Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Professional Autonomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,693 records · Page 94Linked to original sources
PubMed2002

Assisted living facilities as a site for NP practice.

PURPOSE: To describe what an assisted living facility (ALF) is who resides in ALFs, and the benefits of nurse practitioner (NP) practice in an ALF for the client, facility, NP, and practice. DATA SOURCES: Selected scientific literature, legal and regulatory guidelines, consumer information and guidelines, Internet sites, and the authors' experiences. CONCLUSIONS: Assisted living facilities are nonmedical residential settings grounded in a philosophy of providing residents with choice, autonomy, privacy, independence, dignity, and respect in a housing environment as homelike as possible. Nationally, ALFs vary considerably by size, services provided, and regulations imposed by states. IMPLICATIONS FOR PRACTICE: Assisted living facilities are now a popular choice for individuals who desire assistance with selected activities of daily living (ADL) while maintaining maximum independence. They are becoming an excellent site for the provision of in-home primary care in order to facilitate aging in place.

Accreditation↗
PubMedDate not supplied

Physician-owned imaging centers: the future is now.

Although changes in the health care arena have made inroads in physicians' autonomy and reimbursement, new opportunities have also emerged. We describe basic principles that can help develop freestanding, independent, physician-owned imaging centers offering cost-competitive, high-quality services. To succeed, physicians must invest in their companies, think strategically, pursue clear objectives, examine data and be willing to assume a certain amount of risk. Marketing their services is critically important and requires careful attention to patients and referring physicians. We have found that, while these challenges are large, the rewards are substantial.

Ambulatory Care Facilities↗
PubMed2001

Hospital care pathways for patients with schizophrenia.

Greater emphasis is being placed on reducing clinical variation in managing patient groups in the reformed National Health Service (NHS) in the United Kingdom (UK). The use of a care pathway to enable greater control over the process and quality of care will be explored for patients suffering from schizophrenia. The paper addresses three main factors for the development of care pathways for people suffering from schizophrenia: predictability of the illness; nature of standardized care; and role autonomy. It is argued that the diagnosis of schizophrenia does not lend itself easily to predicting care and treatment within a care pathway framework. However, a care pathway may bring other benefits, such as standardized care and a greater control over the delivery of care. Development and implementation of hospital care pathways require extensiv research. Qualitative research directions are advocated due to the possib difficulties of conducting an experimental study.

Case Management↗
PubMed1997

Control over nursing practice: a construct coming of age.

The purpose of this study was to assess the psychometric properties of the Control Over Nursing Practice Scales using data from registered nurses (N = 1117) employed in four acute care hospitals in the Midwest. Psychometric evaluation included dimensional analysis, reliability estimation, and validity assessment of six dimensions of a 33-item instrument: responsibility and influence of head nurses, staff nurses, and committees; access to ideas; use of personal resources; and research utilization. Factor analysis reproduced six dimensions that explained 61% of the variance. Coefficient alphas ranged from .75-.89. Correlations between Control Over Nursing Practice with autonomy, group cohesion, job stress, and job satisfaction supported construct validity. Empirical testing of known group differences to obtain new information about the construct revealed that critical care nurses scored higher on research utilization than medical-surgical or obstetrical nurses; baccalaureate-prepared nurses scored higher than associate or diploma nurses on responsibility and influence: committees. Contrary to our hypothesis, there were no differences between part-time and full-time nurses on any of the six dimensions.

Adult↗
PubMed1999

The effects of primary nursing on work-related factors.

This study investigates the effects of a primary nursing care delivery system on some work-related factors of nurses in long-stay psychiatric care settings. In a quasi-experimental research design a cohort of 176 nurses was followed for 2.5 years. Results showed that as a result of primary nursing the primary nurses found more autonomy in their work and experienced it to be less complex. Furthermore, primary nurses performed personal care tasks less frequently and worked more according to a patient-oriented care model. Several additional analyses were performed owing to the two main problems encountered in this study, namely a high dropout due to job turnover among nurses and the imitation of the intervention by the control group.

Adult↗
PubMed1998

A survey of psychiatric nurses' opinions of advanced practice roles in psychiatric nursing.

This postal survey established psychiatric nurses' opinions of the content of advanced practice psychiatric nursing roles. A random sample, consisting of 100 members of the Network for Psychiatric Nursing Research (NPNR), was surveyed. 78% returned completed questionnaires. Responses were analysed using the chi-square test, and the Mann-Whitney U-test. Elements of the normal nursing role identified included psychiatric assessment, patient and carer education, and basic psychotherapeutic practices. Identified advanced practice roles included psychiatric diagnoses, prescribing single emergency doses and modifying doses of a wide range of psychotropic medication. Enhanced autonomy in admission and discharge and additional powers under the Mental Health Act were also supported. The prescription of full courses of medication and the prescription and administration of electroconvulsive therapy were rejected as nursing roles. University and Trust employed nurses responded differently in a number of these areas. The study concluded that an advanced practice role which incorporates restricted elements of psychiatric practice is supported by psychiatric nurses, and recommends that pilot sites should be established which test the acceptability and effectiveness of the identified role.

Attitude of Health Personnel↗
PubMed2006

Overload, autonomy, and burnout as predictors of physicians' quality of care.

A model in which perceived overload and burnout mediated the relations of workload and autonomy with physicians' quality of care to their patients was examined. The study was based on data from 890 specialists representing six medical specialties. Including global burnout as well as its three first-order facets of physical fatigue, cognitive weariness, and emotional exhaustion improved the fit between the structural model and the data relative to an alternative model that included only global burnout. Workload (number of work hours) indirectly predicted quality of care through perceived overload. Additionally, the authors found that the paths from the first order factors of emotional exhaustion, physical fatigue, and cognitive weariness predicted quality of care negatively, positively, and nonsignificantly, respectively.

Burnout, Professional↗
PubMed2004

Perceived stress reported by nurse practitioner students.

PURPOSE: To explore the phenomenon of stress as perceived by nurse practitioner (NP) students enrolled in a master of science in nursing program. DATA SOURCES: The study utilized a qualitative approach for data collection and analysis consistent with grounded theory methodology. We recruited 12 students, 4 men and 8 women, during their final year of a university-based NP program. Data were collected through individual interviews and a demographic questionnaire. CONCLUSIONS: Students reported stress levels ranging from moderate to highest ever in their lives. Although reasons given for becoming an NP included increased autonomy and increased ability, high-level stress was attributed to high demands and to independent teaching-learning techniques in the NP courses. Participants also expressed concerns about time management and financial obligations. IMPLICATIONS FOR PRACTICE: Knowledge of NP students' perceptions regarding personal stress can provide insight useful for developing approaches to foster optimum learning. Practicing stress reduction techniques with students would not only facilitate their own stress reduction but would also reinforce their ability to assist clients with this need.

Adaptation, Psychological↗
PubMed1999

Complaints against nurses: a reflection of 'the new managerialism' and consumerism in health care?

This paper discusses the effects of restructuring on nursing as a profession through an examination of the issue of complaints in Ontario. It argues that new managerialist techniques and associated changes in the nature of work are reducing the autonomy of nurses and making it difficult for them to meet the standards of their profession. Simultaneously, the Ontario government has increased the power of the public in the disciplinary process and the College of Nurses of Ontario is encouraging patients to register their complaints. The growth of consumerism in health care, coupled with the disciplinary process, individualizes complaints and deemphasizes their relationship to restructuring. Moreover, in response to the increasing number of complaints - complaints which more often come from the public - nursing organizations have encouraged the legalization of the disciplinary process, thus fostering the individualization of the issues.

Consumer Advocacy↗
PubMed2003

Nurse autonomy, nurse job satisfaction and client satisfaction with nursing care: their place in nursing data sets.

Many changes have taken place in the healthcare system that have influenced nurse autonomy, job satisfaction and client satisfaction. Standardized language facilitates communication within the discipline of nursing. Examples of such language include the Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) systems as well as the Nursing Minimum Data Set (NMDS), which provides a formal structure for electronic data sets to support nursing care. The Nursing Management Minimum Data Set (NMMDS) was designed to identify variables to guide nurse managers in evaluating the impact of nursing interventions on client outcomes. Gaps within NMDS and NMMDS are discussed, and solutions are proposed.

Attitude of Health Personnel↗
PubMed1999

Physician unionization: a threat to integration?

Physicians, primarily those salaried by hospitals and health systems, are increasingly turning to labor unions to help them in their frustration over what they see as eroding clinical autonomy as well as diminishing compensation. Significantly, non-salaried physicians are also looking to the concept of collective bargaining as a tool in their negotiations with health insurers. The pro-labor doctors may get some of what they're looking for in the coming months and years, with a combination of economic and political forces driving the nascent trend forward regionally and nationwide. But victory won't come without a struggle and some major legal and regulatory hassles. And what will physician unionization mean for integrated health systems and other large healthcare organizations? Plenty, say industry observers and those in the trenches.

American Medical Association↗
PubMed2000

Nurse practitioner autonomy in a clinical setting.

The ENPs who participated in this study were providing services to a group of patients similar in age and gender to those using emergency services at a national level. The ENPs were employed in a variety of settings and provided health care to patients with non-urgent through emergent conditions. They ordered less diagnostic tests for patients than providers in a national study, performed various invasive and therapeutic procedures as well as diagnostic procedures, and referred all patients except those transferred to the morgue or who left against medical advice for follow-up care. The ENPs had a slightly higher percentage (94 per cent vs. 84.4 per cent) of patients discharged home than providers in a national study.

Adolescent↗
PubMed1996

Parents' responses to predictive genetic testing in their children: report of a single case study.

There is a widely held view among health professionals that predictive genetic testing of children for late onset diseases is not desirable clinical practice. Yet, little is known about the views of parents, or their responses, to predictive genetic testing in their children. Since such testing is being carried out in some genetic centres, the opportunity was taken to conduct a single case study of the parents of 2 and 4 year old sisters who were tested for the gene for familial adenomatous polyposis. Interviews before testing, after, and 15 months later showed a stable attitude, that parental responsibility included making decisions about such testing, and that the role of health professionals should be one of information giving rather than decision making. These parents had no regrets about having their children tested and reported no changes in their behaviour towards either the child who tested positively or the child who tested negatively. Using standardised scales, mood was found to be within the normal range both before and after testing in the mother and father. This case study is a first step towards systematic empirical studies determining the consequences of acquiescing to parents' requests for genetic testing in their children.

Adenomatous Polyposis Coli↗
PubMed2001

Utilization management: issues, effects, and future prospects.

Utilization management encompasses a diverse set of activities designed to influence the use of health care services and thereby constrain health care resource consumption. Utilization management, which has become one of the most widely used cost-containment approaches, has engendered debate and controversy. Physicians have been outspoken critics of utilization management because it has limited their clinical autonomy and has contributed to an intolerable administrative burden. Insurance carriers, managed care plans, and third-party payers have defended the use of utilization management as an imperfect-but necessary-practice that is needed to reduce consumption of unnecessary or inappropriate health care services. This review examines the operation and effects of three widely used utilization management procedures: prospective utilization review, case management, and physician gatekeeping programs. In addition, it explores the future role of utilization management in the health care system and outlines a set of principles that we believe should be used to guide the development of utilization management strategies in the future.

Cost Control↗
PubMed2004

Factors which influence physicians to join labor unions.

As members of a fiercely independent and individualistic profession, physicians have historically resisted the lure of organizing into collectives and have steadfastly maintained their autonomy. With the advent of managed care, the conditions of work have been altered and many of the assumptions guiding unions and collective bargaining have taken on renewed interest. Proponents of organizing physicians argue that unions can act as representative agents for health care providers to negotiate effectively with managed care organizations (MCO), insurance companies and government for conditions of work to help make their practice of medicine better for patients. Many physicians who previously rejected the notion of unions have reconsidered their entrenched positions and are beginning to weigh the costs and benefits associated with union membership.

Attitude of Health Personnel↗
PubMed1997

Building a sustainable, risk-bearing IPA.

HMOs are increasingly relying on risk-bearing IPAs to expand their networks. Physicians see IPAs as a way to access HMO patients without relinquishing their autonomy. To build a sustainable IPA to bear global risk for HMO enrollees, the IPA's organizers should select a provider panel that is committed to centralized medical management and dominated by primary care physicians, invest in talented managers, empower a strong governing board, and access a management information system that can perform the functions necessary to manage care. Additionally, the interests of any potential outside capital sources should be weighed carefully, and the financial incentives of all of the IPA's providers aligned with the IPA's goal of providing appropriate, cost-effective care.

Capital Financing↗
PubMed2005

Why do nurses enter community and public health practice?

Current policy places much emphasis on public health and care outside hospital. To provide this requires a qualified work force but a large number of community nurses are approaching retirement. While there is a commitment to recruit and retain such nurses, there is little information available on community nurses' career trajectories, or on why staff choose to work in the community and why they undertake community specialist practice (CSP) programmes. This paper reports the findings of a survey of community specialist practice students--community children's nurses (CCNs), community mental health nurses (CMHNs) district nurses (DNs), health visitors (HVs), practice nurses (PNs), school nurses (SNs)--in a large London based programme. They were asked why they had entered community practice and why they had undertaken a community specialist practice programme. Findings were not categorical; the reasons for entering community work included increased initiative, more autonomy and preferred hours. Scope for initiative, autonomy and increased independence were reasons for undertaking the CSP programme, as well as better promotion prospects. Differences were evident in response by age of respondent and by whether they had dependent children. All types of respondents saw themselves as public health practitioners. Practice nurses stood out as different from the others, seeing hours as significant, but not promotion prospects despite expecting higher grades on completion of the programme. The study raises various questions, which could be explored after refinement of the study tool and using students in different locations throughout the country.

Adult↗
PubMedDate not supplied

[Health services management challenges in theory and practice].

This article deals with the management of health services and organizations, focusing on knowledge as an action resource, which turns into a source of autonomy, authority and power for subjects in the context of their practices. The movement towards the consolidation of the Single Health System (SUS) gives rise to the challenge of "adapting" health workers to its principles and guidelines, establishing instruments such as service management with a view to the reorganization of the health work process. In hospital management, the concept of "ambience" was adopted to understand and reorganize hospital functionality, highlighting the physical and technological space, in view of the fact that these elements cannot be constituted without the intermedation of the social and affectual.

Brazil↗