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PubMedDate not supplied

[Interdisciplinary relationships and humanization in intensive care units].

OBJECTIVE: To analyze those aspects of the relationship between the health care team of an ICU that may be decisive in the construction of humanized care. METHOD DESIGN: phenomenology: descriptive and exploratory. ANALYSIS and observation unit: Polyvalent 23-bed adult ICU. DATA COLLECTION: nine extensive interviews. POPULATION: healthcare professionals in interaction in the ICU that is being studied. ANALYSIS: assigning of data to emergent categories. Contrasting with existing theories. RESULTS: Identification of guideline values circumspect to the humanistic paradigm. The value of professional role is accepted as emergency factor of certain attitudes. All the professional groups detect lack of independence situations, which are not always attributable to hierarchical reasons. Systematic interdisciplinary communication is evaluated positively. Humanization requires time, resources, and intergroup relationships and explicit commitment by the institution. CONCLUSIONS: Relief of great suffering situations is the main reason for interdisciplinary disagreement. Construction of a tolerant setting and institutional recognition as factors favoring humanized care. Lack of time and resources as obstacles to the humanization of care.

Allied Health Personnel↗
PubMed2002

Genetic testing.

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Abortion, Legal↗
PubMed2001

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses.

AIM: The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home. BACKGROUND: This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management. METHODS: The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care. FINDINGS: Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity. CONCLUSIONS: Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.

Adult↗
PubMed1999

Senses of responsibility. A challenge for occupational and physical therapists in the context of ongoing professionalization.

The aim of this paper was to delineate different senses of responsibility in the therapeutic relationship between occupational and physical therapists and their patients, in the context of ongoing professionalization. To assist the analysis of the therapists' responsibilities, Ozar's guild and interactive relationship models were employed. The questions with regard to each model asked how the model might be used in order to describe the therapists' professional development in general, and specifically their professional responsibilities. Based on earlier findings, the professional development of the therapy groups has developed in line with both the guild and interactive models, i.e. some therapists have adopted the former and others the latter. Whether therapists in general, in recent years, have shifted their paradigm, and consequently also their choice of relationship model, is a question that necessitates further research. However, based on the results from the analysis here, it seems relevant to propose that therapists, with a renewed sense of urgency, should use Ozar's models as tools for reflection on the development of their professional responsibilities in the therapist-patient relationship, in the frame of a rehabilitation paradigm.

Attitude of Health Personnel↗
PubMed2003

Educating the reflective practitioner: graduates in practice.

This paper draws on interview research exploring how recently graduated acupuncturists and homeopaths construct their professional identities, with a goal of assessing whether the processes and values developed in the program are carried forward into practice. The interviews were designed to engage the participants in telling stories about their work and were analyzed through discourse analysis. Although the two practitioners at the focus of this paper show considerable difference in the sophistication of their client management, both can be seen to use reflection to identify problems and find solutions in their work with clients.

Adult↗
PubMed2005

The largely untold story of welfare reform and the human services.

Welfare reform has placed the lives of clients, the jobs of social workers, and the mission of agencies in jeopardy. Based on interviews with senior staff at 107 nonprofit human services agencies, this article documents the largely untold story of how nonprofit agencies' workers responded to the impact of welfare reform on their clients, their jobs, and the delivery of services. Workers reported less time for social services because of welfare-related regulations, penalties, work mandates, crises, and paper work. They also reported more service dilemmas including less control of the job, more ethical conflicts, less efficacy, and increased burn-out. Even so, workers felt that they were making a difference, and agencies indicated increased advocacy. Relying heavily on the voice of social workers, the article illuminates the experiences and feelings of agency staff as they try to do their best for clients in difficult times.

Attitude of Health Personnel↗
PubMedDate not supplied

Ethical conflict in nurse practitioners and physician assistants in managed care.

BACKGROUND: More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). These providers are likely to be confronted with a variety of ethical issues as they balance quality care with their patients' rising cost concerns. However, very little is known about the ethical conflicts and causes of these conflicts experienced by these clinicians in their daily practice. OBJECTIVE: To identify ethical concerns and conflicts NPs and PAs encounter related to managed care in the delivery of primary care to patients and the factors that influence ethical conflict. METHODS: A cross-sectional self-administered mailed questionnaire was sent to 3,900 NPs and PAs randomly selected from primary care and primary care subspecialties in the United States (adjusted response rate, 50.6%). Respondents were surveyed on ethical issues and concerns, ethics preparedness, and ethical conflict. Bivariate and multiple linear regression analyses were used to evaluate predictors of ethical conflict. RESULTS: Insurance constraints were reported to have interfered with the ability to provide quality patient care by 72% of respondents, with 55.3% reporting daily to weekly interferences. Nearly half of respondents (47%) have been asked by a patient to mislead insurers to assist them in receiving care. A perceived obligation to advocate for patients, even if it means exaggerating the severity of a patient's condition, was the single most significant predictor of ethical conflict, explaining 25% of the variance. DISCUSSION: NPs and PAs are experiencing ethical conflict often associated with their perceived professional obligations to advocate for patients. Being well-prepared in ethics and having sufficient professional independence help clinicians balance the ethical complexities and demands of meeting patients' needs within a constrained healthcare system.

Adult↗
PubMed1993

An organizational culture that optimizes stress: acceptable stress in nursing.

Stressors intrinsically associated with nursing provide a desirable moderate level of stress leading to high job performance. More (or less) stress would likely lead to a drop-off in performance. A large, urban hospital's organization has been designed to minimize further stress arising from its organizational culture. Its dominant values are responsibility, high quality nursing, collaboration, supportiveness, caring, autonomy, clinical development, and professionalism. Expressed in Jungian terms, the organization embodies Great Mother, Anima, Wise Old Man, and Anima archetypes. Nurse executives and administrators who understand the effects of organizational culture on stress may help their institutions operate in stress's healthy midrange.

Female↗
PubMedDate not supplied

The longest minute.

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Attitude of Health Personnel↗
PubMedDate not supplied

Job satisfaction of HIMs working in Victorian hospitals.

The growing demand for Health Information Managers (HIMs) in Victorian hospitals has increased the importance of job satisfaction in maximising performance and ensuring high retention levels both within the profession and the state. This report outlines the results of a job satisfaction questionnaire completed by a sample of HIMs working in Victorian hospitals. The questionnaire focuses on task design, autonomy, performance feedback and professional development opportunities. While the study demonstrates a scope for improvement, it also highlights the general satisfaction of the Victorian HIM population.

Adult↗
PubMed2006

The meaning of quality work from the general practitioner's perspective: an interview study.

BACKGROUND: The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective. METHODS: Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements. RESULTS: Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs. CONCLUSIONS: The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled.

Adult↗
PubMed2000

Case management decision making: goal transformation through discretion and client interpretation.

This study examines the decision-making strategies employed by case managers in a state-funded home care program for the elderly. Specifically, this study applies Lipsky's (1980) theory of street-level bureaucracy to gerontological research on case management decision making in an effort to demonstrate the presence of case management discretion, and the impact of that discretion on home care implementation. Drawing upon individual interviews and focus group interviews, results suggest the applicability of the proposed framework, and indicate the need for policy planners to identify factors for case manager discretion that result in undesirable home care goal transformation.

Aged↗
PubMed1996

Social workers' perceptions of their power and service outcomes.

While social workers are becoming increasingly interested in methods of client empowerment, little attention has yet focused on the links between workers' own power and the services they provide to clients. The authors examine the link between workers' perceptions of their power on the job and perceived service outcomes. Bivariate and multivariate analyses were conducted on survey responses from 591 direct practice social workers in Israel. Results indicate that power perceptions are significantly associated with an array of perceived service outcomes. These findings highlight the relevance of self-efficacy and control theory in understanding social workers' efforts toward effective service delivery. Further, they underscore a need to consider more carefully direct practitioners' own power concerns as they increasingly consider empowerment of their clients.

Burnout, Professional↗
PubMedDate not supplied

[Nurse's image: review of the literature].

The society's image about the nurses is permeated of stereotypes that include figures like saints, prostitutes, witches, heroines and are related to the function of assisting doctors and to a lack of social life. Moreover, the image that the nurses have of themselves and of their work is negative, causing frustration for the lack of autonomy found on the professional reality. Seeking for a better understanding of this problem, a literature review was proceeded, aiming to characterize and analyze the nurse's image. The national scientific production is considered small on the subject. Conclusions indicate that stereotypes negatively influence nursing practice and that in Nursing history it is found many reasons for the existing distortions.

Brazil↗