if they furthered our understanding of students' professional behaviour. METHODS: We transcribed all written comments related to professional behaviour for 1 medical school class in 4 major clerkships, then categorised the comments. Comments were coded into categories by two raters. They were also coded as positive, negative or equivocal. The 3 types of comments were each correlated with a Likert-type score for professionalism for each student in these same clerkships. RESULTS: Most comments covered initiative, working well with others, patient skills and working hard. Of the 1845 comments, 1721 were positive, 106 were negative and 18 were equivocal, neither wholly positive nor wholly negative. The total number of positive comments correlated with the students' numerical professionalism score (r = 0.29, P < 0.001); negative comments correlated negatively with the numerical professionalism score (r = -0.44, P < 0.001). Equivocal comments were significantly negative (r = -0.25, P = 0.002). Qualitative analysis revealed that equivocal comments were focused on maturity, initiative and teamwork. CONCLUSIONS: Written comments contain unique indicators of students' professional behaviour and are largely positive in nature; negative comments stand out by their rarity and intensity. There is a set of negative comments masked by evaluators in language that appears neutral or even partly positive that statistically resemble negative comments and should be regarded as such by students who receive this type of comments. Evaluators should be encouraged and trained to express their qualitative views of students.

Clinical Clerkship↗
PubMed2005

Work empowerment as experienced by head nurses.

BACKGROUND: Head nurses have in the past few decades gained both more power and more responsibilities in their job. Their experience of work empowerment is not known. AIM: The aim of this study was to describe the verbal, behavioural and outcome empowerment experienced by head nurses. METHODS: Data were collected using a structured questionnaire, which was sent to 259 head nurses. The data were analysed using statistical methods. RESULTS: The results suggest that head nurses experience quite strong verbal and behavioural empowerment. They feel less confident in terms of outcome empowerment. Various factors, including stress and the capacity to handle the head nurse's job, were found to correlate with the empowerment experience. CONCLUSION: It seems that head nurses do not have enough power to influence the effectiveness of their organization.

Adult↗
PubMed2007

The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, Australia.

AIMS: This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. BACKGROUND: Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. METHOD: A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. RESULTS: The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. CONCLUSIONS: Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants.

Attitude of Health Personnel↗
PubMed2005

The phenomenon of resilience in crisis care mental health clinicians.

The purpose of this study, undertaken in 2003, was to explore the phenomenon of resilience as experienced by Australian crisis care mental health clinicians working in a highly demanding, complex, specialized and stressful environment. For the purpose of this research, the term 'resilience' was defined as the ability of an individual to bounce back from adversity and persevere through difficult times. The six participants for this study were drawn from Melbourne metropolitan mental health organizations - the disciplines of nursing, allied health and medicine. A number of themes were explicated from the participants' interview transcripts - Participants identified the experience of resilience through five exhaustive descriptions, which included: 'The team is a protective veneer to the stress of the work'; Sense of self; Faith and hope; Having insight; and Looking after yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for clinicians in this role. The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff attrition, and promote staff retention and occupational mental health.

Adaptation, Psychological↗
PubMed2004

Rural nurse practitioners in South Australia: recognition for registered nurses already fulfilling the role.

The introduction of the nurse practitioner role is hailed as a new initiative in the South Australian public health system. In reality, some registered nurses working in rural public health care facilities have been practicing in the role for many years. The role of the rural registered nurse, the pathway towards achieving rural nurse practitioner status and the anticipated advantages of implementing the rural nurse practitioner role will be presented.

Career Mobility↗
PubMed2004

Journeying to professionalism: the case of Irish nursing and midwifery research.

This paper gives a 'discursive' account of the contemporary development of nursing and midwifery research in the Republic of Ireland in the context of advancing professionalism. Initially, the paper views the landscape by placing research in the current framework of Irish nursing and midwifery. It then examines the map of our present location by documenting a baseline. It ascertains the signposts that are in place by exploring the strategic direction for development. Finally, it uses the compass to orienteer the route through the various obstacles by examining the challenges of the role of the joint appointee leading the implementation of the national Research Strategy for Nursing and Midwifery in Ireland.

Documentation↗
PubMed2005

Reaching for the stars: career advancement and the registered nurse.

Clinical nursing has long struggled to secure the place of primacy it deserves in the profession's hierarchy of importance and worth. It is ironic that, even at the beginning of the 21st century, a clinical nurse is generally not as well-recognized, rewarded or remunerated as a colleague working in nursing management, education or research. Until the profession recognizes and takes serious action to remedy this situation, the crisis of recruitment and retention in nursing currently ravaging the globe is likely to continue. In this paper, I present a discursive account of an exciting initiative by a leading private, acute-care hospital which addresses this very problem. A new ladder for clinical nurse specialists (CNSs) introduces a rigorous and systematic approach to the appointment of three classifications of CNS, each requiring evidence of successively higher levels of competency, and which are accompanied by fiscal reward and stronger peer recognition.

Career Mobility↗
PubMed2006

Work-related empowerment of the multidisciplinary team at the Rheumatism Foundation Hospital.

Carried out as part of a staff development project, this study describes the experiences of work-related empowerment within a multidisciplinary team at the Rheumatism Foundation Hospital in Finland. The data were collected using a structured questionnaire consisting of background variables and questions concerning verbal, behavioural and outcome empowerment. The questionnaire was sent to all members of the multidisciplinary team at the Rheumatism Foundation Hospital, with the exception of physicians, departmental secretaries and administrative personnel. The response rate was 58%. The data were examined using statistical methods. The multidisciplinary team felt quite strong verbal and behavioural empowerment, but was less confident in terms of outcome empowerment. Several factors were found to be associated with the different fields of empowerment. In conclusion, the multidisciplinary team felt quite strong work-related empowerment.

Adult↗
PubMed2004

Mandatory reflection: the Canadian reconstitution of the competent nurse.

Over the past two decades, the competency movement has been gathering momentum internationally within the ranks of professional nursing. It can be argued that this momentum is in response to government initiatives aimed at improving consistency in workforce training and accreditation, and fostering national and international portability of qualifications. At the same time, the competency movement has provided the opportunity for regulators, service providers and government to develop mechanisms to reconstitute competent nurses as accountable, self-regulating subjects and to monitor this transformation in particular ways. The ways in which competencies have been taken up to do this transforming work in Canada are unique and deserving of some detailed description and analysis. We argue that Canadian nursing regulatory authorities have chosen to view competence as the rehearsal of ethical attributes consonant with the professional role, as opposed to the enactment of skilled conduct. As a result, reflective practices rather than skill and knowledge have become the cornerstone of nursing competency formulation and review. We argue that this distinctly Canadian approach to competency serves three ends. First, it privileges the "attribute" element of the nursing competency model and side steps the ever-problematic "nursing knowledge" issue; second, self-surveillance by nurses shifts the onus for professional development from industry to the individual; and third, it concedes responsibility for skill assessment by the regulatory authorities to industry control, leaving employers free to determine skill base and skill mix requirements for practice. Finally, we argue that the reflective component of the regulatory framework for Canadian nurses radically fails as a tool for auditing quality and assessing competency. Rather, it functions as a governmental practice that furthers the deregulatory and economic rationalist aims of the Canadian health reform agenda.

Attitude of Health Personnel↗
PubMed2006

Hospital nurse administrators in Japan: a feminist dimensional analysis.

BACKGROUND: Nursing administration research is scarce in Japan during a time when health care is rapidly reforming and baccalaureate and graduate nursing programmes are rapidly developing. Additionally, nursing administration content relies heavily on Western and non-nursing theories, some of which have been criticized for male bias. PURPOSE: The purpose of this article is to present key findings from a qualitative study that explored the perspectives or viewpoints of 16 Japanese senior female nurse administrators in hospitals in order to learn what was happening in their working situations and how they were managing. DESIGN AND METHODS: This feminist study used dimensional analysis strategies for data collection and analysis. Semi-structured, tape-recorded interviews were conducted by both researchers in Japanese, transcribed into Japanese, and translated into English. RESULTS AND DISCUSSION: The resulting explanatory matrix portrayed a story of 16 nurse administrators, most of whom were able successfully to enact a management role in a context of role ambiguity that was congruent with their relational values and beliefs. Important conditions influencing value-based role enactment included organization mission and purpose, organization structure, nurse-doctor relationships, participant-supervisor relationships, and personal attributes. Many participants were able to overcome barriers in these categories using strategies of tempered radicalism and consequently made positive organizational changes. CONCLUSIONS: Advanced formal education, better organizational support, and a raised consciousness among nurses that views nurses and midwives as equal partners with other professionals will enable Japanese nurse administrators to help advance patient-centred care and nursing development and empowerment.

Adaptation, Psychological↗
PubMed2006

Improving international nurse training: an American-Italian case study.

BACKGROUND: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses. AIM: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration. METHOD: A questionnaire was sent to the 85 nurses who all participated in this particular international programme (response rate: 30.6%). FINDINGS: The collected data indicate that personalized and well-aimed training, preparatory language courses, pre-departure exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve this programme. IMPLICATIONS FOR PRACTICE: While the specific circumstances and cultures involved in this particular case study should not be ignored, these factors might also be applied to maximize the positive effects of nurse-migration. Two-way learning is among the positive effects of such an international training experience. Motivational and team-building effects can result in enhanced quality of care and a more efficient allocation of resources. However, the mind-opening effect seems to be the most important learning experience. Therefore, regardless of whether one system is considered better or worse than another, experiencing a different way of nursing/education is considered the most important, enriching element of an international learning experience. The effects of this experience could include avoiding cultural imposition in the increased cultural diversity of nursing in the country of origin.

Attitude of Health Personnel↗