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Results for “Professional Autonomy”

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PubMed2005

Managerialism in the Australian public health sector: towards the hyper-rationalisation of professional bureaucracies.

This paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The case studies included 71 semi-structured interviews with a broad range of public sector health professionals (predominantly nursing and allied health professionals, with some doctors and managers). The data are used to examine the implications of managerialism for the organisation of professional (public) bureaucracies. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy. The impact of managerialism on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality, an ideal type derived from a combination of four forms of rationality identified in Weber's work: practical, formal, substantive and theoretical rationality. Applied to the social organisation of health-care work, this paper critically examines the utility of the hyper-rationality ideal type, noting its limitations and the insights it provides in conceptualising the impact of managerialism on professional (public) bureaucracies.

Australia↗
PubMed1994

Medicine in transition--emerging ethical issues in the global village.

Two major shifts in medicine are radically altering the medical profession worldwide: the shift from a professional to a business ethic, and the shift from a hands-one therapeutic approach to one which is technology-dependent. These paradigm shifts affect the traditional medical ethics and principles of professional autonomy, beneficence (doing what is best for patients) and justice. Constructive responses that will help to protect these important ethical ideals include reflection on professional values, involvement in health policy and nurture of the profession's young and "idealistic" members.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Job satisfaction and autonomy of Hong Kong registered nurses.

This research examines job satisfaction and need for autonomy of 190 registered nurses in Hong Kong using a cross-sectional survey design. The level of job satisfaction towards six job components (autonomy, professional status, pay, interaction, task requirements and organizational policies) was measured using the Index of Work Satisfaction. Results showed that the sample was dissatisfied more than satisfied, they valued the job components of autonomy, professional status and pay more than interaction, task requirements and organizational policies. In addition, comparisons were made between nurses working in different hospitals and also different nursing units within a hospital. The level of need for autonomy was assessed using the autonomy subscale of the Edwards Personal Preference Schedule. Results showed that the level of need for autonomy of this group of nurses was below the mid-score of the sub-scale and there was no significant relationship between their satisfaction with job autonomy and their individual need for autonomy.

Cross-Sectional Studies↗
PubMed1999

Procedures and the professional: the case of the British NHS.

The introduction of procedures to guide medical practice is a growing phenomenon in the British National Health Service. It is thought to be a useful way of managing risk, standardising practice and ensuring that research evidence is incorporated into patient care. However, the mere development and introduction of procedures does not ensure that they are actually followed. In the research reported here focus group methodology was used to investigate the perceptions and opinions of doctors, nurses, midwives and health service managers. Twenty-four focus groups were convened across three hospitals, with discussion focusing on the purpose, development and implementation of clinical protocols. The effect of proceduralisation on professional autonomy and on the working relationships among professional groups also emerged as important themes. The paper concludes that successful implementation of protocols or guidelines in the NHS depends on achieving the right balance between standardising practice and allowing professionals to use clinical judgement. Successful implementation of clinical guidelines also requires that the culture of the health service and the beliefs, attitudes and norms of its employees are taken into account.

Attitude of Health Personnel↗
PubMed1997

Resist and redirect: physicians respond to breast cancer informed consent legislation.

During the 1980s, former breast cancer patients initiated efforts to introduce Breast Cancer Informed Consent legislation in twenty-two state legislatures. Their general intent in proposing this legislation was to insure that women patients were included in the decision-making process regarding their breast cancer treatment. A qualitative analysis of the reactions of medical professional organizations to these efforts revealed a pattern of change over time. Because professionals were not aware of early efforts for Breast Cancer Informed Consent, these met little or no resistance. Subsequent efforts in the early 1980s were met with organized resistance; physicians' organizations responded to the legislation as if it were a threat to their professional autonomy. By the middle of the decade, professionals had co-opted the efforts, shaping the legislation to their benefit. The challenge to physician authority that former breast cancer patients mounted had mixed results, but ultimately illustrated that professions are quite effective at retaining power.

Attitude of Health Personnel↗
PubMed2004

[The change in medical practice. Psycho-social challenges for the profession].

This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physiciansfrom the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes.

Focus Groups↗
PubMed2002

Professionalism and clinical autonomy in the practice of medicine.

Professionalism in medicine requires a reasonable measure of freedom for physicians to determine patients needs based on their own judgment. However, because virtually every medical decision is also a spending decision, third-party payers concerned about rising health care costs have introduced cost-containment tactics that significantly limit physicians accustomed autonomy. In response, groups of physicians have filed class-action lawsuits against managed care plans, alleging causes of action such as fraud, breach of contract, extortion, and violations of federal RICO (Racketeer-Influenced and Corrupt Organizations) law. Such litigation may have merits, but it also faces significant obstacles, in part because the contracts involved may not actually have promised the broad measure of clinical autonomy that the physicians allege was promised, then denied. As physicians seek to restore and retain their professional autonomy, it will be important for them to be increasingly proactive in structuring or modifying the contracts under whose terms they practice as some physicians have successfully done.

Clinical Medicine↗
PubMed2003

Liability in relation to the use of professional medical guidelines.

The author discusses the concept of professional guidelines in medicine and their relationship to potential malpractice accusations. He cites a case of omission to give a patient prophylactic medicine against post-operative thrombosis, as previously recommended in a clinical guideline. This paper develops the discussion of the problems of professional autonomy in the light of standards of medical care being increasingly governed by clinical guidelines. The question of legal liability of medical practitioners in these situations is explored.

Anticoagulants↗
PubMed2006

Re-examining 'professionalism' in pharmacy: a South African perspective.

Although defining itself as a patient-centred profession, private sector (community and private hospital) pharmacy often appears to be that of a product-for-profit centred occupation. This perception has been at the core of the medical profession's attempts to reduce the professional autonomy of pharmacy, and has appeared at the forefront of the South African Department of Health's positioning of private sector pharmacy. Using as a starting point the debate surrounding attempts by the South African Minister of Health to regulate the price of medicines, I propose that the present negative positioning of private sector pharmacy in South Africa could be ameliorated by pharmacy practice that evidences a redefined understanding of professionalism.

Drug Costs↗
PubMed2003

Clinical practice guidelines in dentistry: opinions of dental practitioners on their contribution to the quality of dental care.

OBJECTIVES: To assess the opinions of general dental practitioners regarding the development and importance of clinical practice guidelines and their contribution to the quality of dental care. METHODS: A questionnaire was sent to a representative sample of 1656 dentists in the Netherlands. Factor analysis was conducted to identify scales of variables, and a reliability analysis was conducted to verify the reliability of the identified scales. The effect of the independent variables is expressed as odds ratio per scale part (standard deviation, SD). Regression analyses were conducted to study determinants of the opinions on clinical guidelines. RESULTS: The response rate was 73%; 54% of the respondents supported the development of clinical practice guidelines for dentists. Most respondents indicated that clinical practice guidelines could be used as a checklist, as a support in daily clinical decision making, and as a basis for continuing dental education. The factor analyses yielded four scale factors-contribution of guidelines to effectiveness of care (OR 1.95/SD), contribution of guidelines to professional autonomy (OR 1.70/SD), contribution of guidelines to quality of care (OR 2.52/SD), and contribution of guidelines to collaboration (OR 1.49/SD)-which complied with the criterion of Cronbach's alpha >0.60. Multiple regression analysis with the four scale factors as dependent variables yielded only extremely low correlations for practice and dentist characteristics (R(2)=0.01-0.04). CONCLUSIONS: Only about 50% of dentists support the development and implementation of clinical guidelines. Guidelines are seen as helpful in the provision of continuing dental education and as a support in daily clinical decision making. The most important barrier to successful implementation of clinical practice guidelines is the fear of dental practitioners that guidelines will reduce their professional autonomy. Practice and dentist characteristics are unrelated to dentists' opinions on clinical practice guidelines.

Adult↗
PubMed1985

Ethical dilemmas in nursing: the role of the nurse and perceptions of autonomy.

This study investigated decision making in ethical dilemmas and attitudes toward professional autonomy. It was based on Murphy's identification of three nurse-patient relationship models. The model identification was the result of Murphy's investigation of the levels of moral reasoning of nurse practitioners, from Kohlberg's theory of moral development. Autonomy is necessary for patient advocacy in Murphy's highest order model of nurse-patient relationship. 109 freshmen, 103 seniors, and 82 graduates (baccalaureate nursing) were examined for model selection, risk-taking, restrictions, and anxiety in the decision-making process in specific situations. Autonomy was measured independently. The most significant results indicated that freshmen were less likely to select the autonomous model of relationship, had lower attitudes toward professional nursing autonomy, and were less willing to take risks. Graduates were lower than either student group in their perceptions of restrictions and anxiety. The responses to each dilemma itself varied by situation in relation to the model preferred.

Adolescent↗
PubMed2003

Factors affecting job satisfaction in nurse faculty: a meta-analysis.

Evidence in the literature suggests job satisfaction can make a difference in keeping qualified workers on the job, but little research has been conducted focusing specifically on nursing faculty. Several studies have examined nurse faculty satisfaction in relationship to one or two influencing factors. These factors include professional autonomy, leader role expectations, organizational climate, perceived role conflict and role ambiguity, leadership behaviors, and organizational characteristics. This meta-analysis attempts to synthesize the various studies conducted on job satisfaction in nursing faculty and analyze which influencing factors have the greatest effect. The procedure used for this meta-analysis consisted of reviewing studies to identify factors influencing job satisfaction, research questions, sample size reported, instruments used for measurement of job satisfaction and influencing factors, and results of statistical analysis.

Faculty, Nursing↗
PubMed2007

Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses.

OBJECTIVE: To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. BACKGROUND: Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. METHODS: Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. RESULTS: An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. CONCLUSIONS: The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.

Cross-Sectional Studies↗