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PubMed2003

The ethics of theatre nurse practice under the microscope.

Perioperative practice is a multidisciplinary environment. In some theatres, student nurse allocations are at last becoming longer, although some theatres still only get a brief visit from student nurses who wish to watch an operation all the way through. Furthermore, practically all operating departments have trainee operating department practitioners (tODPs). Diploma and degree level tODPs are now beginning to produce higher academic levels of coursework and many warrant recognition. We should remember that these 'learners' are potentially the theatre practitioners of the future and we should encourage them, not only within the perioperative environment but also towards their academic achievements. Qualified nurses and operating department practitioners (ODPs) now have access to various multi-disciplinary post-registration/gradate courses, which not only build upon theoretical knowledge, but also enhance practical skills. Individuals work long and hard to achieve high level academic pieces of coursework. Unfortunately after courses finish many assignments are packed away, collect dust and get forgotten, instead of the authors being brave enough to submit them for consideration for publication. This new series offers all practitioners the chance to share with others their work within this speciality. Whether you are a nurse or an ODP undertaking, or having recently completed a course, tODP or student nurse (but preferably a member of NATN) the possibility to share your experiences or coursework with other perioperative practitioners is available to you in these articles. It has always been so, but this new series is dedicated to you all and to the hard work you put into your coursework.

Codes of Ethics↗

PubMed2006

Support staff roles in the operating department: a survey of staff opinion.

The expansion of support staff roles throughout the NHS was identified as a key element in the drive for service improvements set out in the NHS plan (Department of Health 2000). However, while examination of the literature identified the opinions of professional representative bodies (Perioperative Care Collaborative 2002a&b), little published data is available of the opinions of staff 'on the shop floor'.

Attitude of Health Personnel↗

PubMed2005

What motivates senior clinicians to teach medical students?

BACKGROUND: This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. METHODS: The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia). Their motivations to teach medical students were assessed applying Q methodology. RESULTS: Of the 75 participants, 18 (24%) were female and 57 (76%) were male. The age distribution was as follows: 30-40 years = 16 participants (21.3%), 41-55 years = 46 participants (61.3%) and > 55 years = 13 participants (17.3%). Most participants (n = 48, 64%) were staff specialists and 27 (36%) were visiting medical officers. Half of the participants were internists (n = 39, 52%), 12 (16%) were surgeons, and 24 (32%) were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41-55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. CONCLUSION: This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

Adult↗

PubMed2003

Professional values and norms for nurses in Belgium.

Because of their responsibilities for providing high-quality care, at times when they are continuously confronted with inherent professional and ethical challenges, nurses should meet high ethical standards of practice and conduct. Contrary to other countries, where codes of ethics for nurses are formulated to support those standards and to guide nurses' professional practice, Belgian nurses do not have a formal code of ethics. Nevertheless, professional ethics is recognized as an important aspect in legal and other professional documents. The aim of this article is to illustrate that codes of ethics are not the only professional documents reflecting nurses' values, norms and responsibilities. Other documents can also set out professional nursing ethics, and as such replace codes of ethics.

Attitude of Health Personnel↗

PubMed2005

Emotional boundary work in advanced fertility nursing roles.

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or 'bounded' relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship.

Adaptation, Psychological↗

PubMed2005

Exploring nursing values in the development of a nurse-led service.

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients' experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care.

Ethics, Nursing↗

PubMed2006

Identifying bioethics learning needs: a survey of Canadian emergency medicine residents.

OBJECTIVES: Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. METHODS: A survey-based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. RESULTS: A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end-of-life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. CONCLUSIONS: This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.

Bioethics↗

PubMed2005

The development and evaluation of an integrated electronic prescribing and drug management system for primary care.

OBJECTIVE: To develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians. DESIGN: A 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients. MEASUREMENT: MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, and providing electronic prescription, stop order, automated prescribing problem alerts, and compliance monitoring functions. Evaluation of technical performance, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases. RESULTS: Perceived improvements in continuity of care and professional autonomy were associated with physicians' expected use of MOXXI. Physician speed in using MOXXI improved substantially in the first three months; however, only the represcribing function was faster using MOXXI than by handwritten prescription. Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient's drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the represcribing function as the most beneficial aspects of the system. Physicians were more likely to use the drug profile for patients who used more medication, made more emergency department visits, had more prescribing physicians, and lower continuity of care. CONCLUSION: Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care.

Attitude of Health Personnel↗

PubMed1996

The personal is the organizational in the ethics of hospital social workers.

Understanding the social context of clinical ethics is vital for making ethical discourse central in professional practice and for preventing harm. In this paper, we present findings about clinical ethics from in-depth interviews and consultation with 7 members of a hospital social work department. Workers gave different accounts of ethical dilemmas and resources for ethical decision making than did their managers, whereas workers and managers agreed on core-guiding ethical principles and on ideal situations for ethical discourse. We discuss the research team's initial interpretations, the relevance of the extant ethics literature to organizational structures and dynamics, and alternative perspectives on clinical ethics.

Administrative Personnel↗

PubMed1999

The institutional turn in professional ethics.

The traditional ideal in which professionals alone or in small groups serve their patients and clients in accord with a public-spirited goal is giving way to practice in which professionals serve in organizations that value mainly their expertise and expect them to act in accord with the organization's goals. The study of professional ethics has not kept pace with this trend and, as a result, has neglected the institutional aspects of ethical problems. I focus attention on these aspects by considering a case that raises 2 problems that are particularly relevant in the context in which professionals now practice: the problem of representation (whom does the professional act for) and the problem of authority (who has the right to make the policy for the institution).

Administrative Personnel↗

PubMed2002

Nurses' perspectives on the distinctive aspects of providing nursing care in a congregational setting.

As the number of parish nurses grow, it is important to understand the unique attributes of providing nursing care in a congregation. Through a focus group and interviews, this qualitative research study explored this question with 17 parish nurses participating in a hospital-sponsored, volunteer health ministry program. Content analysis revealed the nurses felt they had the greatest impact through health promotion and prevention, advocacy, health education, and health counseling, including psychosocial support and spiritual care. The nurses appreciated the unique opportunities afforded by the congregational setting including integrating faith and health in nursing practice, the more relaxed environment, the opportunity for long-term relationships, and the level of professional autonomy. Challenges were experienced from the client's autonomy, the impact of religious beliefs, the nurse's worship experience, and time constraints. This study demonstrates that parish nurses can provide a valuable adjunct to the traditional care system as they practically and conceptually integrate faith and health.

Adult↗

PubMedDate not supplied

Précis of Paul Starr's The Social Transformation of American Medicine. 1982.

The following is a presentation of selected passages from The Social Transformation of American Medicine (original pages numbers enclosed in parentheses) in tandem with the names of the authors in this retrospective issue and the various themes and issues they address.

Capitalism↗

PubMedDate not supplied