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PubMed1998

[Independently offered care and health promotion--a vision of the future? Presentation and discussion of Erickson, Tomlin and Swain's Nursing Theory, describing a "nurse-managed wellness clinic" in the U.S.A].

The article presents Erickson, Tomlin & Swain's theory and paradigm of nursing and describes an example of its application in a nurse-managed wellness clinic in the USA. Interviews with the staff before and after a visit as a participant observer, as well as analyses of the project documentation provided information. The application of the theory in this practical setting is discussed. Emphasis is given to organizational structures that allow autonomy for nursing and therefore provide ideal conditions for the application of the nursing theory.

Attitude of Health Personnel↗
PubMedDate not supplied

[Methods of study of the effects of modern administration (management) on the autonomy and satisfaction of physicians in clinical practice].

Marketing principles in health care delivery systems, reducing financial funds for health institutions and permanently increasing costs of medical equipment are responsible for the growing influence of management on physician's autonomy and working satisfaction. A questionnaire research was carried out in order to determine the best method of examination of this influence in Belgrade. All tested persons were medical doctors working in a primary health centers for 7 hours per day, who examined about 26 patients every day. More than a half of physician improved their knowledge by reading professional publications 6 hours per week. In spite of the fact that they all worked in the same institution, they expressed different opinions regarding the organisation. In the physicians' opinion clinical freedom and working satisfaction were at the high level, and partly connected with management practice. At the same time they were very unsatisfactory with personal income and budgetary distribution in the institution. It is evident that the method described in this article is useful in the analysis of the present situation related to management and physician's practice in the country.

Attitude of Health Personnel↗
PubMed2003

Doctors and managers: poor relationships may be damaging patients-what can be done?

The problem of poor relationships between doctors and managers is a common feature of many healthcare systems. This problem needs to be explicitly addressed and there are a number of positive steps that could be taken. Firstly, there would be value in working to improve the quality of relationships and better mutual understanding of the necessarily different positions of doctors and managers. Finding a common approach to managing resources, accountability, autonomy, and the creation of more systematic ways of working seems to be important. The use of costed clinical pathways may be one approach. Rather than seeing guidelines and accountability systems as a threat to autonomy there is an argument that they are an essential adjunct to it. Redefining autonomy in order to preserve it and to ensure that it encompasses accountability and responsibility will be an important step. A key step is the development of clinical leadership.

Hospital-Physician Relations↗
PubMed2003

Home health care nurses' perceptions of physician-nurse relationships.

This work is a sociological analysis of the physician-nurse relationship in home health care. Data include observation, interview, and survey sources. Results confirm that, largely because of the physician's distance both physically and symbolically, home care nurses take on a more primary care role with patients than do nurses in hospitals. There are fewer instances of conflict between physician and nurse in this setting, as doctors yield more responsibility to nurses than they may in hospitals. In the end, though nurses claim higher levels of autonomy, patients appear to be the true beneficiaries of the in situ shift in nursing responsibility.

Attitude of Health Personnel↗
PubMed1992

Power and change in health care: challenge for nursing.

This article proposes the need for consideration of status and power issues in nursing research, in theory, and at all levels of nursing education. Including the concept of power in nursing curricula will better prepare nurses to participate in social and political decisions affecting health care. By recognizing the role nurses have played, often in the face of opposition, nursing students will gain a sense of the potential power and strength of nurses. Curricular reform and revision of nursing theories to emphasize the sociopolitical context of nursing may change the socialization of student nurses by stressing autonomy, independence, and confidence. These changes may have a positive impact on recruitment, retention, and on efforts to change the public's perception of nursing.

Clinical Competence↗
PubMedDate not supplied

A comparison of practice domains of clinical nurse specialists and nurse practitioners.

This qualitative study was carried out to add empirical data to the discussion of the essentials of advanced practice graduate nursing education. Study participants were 15 nurse practitioners (NPs) whose original preparation was as clinical nurse specialists (CNSs). These nurses subsequently completed post-master's preparation as NPs at a midwest US school of nursing. The nurses were interviewed regarding similarities and differences between the NP and CNS roles based on their own experiences. They stated that their 1-year post-master's NP educational program broadened their knowledge base and increased their skills of direct data collection in history taking and physical examination. They described increased NP role autonomy and clinical decision making. Comparison of study results with the six practice domains of the National Association of Nurse Practitioner Faculties (NONPF) Curriculum Guidelines appeared to verify the NONPF domains as being operant in advanced nursing practice. Each role had distinct expression of the NONPF practice domains, particularly in two areas: management of client health-illness states and the professional role. Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. A "hybrid" CNS/NP curriculum faces the danger of lacking both the depth and specificity of knowledge that has resulted in the roles' past successes.

Attitude of Health Personnel↗
PubMedDate not supplied

Registered nurses' perception of their autonomy and the factors that influence their autonomy in rehabilitation and long-term care settings.

To determine attributes of the registered nurse and the working environment that influence registered nurses' perception of autonomy (defined as independence within one's own practice), data were collected from questionnaires completed by 85 full time registered nurses at a 601 bed chronic/rehabilitation hospital located on two sites in the city of Toronto, Ontario, Canada. Registered nurses experienced a higher perception of autonomy given a more participative management style on the part of their nurse managers. Place of basic nursing education, which was used as an indication of cultural origin, was found to contribute to registered nurse perception of autonomy where basic education was in Canada or the United States. Increased workload (acuity) was found to detract from registered nurse perception of autonomy. Baccalaureate education, and primary or modular nursing care delivery models contributed to high autonomy, whereas diploma education, and functional or team nursing were associated with the low autonomy group in discriminant analysis. Administrative recommendations for nursing include the promotion of a participative management style on the part of nurse managers; attention to cultural diversity of nursing staff; support of advanced education in nursing; support of primary or modular nursing care delivery models; and management of registered nurses' workload in order to encourage a balance between client-focused professional practice activities and the routinized, provider-focused, task-driven activities.

Adult↗
PubMed1993

Preferences for decision-making autonomy.

Nurses' lack of autonomy has been identified as a leading cause of job dissatisfaction, but attempts to increase satisfaction by increasing autonomy have not always been successful. This survey of 356 randomly selected staff nurses and 130 head nurses from 16 hospitals extends previous work by identifying the preferred level of involvement in 21 patient care and 21 unit operation decisions. Staff nurses agreed on 60 percent of the decisions and, in general, preferred independent decision-making for patient care decisions and shared decision-making for unit operation. Head nurses indicated that staff nurses should have a higher level of autonomy than the staff nurses indicated for themselves.

Adult↗
PubMed2006

Job satisfaction in a Norwegian population of nurses: a questionnaire survey.

BACKGROUND: Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries. OBJECTIVES: To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin. DESIGN: In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors. RESULTS: Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital. CONCLUSIONS: Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.

Adult↗
PubMed2002

Organization, work and work reactions: a study of the relationship between organizational aspects of nursing and nurses' work characteristics and work reactions.

This article describes a quantitative, correlational study of the relationship between organizational aspects (such as the predictability of the care), work characteristics (autonomy and workload) and work reactions (work satisfaction and health complaints) in nursing work. The variables have been measured by questionnaires. Subjects were 155 nurses from nine units in two general hospitals in the Netherlands. Several organizational aspects seem to be correlated with work characteristics and work reactions. Organizational aspects particularly influence work characteristics and play, therefore, a mediating role in the relationship between organizational aspects and work reactions. Job satisfaction is not only correlated with the autonomy, but also with workload. Health complaints appeared to be mainly correlated with the workload. It is concluded that for an improvement of job satisfaction and reduction of health complaints, it is not only necessary to improve autonomy and reduce workload, but also to pay attention to organizational aspects because these may influence the work characteristics.

Cooperative Behavior↗
PubMed2007

Excellence through evidence: structures enabling clinical autonomy.

Autonomy is a multidimensional process. Clinical autonomy, the dimension in which patients are the primary beneficiaries, is the focus of this study. Despite high valuation and persistent challenges to nurses to function autonomously, the relationship between autonomous practice and patient outcomes has not been empirically established due, in large measure, to a lack of correspondence between concepts and measurement of autonomy and to a lack of knowledge of enabling structures. The purpose of the research reported here is to identify the structures, practices, elements in the environment, and interventions that nurses, nurse managers, and physicians identify as promoting staff nurse clinical autonomy. Implementation of these interventions would then enable clinical decision making at the frontline and would foster studies to determine whether the expected linkage between clinical autonomy and positive patient outcomes prevails.

Nurse Administrators↗
PubMed1996

A study of prescribing patterns in the community.

Qualified nurse practitioners working in the community prescribe from a wide formulary. Despite degree level education, their prescriptions still have to be signed by a GP. This study describes the prescribing patterns of 41 nurse practitioners over one month. The medications prescribed were categorised and their frequency of prescription noted. The author notes the amount of time wasted by nurses waiting for a doctor's signature due to legal restrictions and states the case for autonomy in prescribing for nurse practitioners. The types of medication and situations where they are being prescribed are also discussed.

Community Health Nursing↗
PubMed1997

HIV infection, risk taking, and the duty to treat.

The paper advances a consequence-based argument in support of the American Medical Association's policy that a physician may not ethically refuse to treat a person with HIV solely because the patient is seropositive. A limited number of alternative arguments, both in support of and in opposition to this policy are also considered, but are found wanting. The paper then concludes with a discussion of some of the other obstacles to quality health care that persons with HIV must often confront.

Blood-Borne Pathogens↗
PubMed1993

Does being in the military affect nurses' perceptions of work life?

This study was a causal comparative investigation of military and civilian nurses' perceptions of selected aspects of work life. The Work Environment Scale, the Maslach Burnout Inventory and the Michigan Job Satisfaction Scale were administered to civilian and military samples matched on selected demographic variables. MANOVA procedures failed to reveal significant differences on measures of burnout and morale. Although military nurses were significantly more satisfied with issues of pay and fringe benefits, civilian nurses reported significantly greater job satisfaction, peer cohesion, supervisory support, decision making, autonomy, task orientation and opportunity to be innovative. These findings and suggested changes are discussed with attention to differences between the military and civilian work setting.

Adult↗
PubMedDate not supplied

Why Britain is reorganizing its national health service--yet again.

The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. The centerpiece of the Labour reform--managed care organizations based on groups of primary care physicians--is based on the Conservative experiment with general practitioner fund holding. Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession--and quite possibly have to do both.

Economic Competition↗
PubMed1992

Nursing students rank high in autonomy at the exit level.

Professional status based on the criterion of autonomy continues to elude nursing. It is important to determine if this condition is due to the denial of professional status by employing organizations or to the lack of individual autonomy possessed by nurses. Female nursing school students were compared to women students from the schools of education, business, technology, and arts and sciences just prior to graduation. Nursing students scored as high on autonomy and masculinity as other female students, and higher on autonomy-related attitudes and behaviors specific to women. These findings conflict with earlier studies and with the position that nursing's denial of professional status is due to a lack of individual autonomy in nurses.

Attitude↗
PubMed2002

Clinical autonomy, individual and collective: the problem of changing doctors' behaviour.

Evidence-based medicine enables the profession to resist at least some of the challenges to its traditional autonomy: if informed doctors provide what is scientifically proven to be the best care there is less justification for external constraints. Yet, this defensive strategy depends on enforcing a new discipline within the profession such that individual practitioners accept mechanisms of external 'decision support' in their clinical practice. A study of the ways in which general practitioners in British Primary Care change their clinical behaviour shows that an emphasis on a 'patient centred' approach establishes an alternative individualised autonomy that seems inimical to the logic of evidence-based medicine. A tension therefore emerges between the maintenance of the autonomy of the profession as a collectivity through the promotion of a therapeutic rationality and the maintenance of the autonomy of the individual practitioner through the rhetoric of patient-centredness.

Attitude of Health Personnel↗
PubMedDate not supplied

[Monitoring of intravenous heparin therapy after thrombolysis. Is management by nurses possible?].

IV heparin is a very common therapy in CCUs. In Udine CCU, after the definition of common guidelines, nurses were experimentally charged to administer and monitor the heparin therapy in myocardial infarction patients. Hemorrhagic complications in thrombolyzed and heparinized patients were analysed. No differences were observed with respect to the frequence of complications between the "control" year 1992 before the experiment of autonomy and the following year 1993 (10/67 vs 16/97, OR: 1.1). It can therefore be concluded that nurses are able to administer and monitor IV heparin therapy autonomously from close medical supervision and guidance.

Drug Monitoring↗