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PubMed2005

To be a nurse or a neighbour? A moral concern for psychiatric nurses living next door to individuals with a mental illness.

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses' experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was used for data collection and analysis. The process of 'behaving as a nurse or not' was identified as a core category. Four subcategories were identified: 'receiving involuntary information', 'to take action or not', 'behaving as a mediator in the neighbourhood' and 'the freedom of choice'. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time.

Adult↗
PubMedDate not supplied

Job satisfaction among hospice interdisciplinary team members.

The purpose of this study was to investigate job satisfaction among hospice interdisciplinary team (IDT) members. Interdisciplinary team members (N = 76) from several hospices in Ohio participated in the study. Pearson product-moment correlations (p < .05) revealed that there were significant relationships between job satisfaction and autonomy, role ambiguity, role conflict, supervisory support, task significance, routinization, positive affectivity, negative affectivity, and team functioning. Multiple regression analysis (p < .05) revealed that supervisory support, positive affectivity, role ambiguity, autonomy, and routinization were significant predictors of job satisfaction.

Adult↗
PubMed1999

The regulation of autonomy in nursing: the Italian situation.

We reflect upon the meaning of freedom and autonomy in nursing behaviour, attempting to outline the contemporary situation of nursing in Italy, where the profession is achieving important results after a long period of submission and subordination. The way to real emancipation is not easy, but a statement of law on the one hand--abolishing constraints such as the Mansionario--and professional self-regulation on the other--the recent new Deontological Code--represent a real conquest in that direction. However, no statement of law or deontology can be sufficient without deeper reflection by the profession on itself and its tasks, potentiality, social importance and self-esteem.

Codes of Ethics↗
PubMed1997

Restrictive practice environment and nurse practitioners' prescriptive authority.

This study analyzes the impacts of several variables, including a restrictive practice environment, on a nurse practitioner's level of autonomy with respect to prescribing selected categories of medicines. A general linear model is applied to data from the 1992 national sample of nurse practitioners. Results show that among the significant independent variables, a restrictive environment of imposed state laws and regulations reduces nurse practitioners' level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. Results and policy implications are discussed.

Drug Prescriptions↗
PubMed1995

They may want to take charge, but can physicians really organize?

Current managed care network models include physician organizations (POs) and fully integrated regional groups (FIRGs). Proper organization of such networks requires a sequence of essential organizational decisions. If physicians are to organize properly, they must avoid three major pitfalls. Of these, the loss of autonomy is the greatest threat. The proper fit of organizational structure with the founders can assist the entire process significantly.

Decision Making, Organizational↗
PubMed2005

Clinical pathways in 17 European Union countries: a purposive survey.

We undertook a survey of clinical pathways across the 25 European Union countries, Australia. Fifty-one questionnaires were completed by largely self-selected experts from 17 countries. Respondents reported that pathways were important and were becoming increasingly widely used (although the rate of progress was highly variable). One important constraint was reported to be a cultural aversion among doctors that arises at least in part from the implication that pathways require multidisciplinary teamwork which will prejudice medical autonomy. In other words, pathways challenge clinical professional sub-cultures. Other constraints included lack of encouragement by external parties, such as purchasers, with limited financial support for pathway development and implementation and service purchasing that did not reward care providers who use pathways. The obvious implication of the survey is that more needs to be done to achieve a common understanding of pathways. In spite of the large quantity of published papers, survey respondents reported that there are many health professionals who have only a superficial understanding at best.

Attitude of Health Personnel↗
PubMed1992

The end of autonomy? Reflections on the postprofessional physician.

Of the many characteristics that classify the practice of medicine as a profession, autonomy plays the most important role. There are currently assaults on the profession's ability to select, train, and license its own practitioners and on the medical knowledge base itself, as well as the standards for applying it. This article examines factors contributing to this reduction in autonomy and reviews potential impacts on the profession, patients, payors, health care organizations, and managers.

Education, Medical↗
PubMed2006

Teaching internal medicine residents in the new era. Inpatient attending with duty-hour regulations.

BACKGROUND: Little is known about the impact of resident duty-hour regulations on the inpatient teaching experience. OBJECTIVE: Provide descriptive information on the effect of resident duty-hour regulations on attendings and the educational environment. DESIGN: Qualitative analysis of attending focus groups and e-mail survey of residents in Internal Medicine. PARTICIPANTS: Inpatient attending physicians at 2 academic centers and residents at the affiliated university-based Internal Medicine residency program in Portland, OR. RESULTS: Seventy-two percent of eligible attendings participated in 2 focus groups. Three themes were generated: increased clinical role, altered time management, and altered teaching. Attending physicians report performing more clinical work, teaching less, using more focused teaching methods, and experiencing an increased perception of intensity. Forty percent of eligible residents completed our e-mail survey. We organized residents data using the same 3 themes as attending physician data. Residents observed attending physicians performing increased clinical work, being more time aware, delivering more focused teaching, and having less time to teach. Participants noted changes in autonomy and professionalism. Strategies to enhance teaching effectiveness in the new environment were described. CONCLUSION: Duty-hour regulations have increased attending clinical responsibility and decreased teaching time in 1 residency program, leading to the perception of a more intense attending experience. Duty-hour regulations encourage educators to determine what is critical to preserve in the educational experiences of learners and challenge us to reexamine autonomy and professionalism in training.

Attitude of Health Personnel↗
PubMed1994

Hungarian midwives and their practice: a national survey.

In 1975 the Hungarian educational system for midwives was shortened from a three year programme to one of ten months duration in order to provide a more immediate supply of midwives in a relatively short period of time, and to reduce the costs associated with midwifery education. Ten years after the educational programme change, a national survey of Hungarian midwives (n = 290) was conducted by the European Regional Office of the World Health Organization and the Hungarian Ministry of Health. This study describes the effects of the two educational programmes and years of practice on Hungarian midwives' self-perception of competency, satisfaction and summative score of responsibility and autonomy. Significantly different group mean scores on variables related to competency and satisfaction were found for the two groups.

Adult↗
PubMed2006

The extent to which students' perceptions of faculties' teaching strategies, students' context, and perceptions of learner empowerment predict perceptions of autonomy in BSN students.

This descriptive correlational study examined the extent to which students' perceptions of faculties' teaching strategies, students' context, and perceptions of learner empowerment predicted perceptions of autonomy in senior female generic baccalaureate degree (BSN) students in Northeastern Pennsylvania, USA. Dunkin and Biddle's Model for Classroom Teaching (1974) provided the theoretical framework for this study. The sample of 198 female senior nursing students was drawn from 32 nursing programs accredited by the National League for Nursing Accrediting Commission [National League for Nursing Accrediting Commission (NLNAC) 2002. Directory of accredited programs. Retrieved July 16, 2002 from, http://www.nlnac.org/]. Three separate instruments were used in this study: (1) Learner Empowerment Measure [Frymier, A.B., Shulman, G.M., Houser, M., 1996. The development of a learner empowerment measure. Communication Education, 45, 181-199.]; (2) Autonomy, Caring Perspective [Boughn, S., 1995. An instrument for measuring autonomy related attitudes and behaviors in women nursing students. Journal of Nursing Education, 34, 106-113.] and (3) an investigator designed student demographic data questionnaire. Data were analyzed using stepwise multiple linear regression to estimate path coefficients. Inspection of the findings revealed that there was a significant direct effect (t = 4.299, p < .001) between perceptions of learner empowerment and perceptions of autonomy. Age was also found to have a statistically significant direct effect on perceptions of autonomy (t = 2.652, p = .009). The findings from this study support a link between learner empowerment, stated as a priority in nursing education, and autonomy identified as a priority in practice.

Adult↗
PubMed2002

Addressing the barriers to midwifery--Australian midwives speaking out.

This research gives a voice to midwives in identifying the barriers and current problems in the organisation of maternity care in Australia. Using a critical feminist research approach, data was collected from a cross section of midwives nationally. Through standard qualitative research methods, themes were identified that enabled analysis of significant issues affecting the current status of midwifery. The system of maternity care was identified as being dominated by medicine, not evidence based and restricting of women's choices, with midwifery autonomy not recognised or supported. The invisibility of midwifery within the community was identified as a significant barrier which, in conjunction with the occupational imperialism of obstetrics, ensures ongoing strategic control of maternity services and a denial of the rights of consumers to access midwifery care.

Attitude of Health Personnel↗
PubMedDate not supplied

Nurse case manager role attributes: fifteen years of evidence-based literature.

Nurse case management has been shown to provide quality patient care. Transition into the nurse case manager (NCM) role has presented administrators with a strategy to retain highly experienced registered nurses. An evidence-based literature review was pursued to examine provider and patient satisfaction associated with NCMs in acute and community care practice delivery settings. Qualitative and quantitative empirical findings were gathered to determine consistent role attributes. Autonomy was described as high by NCMs with interdisciplinary collaboration seen as an important practice activity. Mixed results were uncovered in nurse case management's effect upon staff nurse practice as well as patient and provider satisfaction. From the findings generated, recommendations were developed to improve the practice and expectations of the NCM role.

Attitude of Health Personnel↗
PubMed2002

The effects of nurses' job satisfaction on retention: an Australian perspective.

OBJECTIVE: The effectiveness of any strategy that aims to improve recruitment and retention in the nursing profession will depend in part upon understanding the factors and influences on nurses' job satisfaction. BACKGROUND: The nursing work force is aging. The question now commonly asked by the nursing profession worldwide is: Who will replace this work force? Although the number of employed nurses continues to decline, patient acuity and turnover in our healthcare system continues to increase. This increasing dilemma is further deepened by progressively falling annual recruitment of new nurses and has resulted in an alarming shortfall of nurses. METHODS: This study used a multigroup longitudinal design to elicit nurses' attitudes toward their job satisfaction and retention plans. RESULTS: The results revealed that professional status was found to be significant of retention. The results indicated that job satisfaction remained relatively stable with time for experienced nurses (N = 528/332). For new graduates (N = 506/110) the issue of pay became a significant area of dissatisfaction in the transition from student to registered nurse. CONCLUSION: The results from this study contribute to the expanding body of knowledge that indicates professional status, autonomy, and remuneration are career issues of great concern for nurses and is particularly relevant for the retention of the newly registered nurse.

Adult↗