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PubMedDate not supplied

[How to overcome problems of a nursing education towards professional autonomy].

This article, through an historical report of the legislation concerning nursing education, shows "schizophrenia rôle" that brings to a confusion. The professional authonomy, by turns denied or asserted, has always been for us the "litmus paper" indicating a series of difficulties interfering with the professional development. We believe that only in a "global education" (D.V.--Nursing Degree) we can find the natural solution of the difficulties met in Italy by a nursing profession that is young from an historial point of view, but is aware of its education needs.

Education, Nursing, Baccalaureate↗
PubMed1994

Outsourcing therapy services. A strategy for professional autonomy.

Explores the problems and opportunities for professions allied to medicine (PAMS) in the new NHS internal market. Uses a mechanism from IT, namely outsourcing, to provide a new organizational model for the effective delivery of care by this group of professionals who are marginalized by the new role of the doctor as manager.

Allied Health Personnel↗
PubMed1994

Professional autonomy and accountability. A critique of current health reforms and an alternative proposal.

Many countries have become increasingly concerned about the cost of health services, and the issue is considered to be a crisis in the United States. There are many factors that influence the performance of health service professionals, and they all need to be taken into account in reforming the industry. Accountability is important, but it must be compatible with the underlying character of health service delivery. A long-term programme needs to be developed to provide the environment in which professionals can work most effectively. This requires a greater emphasis on professionally-based processes that promote performance and provide accountability.

Health Care Reform↗
PubMed2001

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.

Cooperative Behavior↗
PubMed1992

Professional autonomy and managed care in Dutch health centres: stakeholders' perceptions of a strategic option.

The on-going reforms of the Dutch health care systems call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists.

Ambulatory Care Facilities↗
PubMed2002

[Professional autonomy in the choice and management of therapy. Medicolegal aspects].

Any discussion of the delicate subject of a doctor's autonomy in the choice and management of therapy entails addressing the intimate question of professional and ethical conduct. The professional freedom to choose which therapy to use continues to be the most quintessential expression of the medical professional and, in respect of the primary purpose of safeguarding health, must be aligned with: the choices of the informed patient or his/her legal representatives, existing guidelines and the equitable allocation of resources. On these grounds, the author sets out brief considerations regarding a number of issues frequently raised in the everyday work of the pediatrician and neonatologist: from the doctor's autonomy to adopt a diagnostic-therapeutic approach, with special reference to the prescription of drugs and the subtle differences compared to pharmacological trials, to the promotion and protection of breastfeeding, with explicit reference to the Ministry of Health's recent Circular no. 16 of 24.10.2000 ("Promotion and protection of breastfeeding") which, following a cursory reading of the text, appears to highlight restrictions to the pediatrician's decision-making autonomy. Special emphasis is also given to the medicolegal problems of caring for high-risk neonates. The clinical practice of neonatology often places the doctor in "critical" decision-making situations, with far from negligible ethical and moral implications, not to mention juridical and forensic ones. The author sets out a number of decision-making parameters for use as guidelines: the statistical criterion, the legal criterion and the clinical criterion, the only one capable of adjusting to scientific progress and to the specific technical and professional resources of the medical centre where the doctor is required to intervene in order to preserve even the simple "possibility" of autonomous life for the fetus. From this point of view, the so-called chronological vitality and scientifically proven statistics form part of the numerous criteria available for clinical evaluation. If the clinical criterion is not met, namely if the product of conception is not vital and has never been fully alive in the biologically complete sense of the term, then the omission of therapeutic support is not particularly important in professional and juridical terms. On the contrary, it would show an obstinate persistence of therapy, which would be both ethically and professionally incorrect. Lastly, even during the final stages of life, the doctor must play a participatory role not only by providing palliative treatment but also, and above all, offering moral assistance to sanction the ineluctable end of the therapeutic alliance, that "feeling together" which is the most literal and profound meaning of the word "consent", indicating both "information" but to an even greater extent "discussion" and "empathy" with the patient and his/her family.

Breast Feeding↗
PubMed1998

Physician satisfaction in a changing health care environment: the impact of challenges to professional autonomy, authority, and dominance.

For some time, sociologists have debated whether physicians still retain dominance in the health care world, public faith in their moral and scientific authority, and the autonomy to set work conditions and make clinical decisions. Using ideas derived from this debate, we analyze the impact of changes in the health care environment on physician satisfaction. Our data come from a mailed survey of 510 Arizona physicians. Our results show that background physician attributes did not predict satisfaction, nor did most organizational attributes. However, participation in IPAs (Individual Practice Associations) predicted higher satisfaction, while payment according to a third party payer's fee-for-service schedule predicted lower satisfaction. In addition, physicians were more likely to be satisfied if they wrote the orders that non-physicians had to follow, were paid what they wanted, did not need to subordinate their clinical judgment to that of non-physicians, and believed that their patients had confidence in physicians. Our conclusions discuss both theoretical and policy implications of our findings.

Adult↗
PubMedDate not supplied

Advertising in ophthalmology. I. Advertising is a threat to professional autonomy.

In 1977 the United States Supreme Court ruled that medicine was legally a "trade" and that physicians could not be prohibited from advertising. Since then the ethics and effects of advertising by ophthalmologists have been a source of controversy among ophthalmologists and within professional organizations. What are the effects of advertising on the patient? On the professional image and autonomy of ophthalmologists? These questions are explored in separate statements by authors with differing viewpoints, and summarized in an editorial comment.

Advertising↗