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PubMed1994

Stress in midwifery: a comparison of midwives and nurses using the Work Environment Scale.

Previous research into midwifery has identified a number of potential sources of stress without attempting to understand the variables that might contribute to it. The study sample was drawn from a population of registered nurses and midwives and compares the work environment of 29 midwives with 180 nurses, using the Work Environment Scale Questionnaire. Significant differences were found between midwives and nurses for involvement, supervisor support, autonomy, work pressure and clarity of roles. These results have the potential for forming the basis of future research.

Analysis of Variance↗
PubMed2003

Autonomy among intensive care nurses in Finland.

The purpose of this study was to describe Finnish ICU nurses' (n=172) experiences of autonomy in their work. The research was carried out as part of a project concerned with empowerment in intensive care nursing. Viewed from a psychological perspective, empowerment is understood as referring to the ability to make goal-directed decisions and to take action towards meeting the goals set out. Autonomy, then, is seen as part of empowerment. The data were collected with a structured questionnaire specially designed for this study. The random sample was drawn from 31 Finnish adult intensive care units. The respondents were registered nurses working in eight adult intensive care units. The data were analysed using statistical methods. Autonomy was defined as being composed of three bases: knowledge base (independence, right and responsibility in decision-making), action base (independence, right and responsibility in actions) and value base (independence, right and responsibility in values). The majority of the respondents felt they had more autonomy in decision-making and actions concerning patient care than in decision-making and actions concerning the intensive care unit as a whole. Autonomy usually increased with work experience. Work will be continued to study the autonomy of nurses in different health care organisations in Finland.

Adult↗
PubMed1997

Corporate management and clinical autonomy: the ethical dilemma in mental health.

Funding constraints and management practices are increasing pressure on clinical autonomy within Australian mental health services. The introduction of total quality management, output-based funding and changes to public mental health policy have promoted business-like efficiency and increased control of resources. It is argued that such moves significantly circumscribe the discretionary authority that mental health professionals have previously enjoyed. This paper attempts to highlight the ethical and moral tension inherent with a corporate management approach, and calls for mental health services to acknowledge the value of intellectual capital, creativity and innovation.

Australia↗
PubMed1991

Sexual intimacies with clients after termination: should a prohibition be explicit?

The Revisions Task Force of the Ethics Committee of the American Psychological Association (APA) has proposed that prohibition of sexual intimacies with clients after termination of therapeutic relationships be made an explicit part of the new code. This decision was based on much careful deliberation and input from various individuals and groups. This article supports the proposed change and provides a rationale based on emerging theoretical positions and research findings regarding risks to clients, risks to professionals, and risks to the various mental health professions. The revision would read, "Psychologists do not engage in sexual intimacies with current or former psychotherapy clients."

Altruism↗
PubMed1996

[Autonomy and mutuality in health care].

Taking into consideration the traditional official health assistance forms, the present paper discusses questions related to dependence and independence of nurse and patient in the health/illness process. Under that perspective it proposes a relationship that preserves the autonomy of one and the other, so that both can participate in the process of nursing and self-care.

Delivery of Health Care↗
PubMedDate not supplied

Ethical conflict in long-term care: is legislation the answer?

The Omnibus Budget Reconciliation Act of 1987 radically redefined the relationship between nursing facilities and their residents. To explore the impact of this autonomy-enhancing but controversial legislation on nursing operations in skilled nursing facilities, two focus groups were convened. Nurse administrators identified ways in which the recently implemented legislation facilitates or inhibits resolution of the ethical conflicts they face. Participants concluded that legislation alone was insufficient to create needed reform in long-term care and recommended a multifaceted approach. A model is presented for creating a community of caring that identifies regulatory reform, professional empowerment, and organizational redesign as catalysts for a change.

Adult↗
PubMed2006

Perception of legal liability by registered nurses in Korea.

Liability to the nursing profession is imperative if nurses are to act as an autonomous body. Assessing and communicating effectively is a vital part of nursing for patient safety. This study was designed to identify the attitudes of Korean nurses toward liability in assessment and communication and to investigate the relationship among the variables (i.e., legal awareness, attitudes toward doctor's duty to supervise nurses). The attitudes toward doctor's duty reflect the status of nurses' dependency on doctor's supervision. The study participants were 288 registered nurses in RN-BSN courses at two colleges in Korea. The level of legal awareness was measured using a 25-item Legal Awareness Questionnaire developed by the authors. The measuring instrument for attitudes toward doctor's duty to supervise nurses and nurses' liability was the Attitude toward Duty and Liability Questionnaire, which was modified by the authors. There were significant correlation between attitude toward doctor's duty and nurses' liability, but not between legal awareness and liability attitude. The results of this study suggest that the present educational content aimed at improving liability attitudes of nurses should be refocused with attitude-oriented education and should include an understanding of the increased accountability that comes with greater autonomy in nursing practice.

Adult↗
PubMed1998

Community nurses' experiences of distance learning: implications for autonomy and dependence.

This study examines the experience of a group of students studying a range of health modules by distance learning. The sample included qualified community nurses who were studying a distance-learning research-awareness course in order to convert their community qualification to diploma level and nurses who were studying a range of distance-learning courses as access to a BSc(Hons) in Community Health. Modules studied included a range of 15 credit diploma-level modules in health subjects and a 30-credit research-awareness module. One hundred and twenty questionnaires were distributed generating an 80% response rate. Results revealed a preference for flexible but highly structured materials with clear assignment guidance and support. The results raise important issues in relation to autonomy and dependence and how this may interact with learning style and approaches to study.

Community Health Nursing↗
PubMed1995

Focus on autonomy: supporting an innovative, empowered staff.

Current nursing literature documents the benefits of nurse autonomy with evidence of increased job satisfaction. Health care organizations can support autonomous behavior through empowerment. This article reports how one hospital is responding to nurses' requests for empowerment. The request to focus the nursing division's efforts to enable an innovative empowered staff was initiated during an annual planning session with clinical and administrative staff participation. The first phase of the project involved baseline measurements of autonomy and strategic planning for empowerment through education and leadership modeling. Initial autonomy studies were conducted in 1994 and will be repeated at 18, 36, and 48 months.

Humans↗
PubMed2005

The influence of standardized languages on nurses' autonomy.

AIM: To investigate the influence of standardized languages on nurses' autonomy. BACKGROUND: The uses of standardized languages are expanding. These languages unify communication across health care settings. Autonomy is a favourable concept for nurses. The use of standardized languages may hinder nurses' autonomy; however, these languages may also promote nurses' autonomy. EVALUATION: Review of the literature. KEY ISSUES: The key issue discussed in this paper is whether the use of standardized languages affects nurses' autonomy. CONCLUSIONS: Nurses should use standardized languages in every day practices as it reflects a mastery over their own work. Having control over practice is an important attribute of nurses' autonomy.

Attitude of Health Personnel↗
PubMed1995

Physician issues and Florida health care reform.

Data are presented from a mail survey of Florida physicians one year after passage of the Florida Health Care Insurance and Reform Act. Respondents rated the importance of various issues and reported their perceptions of physician input, knowledge and support for health-care reform legislation. Issues considered important included tort reform, physician autonomy, consumer choice of providers, and freedom from insurance hassles along with reduced paperwork. Ratings were low for input and health-care reform support. Issues of importance to physicians were not addressed by previous legislation; therefore, they must take the lead in focusing new legislation in conjunction with their professional organizations.

Adult↗
PubMed1995

The management of professionals: the preferences of hospital sisters and charge nurses.

This analysis of the preferences of how sisters and charge nurses are managed is the result of a two centre descriptive study using theoretical models of professionalism, developing preferences and exercising situational leadership. It was conducted to determine if the management structure preferred by sisters and charge nurses, in a general acute hospital setting, supported the professionalism of nursing. The outcomes were intended to help develop a strategic plan for the future of nursing and the management of nurses. The research instruments were a self-completed questionnaire (19 were returned, a response rate of 31.1%) and four semi-structured interviews. The findings disclosed some dissatisfaction with the present management arrangements. The sisters and charge nurses felt that their priorities for practice and professional issues were better supported by clinically involved, ward-based senior nurses than by unit-based senior nurses with a general management function. However, sisters' and charge nurses' discussions with ward-based senior nurses were apparently less effective than discussions in peer groups which led to influential collegial autonomy. This preferred management style can be supported by the use of situational leadership theory which would enhance collegial autonomy and professional satisfaction. Recognition of the sisters and charge nurses preferences and adjustment of their management would therefore enable them to participate effectively in organizational decision-making.

Attitude of Health Personnel↗
PubMed2000

Perceived worker autonomy: the foundation for shared governance.

The popular notion that worker autonomy is an outcome of shared governance is challenged in this critical analysis of the author's research and selected literature. Growing evidence is presented that environment, expectations, and clarity of meaning play important roles in fostering and supporting personal autonomy. Staff and administrators can use this valuable information about autonomy to refocus partnership models and team-based strategies for enhanced team effectiveness.

Communication↗
PubMed2005

In harm's way: AMA physicians and the duty to treat.

In June 2001, the American Medical Association (AMA) issued a revised and expanded version of the Principles of Medical Ethics (last published in 1980). In light of the new and more comprehensive document, the present essay is geared to consideration of a longstanding tension between physician's autonomy rights and societal obligations in the AMA Code. In particular, it will be argued that a duty to treat overrides AMA autonomy rights in social emergencies, even in cases that involve personal risk to physicians (e.g., bioterrorist attack, HIV infection, SARS). The argument will be made by way of the logic and language of the AMA Code through its history, commentaries, and precedents. It also will be shown that there are substantial reasons to believe that the logic of the Code is sound in morally relevant ways. The essay will conclude with some philosophical proposals suggesting a framework for the duty to render aid and the extension of those duties to physicians facing personal risks.

American Medical Association↗
PubMed1992

Assessment of ethical decisions and values.

The development and pilot testing of the Professional Decisions and Values Test (PDV) is described. The PDV is designed to assess how ethical conflicts are dealt with by medical and law students and which moral values motivate them. Data from two consecutive classes of entering medical and law students are presented and their action tendencies and ethical values are compared. The findings support the construct validity of the test. Regarding reliability, stability over time is present for action tendencies but not for values. Perhaps the ethical values of entering medical and law students do not become stable until later. Change in ethical values can be studied with the PDV for groups, not individuals, during the first year of professional education.

Attitude↗
PubMed1998

Changes in medical student attitudes as they progress through a medical course.

OBJECTIVES: To explore the way ethical principles develop during a medical education course for three groups of medical students--in their first year, at the beginning of their penultimate (fifth) year and towards the end of their final (sixth) year. DESIGN: Survey questionnaire administered to medical students in their first, fifth and final (sixth) year. SETTING: A large medical school in Queensland, Australia. SURVEY SAMPLE: Approximately half the students in each of three years (first, fifth and sixth) provided data on a voluntary basis, a total of 385 students. RESULTS: At the point of entry, minor differences were found between medical students and first year law and psychology students. More striking were differences between male and female medical students, suggesting early socialization had a substantial impact here. CONCLUSIONS: Results indicate that substantial changes in attitude have developed by the beginning of fifth year with little change thereafter. Gender difference persisted. Some difference in ethical attitudes were found when groups of different ethnic backgrounds were compared. The impact of a move to a graduate medical course, which gives high priority to ethics within a professional development domain, can now be evaluated.

Attitude of Health Personnel↗