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Results for “Professional Autonomy”

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PubMed2002

An analysis of the relationship between job satisfaction and job stress in correctional nurses.

Stamps and Piedmonte's Index of Work Satisfaction and Harris's Nurse Stress Index were completed by 287 registered nurses employed in state prison health care facilities in order to assess job satisfaction and job stress among correctional nurses. Correctional nurses' expectations about job satisfaction were influenced by pay and autonomy. This finding was consistent with studies of hospital nurses. Important sources of job satisfaction were professional status and interaction with employees. Analysis of differences between expectations and sources of job satisfaction may provide understanding of career benefits and sources of dissatisfaction. Time pressures and organizational support and involvement were sources of stress. Multivariate analyses showed an inverse relationship between stress and job satisfaction. Information about job satisfaction and work stress and their correlates may be used to develop strategies to improve the recruitment and retention of correctional nurses.

Adult↗
PubMedDate not supplied

Physician care in assisted living: a qualitative study.

OBJECTIVES: To identify patterns and emerging concepts used by assisted living (AL) residents, their families, and the facility staff to describe the care provided by physicians to the AL residents. DESIGN: Qualitative research and analysis based on audio-taped and transcribed ethnographic interviews with residents, family members, and staff of AL facilities. SETTING: Three AL facilities representing small and traditional AL facilities. PARTICIPANTS: Forty-three in-depth interviews including 16 AL residents, 13 family members, three facility managers, and 11 staff members. MEASUREMENTS: Ethnographic, audio-taped interviews coded by consensus by a doctoral-level analysis team. Coding focused broadly on any references to physicians or doctors in the interviews. RESULTS: Emergent themes included four major physician-related themes in AL including: magnification of physician authority; disagreements with physician care; physician communication; and continuity/discontinuity of physician care. CONCLUSION: Physicians caring for residents of AL facilities should consider how residents, families, and staff stakeholders may influence their patient care for AL residents in terms of their authority, decision-making, communication, and continuity of care.

Aged↗
PubMed2001

Doctors' and nurses' perceptions of ethical problems in end-of-life decisions.

AIMS: To identify and compare doctors' and nurses' perceptions of ethical problems. Rationale. Ethical problems are a source of tension for health professionals. Misunderstandings or conflicts may result from differing perceptions of ethical problems. If true collaboration is to be achieved, it is important to understand the perspectives of others, particularly when difficult end-of-life decisions must be made. METHODS: In this qualitative study a total of seven doctors and 14 nurses working in acute care adult medical-surgical areas, including intensive care, were asked to describe ethical problems that they frequently encounter in practice. Interviews were taped and transcribed. Thematic analysis followed. RESULTS: All participants experienced ethical problems around decision making at the end of life. The core problem for both doctors and nurses was witnessing suffering, which engendered a moral obligation to reduce that suffering. Uncertainty about the best course of action for the patient and family was a source of moral distress. Competing values, hierarchical processes, scarce resources, and communication emerged as common themes. The key difference between the groups was that doctors are responsible for making decisions and nurses must live with these decisions. Each group, therefore, asked different questions when encountering and interpreting sources of moral distress. CONCLUSIONS: It was concluded that observed differences between doctors and nurses were a function of the professional role played by each rather than differences in ethical reasoning or moral motivation. Although this was a small qualitative study on one institution, and may not be generalizable, results suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administrators should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.

Adult↗
PubMed2002

A critical review of the arguments debating the role of the nurse advocate.

AIMS OF THE PAPER: This paper critically reviews the arguments for and against undertaking the role of nurse advocate. BACKGROUND: Advocacy has become a popular concept in nursing literature over the past two decades. By addressing issues of power and accountability, conclusions are drawn about the risks facing nurses who would practice patient advocacy. METHODS: Review and analysis of theoretical debate. RESULTS: Empirical evidence is sparse and philosophical arguments predominate in the field of patient advocacy. Humanistic arguments that promote advocacy as a moral imperative are compelling. However, in reality nurses appear to lack the power base to comply except by covert means. Informed consent with a knowledge of the consequences of undertaking such an intervention is as relevant to the nurse as it is to the patient. CONCLUSION: Nurses need to be empowered first, if they are to empower their patients. There may however, be more suitable candidates for the role of patient advocate and nurses should recognize that they do not have a monopoly on ethical decision making.

Conflict, Psychological↗
PubMed2005

[Does evidence-based surgery harm autonomy in clinical decision making?].

Evidence-based clinical guidelines in surgery are frequently confronted with scepticism by the medical staff, especially because a confinement of free decision making in therapy is expected. Considering that medicine is not merely natural science, but can as well be comprehended as social science or art, evidence-based medicine (EbM) may lead to an oversimplified and rigid standardization in medical care ("cook book medicine"). In addition, scientific progress might be prevented by inflexible guidelines. However, it is important for surgeons to engage in the development of evidence-based guidelines in order to put forward their interests, because it is the lack of medical guidelines that might threaten free decision making in surgery - by not confronting economical pressure with decisive minimal standards in medical care. Therapeutical freedom is a substantial principle in medicine, but it should be considered that according to occidental tradition, "freedom" is necessarily involving reason and conscientiousness.

Clinical Competence↗
PubMed1996

The identification of ethical issues in physical therapy practice.

BACKGROUND AND PURPOSE: The purpose of this study was to identify the current ethical issues facing physical therapists and (2) ethical issues that may be faced in the future by physical therapists. SUBJECTS AND METHODS: The Delphi technique was used as the research design for this study. The panel of experts for the study were selected from Papers submitted by past and present members of the Judicial Committee of the American Physical Therapy Association. A series of three questionnaires were sent to the members of the panel. Following the Delphi technique, the first questionnaire contained broad questions designed to elicit a wide range of responses. The second and third questionnaires were then developed from the information received in the preceding questionnaire. RESULTS: The results of the first question of the study identified 10 current ethical issues as consensus choices by the panel and 3 issues as near-consensus. The panel responses to the second question identified 4 future ethical issues. A combined list of current and future contained 16 issues in physical therapy. CONCLUSION AND DISCUSSION: The 16 issues addressed ethical considerations in different areas of physical therapy practice: 6 issues involving patient rights and welfare, 5 professional issues, and 5 issues relating to business and economic factors. Thirteen of these issues have not been discussed in previous physical therapy literature and would be suggested topics for future study.

Attitude of Health Personnel↗
PubMedDate not supplied

Ethical conflict associated with managed care: views of nurse practitioners.

BACKGROUND: Ethical conflict of nurse practitioners (NPs) practicing within a managed care environment has not been systematically examined, yet like physician practitioners, NPs are confronted with daily ethical conflicts. OBJECTIVE: To determine perceptions toward ethical conflict in practice espoused by NPs affiliated with managed care systems and to identify the relationship between selected individual, organizational, and societal/market contextual factors and ethical conflict in practice. METHOD: Descriptive, cross-sectional, correlational survey of a stratified random sample of 700 NPs licensed and certified to practice in the state of Maryland, conducted from November 2000 to January 2001. RESULTS: A majority of respondents reported being moderately to extremely concerned with managed care. Eighty percent of the sample perceived that it was sometimes necessary to bend managed care guidelines with 61% agreeing that the practitioner must weigh the patient's interest against managed care organizations' interests. The NPs in a staff/group model health maintenance organization (a) were less ethically concerned (p <.001); (b) perceived the ethical environment more positively (p <.001); and (c) had lower ethical conflict scores (p <.001) than NPs in other types of practice settings. DISCUSSION: Results from this study indicate that NPs are experiencing ethical conflict associated with practicing within a managed care environment; however, NPs in a staff/group model health maintenance organization report these concerns less. Ethical support through intervening strategies (i.e., ethics education and interdisciplinary ethics support systems) may help mitigate the conflict associated with this system of care.

Analysis of Variance↗
PubMed2000

Genetics services in a social, ethical and policy context: a collaboration between consumers and providers.

We report a unique, collaborative effort by users and providers of genetic services to arrive at outlines for optimal ethics and clinical practice. Using focus groups of consumers (users) and providers (held separately), a provider-consumer project team developed 1) a consumer wish list, 2) an experientially based ethical overview of situations arising in practice, and 3) detailed suggestions for consumer-provider interactions in clinical settings. Consumers were primarily interested in accurate information, respect for persons, a smoothly functioning team, with the consumer as an equal member of the team, family integrity, and providers who knew the limits of their knowledge and were willing to refer. "Non-directive" counselling and privacy were not major issues in consumer focus groups; some thought providers should openly state their own opinions. Providers had a rather different list of priorities. Books and papers on clinical ethics usually originate from bioethicists and physicians. This pilot project is unique in including consumers and providers equally.

Community Participation↗
PubMed1989

Proletarianization or restratification of the medical profession? The case of obstetrics.

Professional dominance, autonomy, and control have been consistently emphasized in theories of the medical profession. Recently, however, the professional hegemony that physicians have enjoyed is increasingly being questioned in the light of profound changes that are taking place in the organization of health care in the United States. Debates about the implications of the power of medicine and the means by which it is maintained are being replaced by attempts to understand professional decline. Proletarianization (McKinlay and colleagues) and restratification theory (Freidson) are two prominent and competing predictions for the future of the medical profession. Taking obstetrics as a critical case, this article considers the relative ability of these theories to elucidate the changing organization of maternity care in one state and presents a case study of patient care in one hospital. It suggests a disjuncture between obstetricians' inability to protect their interests as a corporate body and their relative ability to control the organization of everyday medical work. It is concluded that more theoretical clarity is needed on professional behaviors at the macro and micro levels.

Ambulatory Care Facilities↗
PubMedDate not supplied

Subjugation of autonomy.

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Dentist-Patient Relations↗