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PubMed2005

The importance of job autonomy, cognitive ability, and job-related skill for predicting role breadth and job performance.

Role theory suggests and empirical research has found that there is considerable variation in how broadly individuals define their jobs. We investigated the theoretically meaningful yet infrequently studied relationships between incumbent job autonomy, cognitive ability, job-related skill, role breadth, and job performance. Using multiple data sources and multiple measurement occasions in a field setting, we found that job autonomy, cognitive ability, and job-related skill were positively related to role breadth, accounting for 23% of the variance in role breadth. In addition, role breadth was positively related to job performance and was found to mediate the relationship between job autonomy, cognitive ability, job-related skill, and job performance. These results add to our understanding of the factors that predict role breadth, as well as having implications for how job aspects and individual characteristics are translated into performance outcomes and the treatment of variability in incumbent reports of job tasks.

Adult↗
PubMed1993

Learning from success: autonomy and empowerment.

Evidence of autonomous, empowered behavior among nursing personnel at all levels is one of the critical factors looked for by teams reviewing a hospital for magnet hospital status. The kind of culture and leadership strategies which can ensure an atmosphere necessary to facilitate such behavior are described as they exist at a suburban community hospital which has achieved this distinction most recently.

Achievement↗
PubMed2006

A unit-based protocol to enhance Jordanian nurses' autonomous decision making.

AIM: To develop a unit-based protocol to enhance Jordanian nurses' autonomous decision making. BACKGROUND: Many escalating changes are influencing health care organizations, which require the enhancement of nurses' autonomy to manage these frequent changes. Autonomy is addressed in the context of accountability, authority and responsibility. Nurses' involvement in patient care and unit operation decisions is a part of their autonomy. Autonomy will influence nurses' job satisfaction and retention, patients' satisfaction and the quality of nursing care. METHODS: This protocol was developed based on a personal experience, nurses and senior nursing students' feedback, a review of the literature, and consultation with a group of 26 nurses in a teaching hospital. The nurses were asked on the comprehensiveness and applicability of the protocol to health care settings. Nurses' suggestions regarding the protocol were taken into consideration during the development and revision stages. RESULTS AND CONCLUSIONS: A unit-based protocol was developed to enhance nurses' autonomous decision making through activities that support the process of autonomy and work environment. This protocol will have positive short, intermediate and long-term outcomes for patients, nurses and organizations.

Attitude of Health Personnel↗
PubMedDate not supplied

Autonomy and the developing role of the clinical nurse specialist.

The role of the clinical nurse specialist has developed in response to social, technological and political changes that have impacted upon the delivery of health care. Nursing has traditionally been associated with femininity and in a paternalistic health structure the concept of nursing care can be devalued because autonomous nurses may threaten the balance of power. Autonomy is a multi-faceted concept and yet, if nurses have the courage to embrace both the traditional values of nursing and the expertise that their caring role brings to health care, they will be able to develop their own competence and autonomous practice. Nurses may not need autonomy in order to enhance their roles but they do need to concentrate on the concept of care as a team phenomenon. This notion is included in the UKCC's higher level of practice initiative which may direct specialist practice in the future. A negative element to nurse specialization is that nursing care can become fragmented, thus compromising the continuity and accountability of patient care.

Feminism↗
PubMedDate not supplied

Practice profile of members of the American College of Nurse-Midwives. Findings of a direct mail survey.

The scope of practice of today's nurse-midwife is much broader than that of the stereotypical "someone who specializes in delivering babies." Today's nurse-midwife sees approximately 140 clients each month and is involved with providing care to the "total" client. This encompasses not only care related to pregnancy, but also well-woman gynecology, nutrition, mental wellness, and primary care. Although the majority of clients seen by CNMs are in their childbearing years, the practice of nurse-midwifery encompasses postmenopausal women as well. When comparing the results of this survey to responses to similar questions posed 3 years earlier, practice size, number of births attended per month, years in practice, and types of conditions treated were answered in a similar fashion. Although the percentage of CNMs reporting pregnancy care activities remains virtually unchanged, a trend toward an increasing CNM role in well-woman gynecology and primary care is seen. About 5% more CNMs now state that well-woman gynecology and primary care are part of their monthly practice than did in the earlier survey. The biggest change in the greater number of CNMs reporting prescribing autonomy and authority over the 3-year period. In the earlier survey, 51% of the polled CNMs reported full prescribing authority versus 84% who report full prescribing autonomy and authority in 1996. The prescriptions CNMs write each week reflect the diversity in their practice, ranging from those for antibiotics and antifungal agents to those for calcium supplements, antidepressants, and tranquilizers. For 19 of the 36 categories of pharmaceuticals included on the survey, at least half of all CNMs report having the opportunity to prescribe or order products during a "typical" week. In total, for these 36 categories, an average of 94 prescriptions/orders are written each week.

Adult↗
PubMed1991

Sources of countervailing power in medicine.

In recent years a substantial literature has emerged on the alleged deprofessionalization and proletarianization of physicians. The contention is that corporatization is transforming the practice of medicine, divesting physicians of control over many features of their work, consistent with the needs of advanced capitalism. I examine the hypothesis skeptically, differentiating between the cultural role of medicine, the political and social legitimacy of medical concepts, and the personal autonomy of the individual physician. I suggest that while physicians are less autonomous than they used to be, the constraints imposed on them fall within a medical paradigm. From a cultural or social perspective, medicine is more central to the economy and more powerful than ever before. As its centrality and importance increase, there is more at stake, and interests compete more aggressively. I conclude that there is little evidence in support of the hypothesis.

Attitude of Health Personnel↗
PubMed2000

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course.

An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course Small groups were set up purposefully on a part-time post-registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in-depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self-confidence to challenge the status quo and make their own judgements, and a less rule-bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.

Attitude of Health Personnel↗
PubMed1998

A bad disease, a fatal cure: why sterilization is permissible and the autonomy of medicine is not.

The debate in this issue regarding the Roman Catholic condemnation of the morality of sterilization is puzzling for Protestants. As I will argue the puzzlement arises on two grounds. First, why would anyone object to direct sterilization for the cure or prevention of disease? Second, if one wanted to challenge such an objection on moral grounds why would one turn to medicine to do so? For Christian ethics there is nothing wrong in principle with direct sterilization when there are good reasons for precluding the possibility of an additional pregnancy; and it is a serious theological mistake to treat medicine as an independent moral authority.

Catholicism↗
PubMedDate not supplied

Nurses' attitudes toward control over nursing practice.

A random sample of 323 nurses registered in Illinois was used to examine nurses' attitudes toward nurse control over nursing practice. Most supported nurse autonomy, independent practice, and third-party reimbursement, though a fairly sizable minority did not, particularly with regard to independent practice. Regression analyses found that favorable attitudes were associated with a more college-based initial nursing program, a more recent year of initial licensure, a greater attachment to the labor force, and a stronger commitment to a nursing career. Neither family status, current employment situation, nor future career plans had any significant effect.

Adult↗
PubMed1998

Sterilization, Catholic health care, and the legitimate autonomy of culture.

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to Catholic morality through Vatican II's affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake.

Altruism↗
PubMedDate not supplied

Ethical dilemmas in home care case management.

The role of case manager is fraught with challenges in a healthcare environment characterized by rapid aging of the population, a move against institutionalization of seniors, and the need to contain healthcare costs. This study examined experiences of 89 case managers through focus groups in five urban and five rural regions of Canada to identify ethical dilemmas and issues encountered in their role. Overall, the case managers expressed frustration for the lack of support for their work as evidenced by inadequate resources and few agency policies. The analysis of the focus group data revealed four main themes in relation to ethical concerns and dilemmas: (1) issues related to equity, (2) beneficence, (3) non-maleficence, and (4) autonomy and power imbalances. The situation facing these workers is grave and steps must be taken to provide them with ongoing training, support, and resources to continue in this vital role. System changes that would reduce some of the ethical conflicts experienced by case managers include funding for long-term care to keep pace with growing demands, better management of client waitlists to ensure that the most needy are given the highest priority, more supportive housing options that provide for some on-site coordination of services, better opportunities for health promotion, and better interdisciplinary teamwork so that case managers are not left making decisions in the absence of other key service providers.

Aged↗
PubMed1998

Professional dentistry's road to autonomy.

Throughout recorded history the dental ills of mankind have been treated by medical specialists particularly associated with surgery. However, deep-rooted cultural tradition relegated surgeons and those engaged in the dental art to a class deemed socially, intellectually and economically inferior to that of the physician, causing widespread neglect of dentistry until the 16th century. Organizational developments and advances in the technology of medicine and surgery during the next two centuries in Europe engendered the emergence of dentistry from a virtual trade to a recognized specialty of medicine, setting the stage for its phenomenal growth in 19th century America. Perceiving the common need, far-seeing and dedicated representatives of dentistry organized, collected available literature, instituted an unprecedented system of dental education, eliminated the untutored and untrained practitioner, and left the heritage of an independent and honored self-governing health care profession.

Barber Surgeons↗
PubMedDate not supplied

Impact of the Leading an Empowered Organisation programme.

AIM: To evaluate the impact of the Leading an Empowered Organisation (LEO) programme on the role of grade G nurses and their multidisciplinary colleagues in one NHS trust. The LEO programme encourages and promotes leadership skills among NHS staff. METHOD: A purposive sample of four grade G nurses, one from each of the hospital's four clinical divisions, was included. Each grade G nurse, and his or her matron, nominated eight colleagues for interview. The final sample comprised four grade G nurses and 32 of their colleagues. Data were analysed using the principles of thematic analysis described by Attride-Stirling (2001). FINDINGS: The LEO programme improved the grade G nurses' approach to their work in relation to competence, communication strategies, problem solving, risk taking, leadership and management style. Factors that affected the grade G nurses' implementation of the LEO principles included: relationships, personality, experience, work context, staffing levels, autonomy and authority. CONCLUSION: This study provided insight into how the grade G nurses applied the principles of the LEO programme in their daily work. Their ability to apply the LEO principles was both restricted and assisted by the culture in which they worked. A partnership between theory and practice is needed. This finding has implications for the LEO programme and the need for it to be implicit in the local working philosophy, that is, the context in which its principles are to be used. This is so that the working context and people within it are intimately engaged with the individual undertaking the course.

Attitude of Health Personnel↗
PubMed1998

A comparison of practice characteristics among physician assistants in HMO and non-HMO settings.

Health maintenance organizations (HMOs) have continued to grow in both number and enrollment. A major goal of HMOs and other managed care structures is the containment of health care costs. The utilization of physician assistants (PAs) would seem to nicely mesh with these organizations. This study examines the roles, productivity, and clinical autonomy of PAs in HMO settings. In this examination, PAs working with HMOs are compared with PAs working in non-HMO settings, both urban and rural. The results of the study document that PAs working in HMO environments primarily focus on ambulatory care, with few inpatient or administrative responsibilities. Further, PAs working in HMO settings have a highly autonomous practice with approximately 70 percent of patient visits never being discussed with a supervising physician. Lastly, the results suggest that many of the attributes of an HMO practice are found in rural practice as well. Consequently, as HMOs reach out farther into rural America, PAs in rural settings will have fewer practice modifications to make than urban PAs in their transition to practice in an HMO modality.

Adult↗
PubMedDate not supplied

Cognitive and ethical maturity in baccalaureate nursing students: did a class using Narrative Pedagogy make a difference?

The purpose of this project was to examine the effect of Narrative Pedagogy in nursing education on students' ability to move toward cognitive and ethical maturity and thereby increase their autonomy in nursing practice. Students taking a class using Narrative Pedagogy demonstrated "entry" and "exit" mean scores that showed marginal and statistically significant (p < 0.05) improvement on the Measure of Intellectual Development and the California Critical Thinking Disposition Inventory. Using nonparametric and parametric analyses of variance, there was minor improvement on both scales in cognitive and ethical maturity and the disposition to think critically in the intervention group. For all variables, there were no significant differences between the control group and the intervention group, with or without adjustment for age, the only significant covariate. The cognitive and ethical growth documented by either instrument is probably not large enough to be considered practically significant in terms of movement toward autonomous practice.

Adult↗
PubMed1998

Interpersonal relations in nursing: a philosophical-ethical analysis of the work of Hildegard E. Peplau.

Nursing typically has been viewed as a moral practice, for instance by new developments in the ethics of care. Nevertheless, many philosophical-ethical presuppositions of nursing theories remain to be clarified. This paper presents a philosophical-ethical analysis of the work of Hildegard E. Peplau. Analysis of the philosophical-ethical background of Peplau's works illuminates a view on nursing practice that is relevant today. Three main components are analysed more deeply, i.e. the professionalization of nursing, the philosophical underpinnings of Peplau's view on nursing science, and the nurse-patient relationship as the central event in nursing.

Ethics, Nursing↗