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PubMed1998

Sterilizations reconsidered?

Cowdin and Tuohey argue for a rethinking of Catholic bioethical principles and the Church's moral authority. Citing the Second Vatican Council for support, they argue that if the Church were to respect the proper autonomy of medicine, it would allow sterilizations. In this essay I argue against Cowdin and Tuohey's understanding that the Church has derived its moral laws independent of consultation with medicine and that it treats medicine simply as a source of technical expertise. I also argue that they misunderstand that nature of autonomy as well as the Church's position regarding the type of autonomy they request for medicine. I will especially argue against their understanding of the principles of totality and double effect as "dispensations" from the moral order. I conclude that they have provided no grounds to cause the Church to reconsider its condemnation of all sterilizations.

Catholicism↗
PubMed2006

Using initiative to achieve autonomy: a model for advanced practice in medical nutrition therapy.

The purpose of this research was to generate a model of advanced medical nutrition therapy (MNT) practice based on descriptions of their clinical activities provided by advanced-level MNT practitioners. A qualitative approach using grounded theory methodology was employed. The model of advanced MNT practice was based on interviews with 21 credentialed advanced practice registered dietitians from across the United States and Canada. Verbatim transcripts of the interviews were coded for aggregation into themes and subthemes. The resulting model included a single overarching theme: using initiative to achieve autonomy. The five subthemes are aptitude, attitude, expertise, context, and approach. The model provides a richer picture of advanced MNT practice than was previously available and is presented for discussion and debate. Validation of the model is required before incorporation into education or practice.

Attitude↗
PubMed1990

The reproduction of physician autonomy in Ontario medical group practice.

A belief exists about the advantages of group medical practice over solo practitioners. The paper through a survey of 105 group practices examines a number of organisational and operational factors. The results suggest that practices are not always organised in a way to maximise the benefits of group operation but are still characterised by an individualistic approach.

Decision Making, Organizational↗
PubMedDate not supplied

Australian triage nurses' decision-making and scope of practice.

A survey of 172 Australian triage nurses was undertaken to describe their scope of practice, educational background and to explore the self-reported influences perceived to impact on their decision-making. The survey results reveal variability in the educational requirements for nurses to triage. Indeed, over half of the nurses who participated in the study worked in emergency departments that provided no specified unit-based triage education. Additionally, substantial inter-respondent variations in nurses' self-reported participation in a range of decisions to expedite emergency care were identified. Analysis revealed significant associations between demographic characteristics of the triage service, levels of nurse' autonomy and the nurses' self-reported participation in a number of triage decisions. The findings of this study have implications for emergency nurse education and the development and evaluation of triage practice guidelines.

Attitude of Health Personnel↗
PubMed1998

Autonomous or automatons? An exploration through history of the concept of autonomy in midwifery in Scotland and New Zealand.

Through the World Health Organization's definition of midwifery, midwives are frequently heard to describe themselves as autonomous practitioners. In this article this notion is refuted. An overview of individual and collective autonomy is first presented to contextualize the subsequent discussion. Then the notion of autonomy in relation to midwifery practice in Scotland and New Zealand is critiqued through tracing the history of midwives and midwifery in these two countries. Issues relating to midwifery registration, medicalization of birth and consumerism are discussed. Each of these categories is suggested as limiting to autonomous practice within midwifery.

History, 20th Century↗
PubMed2006

Relationships between felt accountability as a stressor and strain reactions: the neutralizing role of autonomy across two studies.

Felt accountability, conceptualized as a workplace stressor, has been gaining increased attention in terms of its importance for explaining variance in work attitudes and behaviors. Building on these investigations, the present research tests in 2 studies a conceptualization that positions job autonomy as a moderator of the relationships between felt accountability and strain reactions. In Study 1, the interactions of Felt Accountability x Job Autonomy on job tension and job satisfaction were investigated. As hypothesized, the results demonstrated that autonomy neutralized the dysfunctional effects of accountability for each outcome. Study 2 extended the findings from Study 1 by replicating the form of the interactive effects, with job satisfaction and emotional exhaustion serving as strain reactions. Implications, strengths and limitations, and suggestions for future research are discussed.

Administrative Personnel↗
PubMedDate not supplied

Knowing what we mean by wanting autonomy.

Central to decisions regarding merging your medical group into another organization is the concern for loss of autonomy. Merging the vehicle from which the physician's livelihood is derived demands careful consideration and clear understanding of what will be gained and what will be lost. In the marriage of any two parties, whether individuals or businesses, some autonomy must be forfeited or the marriage won't work. Understanding what autonomy means to the individuals or businesses is essential before the forfeiture of any autonomy can be assessed. The author suggests autonomy can be defined in three levels, each building on the one before and each carrying different levels of importance to those considering a marriage or merger with another. Understanding these levels, and what importance one places on each, will make the decision process easier to address by both parties in the merger.

California↗
PubMed2001

Employment-related factors in chronic pain and chronic pain disability.

BACKGROUND: Disability is a multifactorial phenomenon. Social scientists suggest that nonclinical factors, including age, education, and job status, correlate with disability. OBJECTIVE: Do employment-related factors predict chronic pain and/or chronic pain disability? METHODOLOGY: The literature search identified 15 observational studies to provide the evidence about this question. RESULTS: Review topics included job satisfaction, type of work, modified work and work autonomy, other employment-related factors, and socioeconomic status. Most subjects in the studies had low back pain. The studies used return to work as an outcome predicting chronic pain disability. CONCLUSIONS: Lack of modified work and lack of work autonomy predicted chronic pain disability (level 2). There was limited evidence (level 3) that lack of job satisfaction, perception of difficult job conditions and demands, heavy physical demands of the job, private rather than public employment, and lower socioeconomic group predict chronic pain disability. The number of years employed varied as a predictor in different studies (level 4b).

Chronic Disease↗
PubMed2005

Exercise of autonomous home care practice: the relationship with nurse characteristics.

This study examined how the value of autonomy is reflected in home healthcare agencies' practice models and how staff registered nurse (RN) characteristics (education, experience, certification) relate to the RNs' perception of their ability to exercise autonomous practice: control over practice decisions (clinical autonomy) and control over practice setting decisions (organizational autonomy). RNs (N = 82) from 11 agencies were found to have more control over practice decisions than practice setting decisions. No significant relationship was found between RN characteristics of education, RN experience, home healthcare experience, and specialty certification.

Attitude of Health Personnel↗
PubMed1996

Physicians and group practice: balancing autonomy with market reality.

Developing or joining multispecialty group practices is emerging as a premier competitive strategy for physicians. "Physicians and Group Practice: Balancing Autonomy with Market Reality" explores the driving forces causing the restructure of physician services into multispecialty group practices. The growth and characteristics of group practices are outlined as well as the advantages and trade-offs inherent in a group practice.

Capitation Fee↗
PubMed2006

Nurse dose as a concept.

PURPOSE: To describe the concept of Nurse Dose. METHODS: The concept of nurse dose has been identified from decades of clinical research as a concept essential in the delivery of safe and high quality health care. The components of nurse dose were conceptualized through review of the literature from nursing, medicine, and health services research. FINDINGS: Nurse dose is conceptualized as having three equally essential components: dose, nurse, and host and host response. Dose in the macro view includes the number of nurses per patient or per population in cities, states, regions, or countries. Dose in a micro view includes the amount of nurse time and the number of contacts. The nurse component consists of the education, expertise, and experience of the nurse. Host is represented by an organization and its characteristics (culture, autonomy, practice control) in a macro view and by the patient and characteristics (beliefs, values, culture) in a micro view. Host response includes response to the autonomy and acceptability of the nurse. CONCLUSIONS: Greater nurse dose has been associated with decreases in patient mortality, morbidity, and healthcare costs.

Clinical Competence↗
PubMedDate not supplied

NHS walk-in centres and the expanding role of primary care nurses.

Forty pilot NHS walk-in centres have opened over the past two years to provide drop-in nurse-led primary care in England without the input of doctors. As such, these centres represent a revolution for nurse-led care in the health service. However, research suggests that there is considerable variation in the degree of autonomy and independence exercised by the nurses in the different centres. This article discusses this variation, the role of walk-in centre nurses and how this might develop in future.

Attitude of Health Personnel↗
PubMed1995

The independent practice association in theory and practice. Lessons from experience.

This article examines an advanced managed care area, the San Francisco East Bay Area in California, for basic organizational issues posed by managed care for the medical profession. Of the three basic structures found, the independent practice association (IPA) model is theoretically most promising. Unlike the integrated health plan, the IPA seeks to retain traditional practice autonomy. Unlike the isolating direct gatekeeper model, the IPA assembles physicians in self-directed groups to invent and implement solutions and to exert political influence upward. In practice, however, it has proved difficult to balance practice autonomy with IPA authority. Both large, successful East Bay Area IPAs show signs (perhaps inevitably) of favoring authority over autonomy, as shown by their policies on governance, membership, and administration. Several policies are suggested to help redress this balance. Medical leaders must act now, before all the evidence is in, or the institutions of the past--hospitals and insurance companies--will control our future.

Decision Making, Organizational↗
PubMed2004

Key issues in transforming health care organizations for quality: the case of advanced access.

BACKGROUND: The 2001 Institute of Medicine (IOM) report highlighted the need for transformation of the U.S. health care system. This rigorous qualitative evaluation of transformational change for patient access in one large multispecialty group practice identifies the major issues facing organizations addressing the IOM challenge. METHODS: Semistructured depth interviews were conducted with the medical and administrative leaders at all levels, physicians, and nurses from 17 primary care clinics in one integrated medical group two years after they began to transform their approach to primary care patient appointment access. RESULTS: The mean time to third-next-available appointment was reduced by 76% during one year, from 17.8 days to 4.2 days. Nine important issues related to the change process were identified from clinic interviews. When combined with issues identified by central leaders, 13 themes stood out as lessons in transformational change. A major issue is the tension between physician autonomy and both effective organizational function and putting patients first. Physician autonomy is also diminished by the need to standardize and systematize care. CONCLUSIONS: Transformational change in care delivery is possible in large and complex group practices. Changes that directly affect care delivery and physician autonomy present particular challenges to physicians that need to be attended to if the changes are to be successful.

Ambulatory Care Information Systems↗
PubMed1995

They don't care: unemployed physicians in the Nordic countries.

Recent sociological research on the medical profession has been concerned with the profession's power and autonomy. So far, little research has focused on the total loss of the market value of a large number of physicians, that is, on the increasing rate of unemployment among physicians in some European countries. The author describes the extent of physician oversupply in the Nordic countries and examines the reasons for and implications of the growing unemployment among physicians.

Economics, Medical↗
PubMed1997

Nurses' reflections on problems associated with decision-making in critical care settings.

The present study investigated nurses' perceptions of the problems associated with their decision-making in critical care settings. This paper reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis "due to knowledge base', "lack of time to make decisions', "lack of time to implement decisions', and "personal values conflicts with other staff'. Nearly one-third (30.3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care: the demands of new intensive care technology upon the nurses' knowledge bases; and the need for in-service education to address this problem. The paper concludes with arguments for the use of in-depth interviews to further study these issues.

Adult↗
PubMed1997

Patients' rights in laboratory examinations: do they realize?

This article discusses the rights of patients who are attending hospital for the most common laboratory examinations and who may also be taking part in research studies. A distinction is made between five kinds of rights to: protection of privacy, physical integrity, mental integrity, information and self-determination. The data were collected (n = 204) by means of a structured questionnaire specifically developed for this study in the clinical chemistry, haematological, physiological and neurophysiological laboratories of one randomly selected university hospital in Finland. The analysis of the data was statistical. On the whole, patients' rights were realized reasonably well. This was most particularly the case with protection of privacy, as well as with the rights of physical and mental integrity. The rights to information and self-determination were less well realized. There are various steps that health care professionals and organizations can take to make sure that patients can enjoy their full rights, by counselling the patient, by giving opportunities to plan the examinations in advance, and by arranging a sufficient number of small examination rooms.

Adolescent↗
PubMed1995

Cutting out the middlemen: physicians as providers, direct contractors, and payers. Interview by Donna Vavala.

While many physicians and physician groups are forging alliances with other groups, with hospitals, and with other elements of the health care delivery system, an Ohio group decided that the loss of autonomy involved in these approaches was not acceptable. Instead, the group became the core of a new entity aimed at restoring physician control over the provision of and payment for health care services. In an interview with the principal of the new organization, Physician Executive learned the basis for the venture.

Contract Services↗