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PubMed1999

The Israeli Patient's Rights Law: evidence for deprofessionalization?

In this paper, the Israeli Patient's Rights Law of 1996 is discussed within the framework of Haug's predicted process of deprofessionalization. It is argued that the law reflects global processes such as the diffusion of knowledge, consumerism, and values that emphasize human rights and democracy. By guaranteeing patients' access to medical information, by submitting medical decisions to extra-professional regulation, the law erodes professional power.

Disclosure↗
PubMed2003

Moral stress: synthesis of a concept.

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient's vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

Attitude of Health Personnel↗
PubMed2001

A cybernetic theory of morality and moral autonomy.

Human morality may be thought of as a negative feedback control system in which moral rules are reference values, and moral disapproval, blame, and punishment are forms of negative feedback given for violations of the moral rules. In such a system, if moral agents held each other accountable, moral norms would be enforced effectively. However, even a properly functioning social negative feedback system could not explain acts in which individual agents uphold moral rules in the face of contrary social pressure. Dr. Frances Kelsey, who withheld FDA approval for thalidomide against intense social pressure, is an example of the degree of individual moral autonomy possible in a hostile environment. Such extreme moral autonomy is possible only if there is internal, psychological negative feedback, in addition to external, social feedback. Such a cybernetic model of morality and moral autonomy is consistent with certain aspects of classical ethical theories.

Cybernetics↗
PubMed2001

Autonomy: an important component for nurses' job satisfaction.

This quantitative pilot study (n=178), conducted in a large Brisbane teaching hospital in Australia, found autonomy to be the most important job component for registered nurses' job satisfaction. The actual level of satisfaction with autonomy was 4.6, on a scale of 1 for very dissatisfied to 7 for very satisfied. The mean for job satisfaction was 4.3, with the job components professional status and interaction adding most substantially to the result. There was discontentment with the other two job components, which were task requirements and organisational policies. Demographic comparisons showed that nurses who were preceptors had significantly less job satisfaction than the other nurses at the hospital.

Adult↗
PubMedDate not supplied

Female and married: damaging to the therapy profession?

The first half of this paper describes the socialization process of women to their role in life. An examination is made of the literature and the lessons female children are taught about their place in the adult world in relationship to men. This "place" is typified by the hospital structure where the majority of therapists are employed. The second half of the paper looks into four aspects of professionalism--motivation, autonomy, commitment, and a sense of community--and examines each with the added dimension that membership in the therapy professions is predominantly female and married. Criteria for professionalism are defined on a continuum. Female occupational therapists fit much of this criteria, but conflicts of motherhood and career have a negative effect on their professional life and thus on their profession as well.

Adult↗
PubMed1995

[A study on autonomy in hospital-based midwifery practices in New York].

The purpose of this study was to identify the reality and understanding of American midwives in hospitals by focusing on autonomy as a profession. The method was conducted by interview and participant observation to 13 nurse-midwives in four hospitals. The data indicated that midwifery services belonged to obstetric and gynecology departments in three hospitals. Nurse-midwives had midwifery clinics and had responsibility to normal women antepartally, intrapartally, and postpartally. They distinguished midwifery as a profession from medicine and nursing. However, some midwives stated conflicts with doctors and nurses. Most of them had been motivate to be a midwife directly. It was said that nurse-midwives in New York City have struggled to gain autonomy in hospital systems.

Female↗
PubMed2002

The absent professor: why we don't teach research ethics and what to do about it.

Research ethics education in the biosciences has not historically been a priority for research universities despite the fact that funding agencies, government regulators, and the parties involved in the research enterprise agree that it ought to be. The confluence of a number of factors, including scrutiny and regulation due to increased public awareness of the impact of basic research on society, increased public and private funding, increased diversity and collaboration among researchers, the impressive success and speed of research advances, and high-profile cases of misconduct, have made it necessary to reexamine how the bioscience research community at all levels provides ethics education to its own. We discuss the need to and reasons for making ethics integral to the education of bioscientists, approaches to achieving this goal, challenges this goal presents, and responses to those challenges.

Biomedical Research↗
PubMed2001

Practice autonomy among primary care physician assistants: the predictive abilities of selected practice attributes.

The practice autonomy of primary care physician assistants (PAs) is of interest to those organizing, financing, and delivering health services. This study examined the predictive abilities of practice attributes with respect to multidimensional aspects of practice autonomy (clinical decision making and prescriptive authority) in primary care PAs. A sample of 225 practicing PAs was used to construct the 16-item Physician Assistant Autonomy of Practice Instrument (PAAPI), which includes three subscales, routine prescriptive authority, advanced prescriptive authority, and clinical decision making. All were used as dependent variables in multiple regression analyses. The most significant correlates of practice autonomy included years in practice as a PA, years in practice with supervising physician, annual income from practice, recognition as the exclusive primary care provider for patients, primary practice in a rural county, and primary employment setting (single-specialty group practice). More primary care PAs continue to be used in under-served rural areas and in managed care. Organizational structure of the work setting may influence these PAs' practice autonomy.

Adult↗