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PubMed2000

Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes.

This article describes a model changing autonomy which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients' conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients' strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork, Facilitating strategies of the family encompass emotional and instrumental support Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.

Activities of Daily Living↗
PubMed2005

[Psychodynamic analysis of nurses' work in long term care units: between pleasure and suffering].

Motivated by the constant increase in nurses'mental health problems, the study of Alderson (2001)--using the psychodynamic approach of work ("Psychodynamique du travai")--looks at the subjective and collective experience of nursing in a chronic care facility. The results of the study show that the major source of suffering in the nurses'work experience is their perceived lack of recognition, of autonomy and of professional power, deficits that are largely maintained by an inadequate organization of the nurses'work. Suggested solutions, according to the nurse subjects, include a necessary transformation of work and its context.

Adult↗
PubMed2005

Advanced nursing practice: policy, education and role development.

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Accreditation↗
PubMed1984

Work autonomy and the community mental health professional: guidelines for management.

Work autonomy is an important characteristic of professional positions in community mental health programs. Yet this concept of work autonomy is so ambiguous that managers are often uncertain about the most effective job redesign strategies. Considering (1) formalization of organization rules, procedures, and job descriptions, (2) the routineness of the work technology, and (3) the degree of decision-making centralization as the essential components of work autonomy, the researchers found that job satisfied employees prefer certainty in job expectations even though this may reduce their overall autonomy. At times of economic uncertainty, special attention must be given to managing turbulence in the external environment so that professionals can effectively exercise autonomy in their service delivery functions.

Community Mental Health Centers↗
PubMed1994

The private psychiatric hospital scandal: a critical social approach.

The recent events that transpired in the for-profit psychiatric hospital industry in which hospitals were alleged to engage in practices which ranged from unethical to illegal underscore the importance of examining the contexts of nursing practice. A wide range of environmental factors and unchallenged assumptions may influence the care of clients and may become obstacles to effective and ethical nursing practice. Critical social theory offers nursing a potentially valuable tool from which to illuminate and examine otherwise unexamined aspects of the environment.

Authoritarianism↗
PubMed2003

Health care ethics and health law in the Dutch discussion on end-of-life decisions: a historical analysis of the dynamics and development of both disciplines.

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction.

Bioethics↗
PubMed2006

The Acute Care Nurse Practitioner: challenging existing boundaries of emergency nurses in the United Kingdom.

AIM: This study explored the opinions of nurses and doctors working in emergency departments towards the development of the Acute Care Nurse Practitioner service in the United Kingdom. BACKGROUND: Studies carried out in the United States and Canada suggest that the Acute Care Nurse Practitioner can have a positive impact on the critically ill or injured patients' experiences in the emergency department. This role is well developed in the United States and Canada, but is still in its infancy in the United Kingdom. DESIGN AND METHODS: A descriptive, exploratory design incorporating questionnaires (n = 98) and semi-structured interviews (n = 6) was employed. The sample included nurses and doctors from seven emergency departments and minor injury units. RESULTS: Respondents felt it was important for the Acute Care Nurse Practitioner to have obtained a specialist nurse practitioner qualification and that the Acute Care Nurse Practitioner should retain a clinical remit. While participants seemed comfortable with nurses undertaking traditional advanced skills such as suturing, reluctance was displayed with other advanced skills such as needle thoracocentesis. Three main themes were identified from the interviews: inter-professional conflict, autonomy and the need for the Acute Care Nurse Practitioner. DISCUSSIONS: Doctors were reluctant to allow nurses to practise certain additional advanced skills and difficulties appear to be centred on the autonomy and other associated inter-professional conflicts with the role of the Acute Care Nurse Practitioner. CONCLUSION: Nurses and doctors identified a need for the Acute Care Nurse Practitioner, but the blurring of boundaries between doctors and nurses can result in inter-professional conflict unless this is addressed prior to the introduction of such advanced practitioners. Relevance to clinical practice. As the role of the emergency nurse diversifies and expands, this study re-affirms the importance of inter-professional collaboration when seeking approval for role expansions in nursing.

Acute Disease↗
PubMed2003

Separated after birth.

Bioethics has developed against a backdrop of increased concern for human and civil rights, including the rights of patients to decide about their own treatment. The recent case of Laleh and Ladan Bijani, the twenty-nine-year old Iranian conjoined twins who died in a Singapore hospital on Jul 8, after more than fifty hours of surgery aimed at separating them, highlights the tensions between respect for patient autonomy and professional medical judgment.

Adult↗
PubMedDate not supplied

Doctors' autonomy.

Explore the source record for details and available documents.

Professional Autonomy↗
PubMed2004

Court-mediated disputes between physicians and families over the medical care of children.

OBJECTIVE: To describe the judiciary's approach to parent-physician disputes over the care of sick children. DATA SOURCES: Court publications. STUDY SELECTION: Fifty parent-physician disagreements over the care of children led to physician requests for court intervention and resulted in judicial opinions published by the court. The opinions describe 66 children from 20 states. DATA SYNTHESIS: Physicians prevailed at the initial decision in 44 (88%) of the 50 disputes and at the final decision in 40 disputes (80%). Physicians were more likely to prevail in religion-based disputes than in other cases (27 of 30 vs 13 of 20; P<.03), but they were less likely to prevail in disputes concerning life-threatening or potentially disabling conditions (23 of 31 vs 17 of 19; P<.19). Courts acknowledged the pediatric patients' views in only 10 of the disputes (9 of the 19 cases involving adolescents and 1 of the 31 cases involving children younger than 12 years). For most courts, the petitioning physicians provided the only source of scientific information. CONCLUSIONS: Published court opinions create precedents for future decisions and provide insight into the consequences of seeking court intervention for the physician who encounters parental refusal of care.

Adolescent↗
PubMed2005

The process of giving information to families of critically ill patients: a field of tension.

We conducted research to study nurses' views on factors that influence their relationship with patients' relatives in intensive care units in three hospitals in Mallorca (Balearic Islands, Spain). This article focuses on the findings related to the process of giving information to the family. We used a post-structuralist theoretical framework and data were collected through observations and interviews. The analysis revealed that nurses thought information eases relatives' worries, but they felt that in order to avoid conflicts with physicians they should restrain themselves from providing it. We propose that the existing power relationships in intensive care units should be challenged if we expect health care professionals to offer patients' relatives a planned information process.

Adaptation, Psychological↗
PubMed2006

Student self-assessment and its impact on learning - a pilot study.

Student self-assessment is widely reported to offer numerous advantages to the learner. It is a popular practice for empowering students and the advantages are claimed to incorporate increased dialogue between students and teachers and the development of skills that encompass critical awareness and reflectivity. It is, potentially, a process that may enable health care practitioners to be lifelong learners, equipped with the skills for autonomy in learning and professional practice. As such it might be viewed as an essential element of the curriculum. This paper reports on a study designed to evaluate the implementation of self-assessment among student health care practitioners. The pilot study examined the impact of self-assessment on learning and how the process was perceived by students and staff. Findings indicated that a varied approach had been taken to its implementation, which had significant repercussions in the way in which it was perceived by students. Similarly, there was a varied approach taken by students to the process of self-assessment and this had significant repercussions for its overall value as a learning tool. The outcomes of this study provide a sound rational for maintaining and expanding the practice of student self-assessment and important lessons for the process of doing so.

Anxiety↗
PubMed2002

Participating in decisions about treatment: overt parent pressure for antibiotic medication in pediatric encounters.

This article examines how parents and pediatricians negotiate antibiotic prescribing decisions in cases where parents overtly advocate this medication. Using the methodology of conversation analysis, this paper examines audio and videotaped acute care pediatric encounters and discusses four primary ways in which parents raise antibiotics in pediatric encounters. These formulations vary in their directness with indirect formulations being more common. The article argues that both parents and physicians are oriented to antibiotics as negotiable in and through their interaction. Finally, in contrast with existing research, this study suggests that overtly advocating for antibiotic treatment is relatively unusual; future research will need to incorporate an understanding of the effect of both explicit and implicit ways parents communicate pressure for prescription treatment.

Adult↗