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Morally autonomous practice?

The structures and contexts within which nurses work results in the moral agency and moral autonomy of the nurse being compromised. This claim results from a confusion of (1) the concept of autonomy with those of freedom and independence; and (2) a confusion of the notion of moral autonomy with that of autonomous professional practice. The drawing of appropriate distinctions allows clarification of the relevant concepts. It also underlines the responsibility of practitioners to recognize the moral dimension of their practice, and the moral implications of their actions, as they attempt to meet the health care needs of their patients and develop practice professionally.

Ethics, Nursing↗

On paternalism.

Explore the source record for details and available documents.

Child↗

Autonomy and paternalism in medicine.

The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied contexts. As neither autonomy nor paternalism has a current universally accepted meaning, their significance varies in both ethical and clinical discussion. Of the two, autonomy has moved further from its original moral context, to the extent that it often now signifies no more than a person's expressed intention. Paternalism, characterised as the antithesis of autonomy, is widely thought not to have any role in medicine. The transforming effects of illness, which may radically alter a person's decision making capacity, are commonly ignored.

Beneficence↗

An evaluation of a nurse extern program.

Externships are meant to bridge the gap between the educational and practice setting for nursing. This project began with discussions of outcomes for nurse extern programs. The Schutzenhofer Nurse Activity Scale and the Meleis Nurse Self-Description Form were used to measure identified outcomes of professional activities and autonomy. Forty-one participants began the study, but 33 completed the pretest and posttest both. Analysis of data showed a positive correlation in Posttest 1 between age and the Meleis Nurse Self-Description Form (NSDF). Dimensions of professional activity changed most in older students. At the end of Phase 2, analysis of data showed significantly greater professional autonomy. However, no significant change in NSDF was seen throughout time. Participants reported increased self confidence.

Adult↗

Patient's autonomy vs doctor's professional integrity.

In recent years, there exists a world-wide tendency to stress patient's autonomy instead of doctor's paternalism in daily medical practice. This tendency must be appreciated as "every human being of adult years and sound mind has a right to determine what shall be done with his own body". But this autonomy sometimes conflicts with the doctor's personal integrity which is essentially a pro-life one. In some western countries, this autonomy is legally admitted even in life-shortening procedures such as an abortion or euthanasia in the terminally ill patients. In 1994 a Japanese scientific council made a report concerning "death with dignity" and declared that the withdrawal of foods from PVS patients should be proceeded under his or his supposed will, and in a criminal case decision in 1995, criteria for the active euthanasia in the terminal patients are proposed. In both situations, the actor should be a doctor. These life-shortening procedures might be appreciated for the autonomy of patient and be legally permitted. But conscientious refusal of doctor against proceeding these acts must be also admitted, as the philosophy of each doctor about the sanctity of terminal life is different from doctor to doctor as in lay persons.

Adult↗

Professional values in health care.

All professionals subscribe to certain values and have concerns about their freedom and autonomy. When professionals work in large and complex organisations such as hospitals, differences in the values of various groups are reflected in disagreement. Tony Kennerley argues that the manager's task is to create harmony out of such dissonance.

Health Personnel↗

Mediation in the medical field. Is neutral intervention possible?

Neutrality is held to be the touchstone of good mediation. True neutrality is elusive, however, and probably not even desirable, at least when applied to patient-provider disputes over medical care. In this context, mediators should not posture as "neutrals"; they should strive instead to protect their clients' autonomy.

Attitude of Health Personnel↗

Canadian public health nurses' job satisfaction.

OBJECTIVES: This study was undertaken to test the applicability of using a standardized questionnaire for measuring public health nurse (PHN) job satisfaction and to determine whether or not scores changed over 30 months. The importance of establishing a method for ongoing measurement of PHN job satisfaction was underscored by changing directions in practice and an emphasis on building public health capacity. METHOD: A 30-month interval, repeated measures descriptive survey design was used. SAMPLE: A randomly selected sample of 87 PHNs employed within 1 Canadian regional health authority participated. MEASUREMENT: The survey questionnaire, the Index of Worklife Satisfaction, was designed to measure the importance of and satisfaction with 6 components of job satisfaction. RESULTS: Pay and autonomy were the most important components; the order of the 4 remaining components changed from first to second surveys. Professional status, autonomy, and interaction were the most satisfying components; PHN satisfaction with professional status and interaction improved significantly over 30 months. A majority of subjects reported that direct client care/client response/making a difference were worklife aspects providing them with most satisfaction. CONCLUSIONS: A valid, reliable questionnaire suitable for ongoing measurement was tested with PHNs, and baseline levels of their job satisfaction were established.

Attitude of Health Personnel↗

Doctors and corporatist politics: the case of the Mexican medical profession.

This study advances our understanding of the relationship between the state and the medical profession in countries where health care services are used as instruments of economic and political control. As a general argument, we maintain that the corporatist nature of the Mexican state impedes the medical profession from achieving autonomy and control over its professional activities. In contraposition to medical professions in developed societies, the nature of the Mexican profession is shaped by state policies and by its reiterated efforts to act independently of the state's tutelage. We analyze this dynamic interaction through three different historical epochs that reflect the complexity and uniqueness of the Mexican medical profession. Whatever attempts the profession has made to control the medical curriculum, the licensing process, the market, or the specific laws that affect its own field, the Mexican state has responded with measures that systematically divide and antagonize the different factions of medical associations. The result is a highly fragmented and disenfranchised medical profession with dissimilar political, professional, personal, and academic aims. In the final analysis, the interests of the corporatist Mexican state prevail over the interests of the groups, including doctors. The evisceration of the medical corps by the Mexican state results in a profession with low salaries, higher rates of unemployment, atomization in terms of political representation, and heavily co-opted medical organizations that seem to neglect the overwhelming health care needs of the Mexican people.

Attitude to Health↗

[Professional nursing].

One aim of Nursing Education is the Professionalization of Nursing. The characteristics of Nursing Professionalization are expertise, accountability and autonomy. The Nursing Education is a starting-point to expertise, what is a starting-point to accountability and autonomy. The professional Nursing is a more extensive concept than immediate nursing. It includes the Developing of Health Care System and the Providing of.

Education, Nursing↗

Why do we need peer review?

Some nurses see peer review as a threatening experience and put up defense mechanisms to resist change. Others are recognizing it as a popular performance-appraisal strategy that will enhance their autonomy and accountability within their professional practice. But why do we need it? And what are the benefits?

Employee Performance Appraisal↗

Analysis of power in medical decision-making: an argument for physician autonomy.

Two of the patient's rights in a Uniform Act for the Terminally Ill should be a) the right to be treated if there is reasonable doubt of the patient's wishes until it becomes clear that the treatment is not beneficial and that the patient is indeed terminally ill, and b) the right not to be subjected to treatment with no medical benefit. A physician with appropriate supporting independent opinions would be the logical individual to whom the responsibility of protecting those rights should be given. This is particularly true when the patient is incapable of his or her own medical decisions and has left no instructions regarding his or her personal goals in medical care in the event of severe illness. Two cases and an analysis of power in medical decision-making illustrate these points.

Communication↗

Clinical issues on consent: some philosophical concerns.

On occasions, laws on consent are subject to modification, largely on account of being subject to common law rather than statute-for example, in the UK. Guideline publications such as the UK Department of Health Reference Guide to Consent for Examination or Treatment are intended to provide information for clinicians on when and how to apply current laws in everyday clinical situations. While the extent to which guidelines influence clinician behaviour depends on how much they are read and followed, what is also relevant, and sometimes omitted from consideration, is discussion about underlying philosophical concepts. This paper analyses philosophical weaknesses relating to English laws on consent, the main focus of attention being applied ethics and the rights of adults with incapacity. It draws comparisons between the US and the UK, and advocates changes in English law in order to help rectify weaknesses in patient protection. Discussion includes references to Scottish law, and the use of advance directives, and it voices concerns about over-reliance on "best interests" determinations. The problem is partly one of logical analysis, and what can happen is that best interests determinations fail to show proper respect for adults lacking the capacity to consent to examination or treatment on their own behalf. This is fundamentally a matter of rights, and requires further investigation and appropriate legal remedies in order to respond to ethical deficiencies in English law as it now stands.

Adult↗

Organizational power and conflict regarding the hospital-physician relationship: symbolic or substantive?

The purpose of this paper is to provide a critical review of organizational power and conflict regarding the hospital-physician relationship. The issue of power being symbolic and/or substantive is discussed. The classification (Mintzberg Model) of organizations as simple structures, machine bureaucracies, professional bureaucracies, divisionalized forms and adhocracies are reviewed. Also, the issue of whether the perceived autonomy that professional employees enjoy increases the likelihood that an executive level manager in a professional bureaucracy (hospital entity) will devote substantial attention to influencing symbolic outcomes as opposed to substantive outcomes in a machine bureaucracy is discussed. In conclusion, conflicts between hospitals and physicians can be resolved in two ways: (1) by avoiding controversial decisions that might threaten the powers and prerogatives of professional groups; and (2) by agreeing to decisions that hold something for everyone involved in the hospital-physician power relationship.

Conflict, Psychological↗