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At least 1,189 records · Page 66Linked to original sources
PubMed1996

Practical ethics in the managed care era.

The dentist of the '90s will have to be a highly competent clinical ethicist to thrive in and feel good about dentistry. Ethics is often mistaken by dental professionals and students to be a dull, dry recounting of the things they must avoid to stay out of trouble. This article points out that ethical reflection is interesting and, on a practical level, essential to both practitioner and patient. Much is new to the dentist in this area, as biomedical ethics have evolved a great deal in the past few years. What follows is an outline of basic normative theory, a discussion of practical modern issues, and some psychological reflection on putting good decisions into action.

Adult↗
PubMed1998

Clinical management as boundary management. A comparative analysis of Canadian and UK health-care institutions.

Focuses on the critical role played by professionals in the management of healthcare institutions in the UK and Canada. Using empirical data, examines the structural models of clinical management, the roles of clinical managers and their relationships with colleague professionals. Compares the approaches taken in the UK and Canada, and explores issues of context, history and relative power. Questions the extent to which professionals are losing autonomy to other professions and management. In particular examines whether the sharing of power inter-professionally may lead to greater, overall collective professional autonomy. Develops themes of the contextual influences on the process of change, and whether professionals are more effectively managed by internal or external processes of control.

Administrative Personnel↗
PubMedDate not supplied

Managed care and the imperative for a new professional ethic.

Physicians complain about the growth of managed care structures and strategies and their effects on treatment autonomy and medical professionalism. Organizational changes and a competitive marketplace make the traditional view less relevant today. New concepts of professionalism are needed that recognize constraints and include patient advocacy within a framework of procedural justice, responsibility for population health, new patient partnerships, and participation in an evidence-based culture. Such changes require more focused efforts in medical education to support the new professionalism.

Attitude of Health Personnel↗
PubMedDate not supplied

Magnet hospital staff nurses describe clinical autonomy.

BACKGROUND: Considerable and longstanding confusion abounds as to what is meant by the concept "autonomy." The 2 dimensions of autonomy-rooted in the clinical act and the autonomy of the discipline or profession-are used interchangeably and measured with the same tools. PURPOSE: The purpose of this research was to ascertain staff nurses' concept of autonomy, to empirically quantify nurse autonomy, and to determine the relationship between degree of autonomy and staff nurses' rankings of quality care on their units and their own job satisfaction. METHOD: Two hundred seventy-nine volunteer staff nurses from 14 magnet hospitals were interviewed individually with the open-ended question and request, "Can you practice autonomously? Give an example of a typical situation that illustrates that you practice autonomously," and with two 10-point rating scales on job satisfaction and quality of care given on their units. Responses were subjected to constant comparative and thematic analyses. On the basis of 3 themes-frequency, organizational sanction, and scope-a 5-category ranked autonomy scale was developed. These magnet hospital staff nurses restrict the concept of autonomy to the clinical act. There is a strong relationship between degree of autonomy as measured by the ranked scale and rankings of job satisfaction and quality of care. An unexpected finding was that 26% of these nurses working in magnet hospital reported situations of unsupported or no autonomy. DISCUSSION: This research is particularly meaningful for nurse managers and researchers. Nurse managers must empower nurses, provide support, provide opportunities for nurses to increase competence, and reward and sanction staff nurse autonomy. After further refinement, the ranked-category scale will be useful in studying the effect of educational efforts and organizational support on the development of clinical autonomy.

Decision Making↗
PubMed1998

Service-level agreements at the Huddersfield NHS Trust.

Service-level agreements (SLAs) have been claimed to be an excellent vehicle for organisational improvement where there is a substantial degree of departmental autonomy. Such a situation is likely to exist in NHS trust hospitals because of the differentiated nature of the work performed by each department, with varying degrees of specialisation and professionalism, access to patients, use of technology and differing cost bases but also an interdependence of the direct services to the support services. It is proposed that SLAs can be used to promote improved integration between departments, quality assurance and provide a framework for cost transfer charging. The article describes and analyses SLAs from an overview of the idea to the particular implementation to date at the Huddersfield NHS Trust. SLAs have been negotiated between the Directorate of Clinical Support and its customers, and these are supported by computerised measurement and reporting tools.

Ancillary Services, Hospital↗
PubMedDate not supplied

Ms. B and legal competence: interprofessional collaboration and nurse autonomy.

--Ms. B's wish for withdrawal of treatment was refused. --The nurses' role and autonomy in the decision-making is unclear. --Historically, tensions have existed in the doctor-nurse relationship. --Interprofessional collaboration is encouraged in order to facilitate team working. --Evidence is lacking that this is working and suggests continuing problems. --Legal and ethical education needs emphasizing in order to ensure respect for patient autonomy.

Adult↗
PubMed2000

The transformative process of residency education.

The author explores a model for transformative learning proposed by the education scholar Victoria Marsick. He begins by outlining Marsick's eight principles (or outcomes) of transformative learning: increased autonomy; increased independence; the ability to separate one's feelings and opinions from those of others; the ability to critically and respectfully examine the views of others; the ability to set personal and professional goals; the ability to see how one's actions affect the system in which one works; the ability to balance and choose among conflicting priorities and at some point transcend self-interest; and the ability to acknowledge one's role in constructing one's reality. Using illustrative examples from his experiences as a resident and a teacher of residents, the author describes each principle of the transformative model. He then suggests how educators can use these principles to ensure a transformative residency experience by which novice professionals become reflective and confident practitioners.

Clinical Competence↗
PubMedDate not supplied

Autonomy and satisfaction among mammographers.

This article reports results of a study assessing the relationship between decision autonomy and task satisfaction in Texas mammographers. As hypothesized, the results indicate a positive correlation between autonomy and satisfaction. The authors also found that no independent variable (age, years of experience, employment status, position or type of imaging facility) had predictive value for mammographers' autonomy and task satisfaction.

Adult↗
PubMed1992

The poverty of professionalization: a critical analysis of strategies for the occupational advancement of nursing.

The purpose of this paper is to evaluate critically the strategies of occupational advancement used by nurses. It is noted that these are frequently framed within the paradigm of professionalization. However, despite the ubiquity of its use, it is argued that this model is inappropriate. Specific strategies are examined. Attempts to appropriate the title of profession by demonstrating that nursing possesses the relevant attributes are dismissed as rhetorical exercises. The rise of managerialism, despite being cloaked in the guise of professionalism, is seen as anti-professional because it restricts the autonomy of individual practitioners. Clinical 'professionalization' is also regarded as problematic because it does not fit with the definition of a professional as an autonomous practitioner. Examination of patient advocacy, and of attempts to validate nursing diagnosis, demonstrate that the occupational advancement of clinical nurses is increasingly dependent upon the co-operation of health care consumers. This dependence is incompatible with the prescriptive powers and exclusive knowledge that are claimed by traditional professions. It is concluded that nurses should abandon the ideology of professionalization and concentrate on the more pertinent issue of maximizing the efficacy of the occupation.

Career Mobility↗