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Results for “Professional Autonomy”

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At least 19 recordsLinked to original sources

PubMed1998

Professional autonomy.

Professional autonomy may represent the first step to implementing measures that will allow CRNAs to attain a level of independent practice consistent with their clinical and educational training. Autonomy is regarded as an essential ingredient of professionalism and confers independent function at the individual practitioner level. The principle of autonomy refers to the individual's capacity to make independent decisions based on the assumption that he or she possesses the cognitive, psychological, and emotional faculties to make rational decisions. Nursing practice meets the first two criteria of professionalism--competence and dedication to an important social good. The third criterion of professionalism, autonomy, has been a focal point for controversy since the late nineteenth century, in which obedience to supervisors and physicians remained a central focus of nursing ethics teaching until the advent of feminism in the 1970s. This article presents a thorough analysis of these concepts with some thoughts on how understanding the fundamental precepts and further research may not only help maintain the current level of CRNA professional autonomy but serve to guide us to become more autonomous in the future.

Humans↗

PubMed2000

Re-evaluating professional autonomy in health care.

Professional autonomy, as the symbol of the traditional freedom of decision-making of medical professionals is criticized. This essay examines the critique. It analyses the underlying assumption that the autonomy of health professionals is incompatible with the need for organisation and management in order to control rising health care costs. It is argued that the concept of professional autonomy should be redefined, not through restricting the decision-making freedom of individual health professionals, but through expanding the concept into the sphere of management, so that managers will take responsibility for patient care.

Attitude to Health↗

PubMed2000

Professional autonomy and the normative structure of medical practice.

Professional autonomy is often described as a claim of professionals that has to serve primarily their own interests. However, it can also be seen as an element of a professional ideal that can function as a standard for professional, i.e. medical practice. This normative understanding of the medical profession and professional autonomy faces three threats today. 1) Internal erosion of professional autonomy due to a lack of internal quality control by the medical profession; 2) the increasing upward pressure on health care expenses that calls for a health care policy that could imply limitations for the professional autonomy of physicians; 3) a distorted understanding of the profession as being based on a formal type of knowledge and related technology, in which other normative dimensions of medical practice are neglected and which frustrates meaningful communication between physicians and patients. To answer these threats a normative structure analysis of medical practice is presented, that indicates which principles and norms are constitutive for medical practice. It is concluded that professional autonomy, normatively understood, should be maintained to avoid the lure of the technological imperative and to protect patients against third parties' pressure to undertreatment. However, this professional autonomy can only be maintained if members of the profession subject their activities and decisions to a critical evaluation by other members of the profession and by patients and if they continue to critically reflect on the values that regulate today's medicine.

Clinical Medicine↗

PubMed2000

Professional autonomy in the health care system.

Professional autonomy interferes at a structural level with the various aspects of the health care system. The health care systems that can be distinguished all feature a specific design of professional autonomy, but experience their own governance problems. Empirical health care systems in the West are a nationally coloured blend of ideal type health care systems. From a normative perspective, the optimal health care system should consist of elements of all the ideal types. A workable optimum taking national values into account could be attained by governance structures that also introduce elements from other ideal type systems. Thus a normative approach to medical practice guaranteeing an essential degree of professional autonomy for a relationship of trust between the patient and the physician, could be combined with an efficient and equitable allocation of health care resources.

Decision Making, Organizational↗

PubMedDate not supplied

[The relationship between professional autonomy and demographic and psychological variables in nursing].

The purpose of this study is to investigate the relationships of professional autonomy in nursing with demographic and psychological variables. The measure of professional autonomy in nursing is constructed by five factors, "Cognition", "Performance", "Concrete judgement", "Abstract judgment" and "Independent judgment", respectively and interpreted to represent the professional work abilities of nursing. Age, years of experience of nursing, arrangement of work place in the hospital, position level and educational background of nursing are selected as demographic variables. Psychological variables used in this study were intention to continue at work as a nurse, work satisfaction and motivation, self confidence and self evaluated aptitude toward nursing. Three-hundred and seventy professional nurses in the public hospital were administered a questionnaire including the five-point scale for professional autonomy in nursing and several demographic and psychological variables. The main results were as follows: (1) Each of the sub-scale scores of professional autonomy in nursing had significant and positive correlations with age, years of experience, work satisfaction and motivation, self confidence and aptitude toward nursing. (2) Nurses worked at the intensive care unit and operation room were significantly higher scores of professional autonomy in nursing than the nurses at the ward and the outpatient clinic. (3) Professional autonomy in nursing was totally increasing with the increase of nurse's position and years of experience. (4) Self confidence, position level and the kind of nursing license were the most explicable variables of professional autonomy in nursing.

Adult↗

PubMed2004

[Do physicians see their professional autonomy strengthen or weaken? The medical profession and the example of evidence-based medicine from a sociological point of view].

The introduction of evidence-based medicine has been discussed vehemently and controversially not only in medical but also in sociological journals. Sociology is primarily interested in this innovation from the perspective of its impact on autonomy and professionalism. The author discusses the possible implications of EbM with regard to the question if it increases or decreases the professional status of medicine. Both the historical development of this debate and the present discourse are being considered.

Evidence-Based Medicine↗

PubMedDate not supplied

Professional autonomy: a pilot study to determine the effects of a professional development program on nurses' attitudes.

In this article, the authors describe a pilot study conducted to evaluate a component of a professional development program designed for Clinical Nurses in a general teaching hospital. Permission was obtained to use an established instrument for measuring attitude toward professional autonomy. A non equivalent pre-test/post-test, control group design was used. Results indicate that the program was influential in changing nurses' attitudes toward autonomy. Implications of using an instrument designed for an American cohort of nurses and modified to depict an Australian nursing culture are discussed.

Adult↗

PubMed2000

Professional autonomy: a stumbling block for good medical practice. An analysis and interpretation.

In this article the various descriptions and interpretations of professional autonomy, as have been given in the articles from Belgium, Italy and the UK are subjected to a further analysis. The implicit claim that professional autonomy of physicians is beneficial for the health of patients is scrutinized and is proven to be untrue and invalid. The conclusion is that professional autonomy is more directed at the interests of physicians than of those of patients and deserves no special place in health care.

Belgium↗

PubMed1997

Professional autonomy: essential for nurse practitioner survival in the 21st century.

This article examines nurse practitioners' (NPs) professional autonomy as a critical component of future practice success and survival. Professional autonomy provides the basis for defining and negotiating NPs' work and worth in primary care. Outcome data and analyses that delineate the unique and overlapping practice roles and responsibilities of physicians and NPs will help determine the relative value of their work. Nurse practitioners practicing as physician "substitutes" risk professional survival. Nurse practitioners need to identify nursing as their practice paradigm and nurses as their professional identity.

Forecasting↗

PubMed1995

[Professional autonomy and the dentist-patient relationship].

This article discusses the concept of professional autonomy from an ethical viewpoint. First it is explained how the professional autonomy of the dentist relates to the autonomy of the patient. Subsequently the influence of the health care system is discussed.

Dentist-Patient Relations↗

PubMed2000

Effects of evidence-based treatment and consent on professional autonomy.

Recent high profile cases like Wisheart (Bristol babies) has placed healthcare professional autonomy under both ethical and legal scrutiny, reflected by the growing number of civil cases brought by the public. The aim of this paper is to investigate the effect of evidence-based treatment on the legal requirements of consent, when the treatment transcends the therapeutic boundary. The potential effect on the autonomy of healthcare professionals is also discussed. The study revealed that although consent remains the cornerstone of defence in many areas of therapeutic treatment, it is open to significant legal challenge in the grey area between therapeutic evidence-based treatment and non-evidenced-based procedures. Consent remains the cornerstone of defence for therapeutic procedures. However, it is less certain with innovative treatment or procedures that transcend the therapeutic boundaries and are shown to be non-evidence-based.

Dental Care↗

PubMed1985

Medical dominance and the development of professional autonomy in physiotherapy.

Has medical dominance declined as a result of the increasing autonomy of developing health professions? The paper argues that to answer this question it is first necessary to define medical dominance and professional autonomy. The paper outlines a categorisation of different types of professional autonomy, which correspond to different types of medical dominance. This categorisation is used to identify the particular aspects of professional autonomy in physiotherapy which have developed over recent years. It is concluded that whilst these changes correspond to a decline in aspects of medical dominance, there is no evidence of a significant decline in medical dominance in health services or that the changes which have taken place are solely a result of developing health professions' struggle for autonomy.

Humans↗

PubMed2003

[Work in medicine: some issues concerning professional autonomy].

The author analyzes several issues pertaining to medical practice as related to the technical autonomy characterizing professional activity in this field. She points to the coexistente of a scientific side and an empirical/pragmatic side of medicine, the latter known as the medical art. The article also discusses the complexity of medical command of technological rationality which presides over the practical use of scientific knowledge. The author defines work in medicine as a "tensive structure" and examines its consequences for self-representation by physicians, their daily work, and themselves as agents of professional labor and subjects of action.

English Abstract↗

PubMedDate not supplied

The impact of financial constraints and incentives on professional autonomy.

General practice has been the subject of extensive reforms over the 1990s in Australia as elsewhere. Reforms have attempted to improve quality and contain the overall cost of health care, and have often been seen as reducing the autonomy of medical professionals. This paper examines the impact of financial constraints and incentives introduced during the 1990s on Australian GPs' perceptions of autonomy. An existing seven component definition of autonomy and six themes that emerged from reviewing publications were used to construct focus group questions. A total of 25 GPs participated in four focus groups. Those who participated believe that their financial autonomy has been diminished by policy changes and consumer expectations. They also perceive that their ability to control clinical decisions, which they regard as the most important aspect of professional autonomy, has been reduced along with financial autonomy. Organized medicine in Australia sees financial accountability and clinical decision making as polar opposites, and has continued to argue that fee-for-service payment is the only appropriate method of remuneration, despite increasing evidence that this does not guarantee clinical autonomy. Major changes to the financing of general practice in Australia are required to address the concerns of GPs, governments and patients.

Attitude of Health Personnel↗

PubMed2000

The professional autonomy of the medical doctor in Italy.

This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician's autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Associations (FnomCeO). The Code 1998 acknowledges the physician's autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain: (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological--and consequently ethical-- characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient's suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician's professional autonomy: (1) the SSN health care Acts; (2) the so-called Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.

Benchmarking↗

PubMedDate not supplied

[The social representation of nurse's professional autonomy in public health].

The object of this study was the nurse's professional autonomy and had the following specific objectives: describe and analyze the social representations of the nurses 'professional role and analyze the professional autonomy-dependence binomial. As theoretical methodological reference it was chose the Social Representations Theory It was proceeded in-depth interviews with 30 nurses of the basic health system from a county in Rio de Janeiro state. To the data analysis it was used the Alceste 4.5 software. The software generated five classes, two express the professional formation/absorption and three the professional. Practice. The analytical categories were constituted from the dimensions in which the social representations express themselves: the conceptions, the positions and the professional practices autonomy.

Nursing↗

PubMed2005

Professional ethics and collective professional autonomy: a conceptual analysis.

In the first section, it is argued that a professional activity involves systematic knowledge and proficiency, a form of continuous improvement of the related bodies of knowledge and proficiency, as well as two levels of understanding: a local one, which is the ability to justify and explain professional acts, and a global one, which involves a conception of the whole profession and its ethical principles. The second section is devoted to a conceptual analysis of professional ethics. It is argued that it consists of a general conception of professionality, a particular conception of the profession under consideration, and a conception of the normative requirements made by the societal envelope of the professional activity, in particular basic norms of democracy. The third section draws conclusions with respect to the nature and limits of professional autonomy. It is shown that such autonomy is much more restricted than its apparent extent. Examples from engineering and other professions are provided.

Codes of Ethics↗

PubMed2001

Managed care, professional autonomy, and income: effects on physician career satisfaction.

CONTEXT: Career satisfaction among physicians is a topic of importance to physicians in practice, physicians in training, health system administrators, physician organization executives, and consumers. The level of career satisfaction derived by physicians from their work is a basic yet essential element in the functioning of the health care system. OBJECTIVE: To examine the degree to which professional autonomy, compensation, and managed care are determinants of career satisfaction among physicians. DESIGN: Cross-sectional analysis using data from 1996-97 Community Tracking Study physician telephone survey. SETTING AND PARTICIPANTS: A nationally representative sample of 12,385 direct patient care physicians. The survey response rate was 65%. MAIN OUTCOME MEASURE: Overall career satisfaction among U.S. physicians. RESULTS: Bivariate results show that physicians with low managed care revenues are significantly more likely to be "very satisfied" than are physicians with high managed care revenue (P < .05), and that physicians with low managed care revenues are significantly more likely to report higher levels of clinical freedom than are physicians with high managed care revenue (P < .05). Multivariate analyses demonstrate that, among our measures, traditional core professional values and autonomy are the most important determinants of career satisfaction after controlling for all other factors. Relative income is also an important independent predictor. Multiple dimensions of professional autonomy hold up as strong, independent predictors of career satisfaction, while the effect of managed care does not. Managed care appears to exert its effect on satisfaction through its impact on professional autonomy, not through income reduction. CONCLUSIONS: Our results suggest that when managed care (or other influences) erode professional autonomy, the result is a highly negative impact on physician career satisfaction.

Attitude of Health Personnel↗