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PubMed2003

[Medicine, ethics and money].

Since the end of the Middle Ages, physicians have been paid in different ways for the care they give. This payment must respect the ethical principles of equity, autonomy and benevolence-beneficence. Equity requires that everybody be treated according to his needs and not according to his means, the necessary means being offered by physicians or provided by society. Autonomy requires that the physician be independent so that no other consideration--including his own material interest--takes precedent over the patient's interests. Benevolence-beneficence places the emphasis on means, in accordance with evidence-based medicine, results being impossible to guarantee.

Altruism↗
PubMed2004

A multi-factor analysis of job satisfaction among school nurses.

Although job satisfaction has been widely studied among registered nurses working in traditional health care settings, little is known about the job-related values and perceptions of nurses working in school systems. Job satisfaction is linked to lower levels of job-related stress, burnout, and career abandonment among nurses. This study evaluated the level of job satisfaction among a convenience sample of school nurses practicing in California. The Index of Work Satisfaction (IWS) was the instrument used. Although the sampled school nurses rated autonomy and interaction as the most important and satisfying factors contributing to job satisfaction, the overall findings indicated that school nurses are relatively dissatisfied with their jobs.

Adult↗
PubMed1997

Nurses' job satisfaction, absenteeism, and turnover after implementing a special care unit practice model.

The purpose of the study was to compare job satisfaction, absenteeism, and turnover between nurses working in a nurse-managed special care unit (SCU) and those working in traditional intensive care units (ICU). A case management practice model with a shared governance management model and minimal technology was implemented in the SCU while contrasting features of a primary nursing practice model with a bureaucratic management model and high technology already in place in the traditional ICU. Individual nurses' perceptions of and their preferences for the SCU practice model also were examined related to job satisfaction. Using analysis of covariance, greater satisfaction with a lower absenteeism rate was found in nurses working in the SCU. Nurses' perceptions and preferences for the SCU practice model were closely related to their job satisfaction and growth satisfaction. The findings suggest that individual perception and preference should be taken into account before implementing autonomy, authority, and responsibility at the organizational level to lead to the desired nurse outcomes in a given working environment.

Absenteeism↗
PubMed1996

Power in practice: a study of nursing authority and autonomy.

Power and politics need to be translated into practice through development of authority and autonomy within the staff nurse role. The purpose of the research described was to identify and compare aspects of agreement or disagreement between nurse leaders and staff about staff nurses' authority and autonomy to deliver patient care. Findings indicated that significant differences exist between staff nurses' and nurse leaders' sense of staff nurse autonomy, and importance of authority and autonomy, differences that can lead to serious misunderstandings and power struggles. These differences, especially concerning management support, can seriously hinder both nurse leaders and staff nurses' success in restructuring cost-effective quality care.

Attitude of Health Personnel↗
PubMed2004

Center for Integrated Health Care: primary and mental health care for people with severe and persistent mental illnesses.

The Center for Integrated Health Care capitalizes on the abilities, drive, and autonomy of advanced practice nurses, resulting in an exciting, timely academic nursing center exemplar. People with severe and persistent mental illnesses receive care that is targeted specifically to a population with chronic mental illnesses and tailored to the unique individual by integrating primary and mental health care. This Center is a partnership between Thresholds, a psychosocial rehabilitation center, staff and University of Illinois at Chicago, College of Nursing faculty. The Center's goals are to provide quality care, support teaching and learning for nursing and other health professional learners, and generate new knowledge related to the integration of mental and physical health care. To achieve long-term sustainability, the Center must partner with a federally qualified health center.

Chicago↗
PubMed1996

[Work and worker reactions in homes for the aged].

This article describes an investigation of relationships between work characteristics and worker reactions in three elderly homes of a Dutch foundation. Moreover, main effects as well as moderating effects of some relevant individual variables were studied. Variables were measured by means of questionnaires; 144 subjects from the caring and household departments took part in the study. From the results it appeared that social support, growth opportunities and work pressure are related to work satisfaction, work motivation and health complaints. The individual variables need for autonomy and coping strategies showed main effects as well as moderating- (buffer-) effects. On the basis of the findings practical consequences for the management of personnel and work have been formulated.

Adaptation, Psychological↗
PubMed2005

Evidence-based medicine: why do opponents and proponents use the same arguments?

There is quite some ethical controversy on Evidence-based Medicine (EbM) with regard to issues of physician autonomy as well as its allocative implications. Yet, there are some shortcomings in the current debate. First of all, some of the arguments brought up against EbM are similarly defaults of "classical medicine" as well, for instance its negligence of social aspects of medicine. Second, it is often maintained that EbM is just a tool to attain cost containment. This argument is false in two regards for neither is there any idea of cutting costs in the roots of EbM nor does EbM once practiced necessarily lead to less costs as there can be underuse as well as overuse. Third, both opponents and proponents of EbM come up with the same arguments against each other. Both maintain that the other way of practicing medicine does not allow for physicians' autonomy and free judgment. Therefore, we are going to search for the different presuppositions on which these "reproaches" rely. In this way we can demonstrate that both opponents and proponents rely on different notions of autonomy and free judgment in their argument. Finally, we hope to show that some of the ethical criticism may be raised against classical medicine as well and that allocation in terms of costs is not primarily an aim of EbM.

Attitude of Health Personnel↗
PubMed2002

Identifying ethicolegal and professional principles in reflexology.

Although few reflexologists are likely to be sued in the course of their professional practice, all practitioners owe their patients a duty of care and must work within the law. Ethical and legal responsibilities are integral to safe and effective practice. This paper will outline the major ethical and legal responsibilities owed by reflexologists to their patients.

Attitude of Health Personnel↗
PubMed1998

How healthcare organizations can achieve true integration.

Of the many organizations that have attempted to become integrated delivery systems (IDSs), only a few have actually achieved this goal. Achieving true integration requires commitment to an ongoing process that consists of a series of increasingly challenging phases: development of the organization's unifying concept and culture, specification of the organizational and administrative structure, integration of funds and other assets, development of synergistic operations, and ongoing commitment to ensuring organizational responsiveness to market forces. In addition, including physicians in the integration process is essential for achieving true integration. To effectively integrate physician practices into the larger organization, IDSs need to overcome physician resistance to losing perceived autonomy and control. Physicians are most likely to accept integration into an IDS if they recognize the advantages they gain from allowing the IDS to assume administrative control of their practices.

Delivery of Health Care, Integrated↗
PubMed2003

The role of performance indicators in changing the autonomy of the general practice profession in the UK.

Performance indicators (PIs) are widely used across the UK public sector, but they have only recently been applied to clinical care. In doing so, they challenge a previously guarded aspect of clinical autonomy-the assessment of work performance. This "challenge" is specific to a primary care setting and in the general practice profession. This paper reviews the qualitative findings from an empirical study within one English primary care group on the response to a set of clinical PIs relating to general practitioners (GPs) in terms of the effect upon their clinical autonomy. Prior to interviews with GPs, primary care teams received feedback on their clinical performance as judged by indicators. Five themes were crucial in understanding GPs responses: the credibility of PIs, the growing need to demonstrate competence, perceptions of autonomy, the ulterior purpose of PIs, and the identity of the assessor of their performance. PIs are playing a key role in changing the locus of performance assessment along two dimensions: location and expertise. As the locus helps to determine the nature of clinical autonomy, it is likely to have implications for the nature of the general practice profession.

Adult↗
PubMed2001

Staff empowerment in Finnish intensive care units.

The purpose of this study was to describe staff empowerment in Finnish intensive care units. The data were collected with a questionnaire comprising demographic background and empowerment items. The concept of empowerment was divided into three components: behavioural, verbal and outcome empowerment. The questionnaire was sent to all registered nurses at Finnish intensive care units (ICUs). Eight hundred and fourteen replied, giving a response rate of 77%. The ICU nurses demonstrated confidence in their own skills and competencies, although least so in the domain of outcome empowerment. Experience of behavioural, verbal and outcome empowerment increased linearly with age. The length of nursing experience was positively associated with behavioural, verbal and outcome empowerment. Experience in ICU nursing correlated positively with verbal and outcome empowerment. Motivation, job satisfaction, respect of job autonomy and the fact that the job of ICU nurses commanded respect in society were associated with behavioural, verbal, and outcome empowerment.

Adult↗
PubMed1994

The risk of not understanding nursing history.

Studying nursing history allows nurses to understand more fully problems currently affecting the profession, such as pay, regulation, shortage, education, defining practice, autonomy, and unity. Present day nurses cannot effectively address these important issues without a foundation of historical knowledge. In short, examining history allows nurses to more fully appreciate their important role in the health care system of the United States. This appreciation can provide nurses with important political strength.

Health Care Reform↗
PubMed2005

In the public interest: autonomy and resistance to methods of standardising nurses' advice and practices from a health call centre in Perth, Western Australia.

The history of nursing is replete with examples of nurses battling for autonomy over their education, knowledge and work practices. The latest battleground is HealthDirect, Australia's first medial call centre, where nurses are required to meet externally imposed clinical standards while satisfying legal and financial obligations. These objectives are arguably achieved when nurses assess callers' health problems via computerised algorithms that determine an appropriate plan of action. That way, nurses' subjective responses to callers are ruled out. To ensure nurses comply with the standard processes, calls are monitored randomly and surreptitiously in formal and informal ways. This paper explores how nurses respond to standard procedures and surveillance, in order to argue that nurses' input partially drives reform processes. Nurses continue to seek autonomy over the advice they give and how their work is evaluated but are constrained by structural power relations.

Algorithms↗
PubMed2003

Predictors of nurse practitioners' autonomy: effects of organizational, ethical, and market characteristics.

PURPOSE: To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed-care systems (e.g., HMOs). DATA SOURCES: A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state. CONCLUSIONS: Although NPs were ethically concerned about their autonomy in a managed-care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs. IMPLICATIONS FOR PRACTICE: Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.

Adult↗
PubMed2000

Physician satisfaction with Medicaid managed care: the Missouri experience.

BACKGROUND: Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors. METHODS: We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction Medicaid managed care, traditional Medicaid and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale. RESULTS: The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care. CONCLUSIONS: Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality.

Attitude of Health Personnel↗
PubMed1994

[The nursing situation in the old and new parts of the Federal Republic of Germany: a comparison of requirements, obstacles and nursing autonomy].

Differences with regard to demands, obstacles and elbow room, affecting nursing activities in general hospitals are examined. An instruments measuring various facets was devised (TAA KH). The results reveal that in all three areas there are significant differences between activities of nursing staff in East and West German Hospitals. The differences are being discussed against the background of the situation in the new Bundesländer.

Germany, East↗
PubMed2005

Factors relating to organizational commitment of older male employees in Japan.

Recently, an increasing number of employers have provided employment opportunities for older adults. Yet, few studies pay attention to older employees' perceptions of their employment. Using a Japanese national sample of 995 male employees aged 55 to 64, this study examined whether the existing research on organizational commitment applies to older employees, whether measures that are unique to older employees have significant relationships to their organizational commitment, and whether the effects of these factors differ by retirement status. The results of hierarchical multiple regression analyses showed significant relationships between employee organizational commitment and employment security, personal relationships in workplaces and job characteristics. Negative ageism and employer-sponsored programs for older employees also had significant relationships to organizational commitment. The effects of salary, job autonomy, job demands, and employer-sponsored programs differed by retirement status. While the study was consistent with the existing research, it also suggested the importance of measures that are unique to older employees.

Age Factors↗
PubMed2002

The growth of managed care and changes in physicians' incomes, autonomy, and satisfaction, 1991-1997.

Using survey data collected in 1991 and 1997 from a panel of almost 1,500 physicians, we analyzed the relationship between changes in physicians' incomes, practice autonomy, and satisfaction, and the growth of HMOs and physicians' perceived financial incentives. Both the growth of HMOs and financial incentives to reduce services were significantly related to lower income growth, reductions in practice autonomy, and decreases in satisfaction. Changes in income and autonomy were both positively and significantly related to changes in satisfaction. Controlling for changes in income and autonomy, HMO growth was no longer significantly related to changes in satisfaction. Having a perceived financial incentive to reduce services remained a negative and significant determinant of the change in career satisfaction.

Attitude of Health Personnel↗