Reasoning bureaucracy in professional organisations: Enabling conditions for professional and bureaucratic values to merge in hospitals

To compare Spanish nursing students' and registered nurses' perception of professional values from the perspective of gender and professional experience. Nursing has traditionally been a female profession; however, the analysis of professional nursing values from a gender perspective has received little attention. The integration of professional values typically begins during academic life and is, thereafter, reinforced during professional activities. A descriptive cross-sectional study was conducted with 159 students (97.4% females) and 386 registered nurses (86.8% females) from primary healthcare centres, hospitals and management positions within the public health system. The validated Spanish adaptation of the Nurses Professional Values Scale was used. This instrument measures three dimensions: ethics, commitment and professional mastery. Descriptive statistics were used to analyse the data, together with bivariate analysis using the chi-squared test. Females granted more importance to professional values. Important gender differences among students were detected. Ethical values were considered to be the most important for both students and nurses, followed by professional mastery and commitment. The importance given to values progressively decreased in the groups under study: students, less-experienced nurses and expert nurses (in decreasing order). Significant gender differences exist with regard to professional nursing values. The values related to professional commitment and mastery should be integrated and promoted during academic education and specifically focus on male students' perceptions. As professional experience increases, the importance attributed to professional values decreases. Professional nursing values should be promoted among universities, health services and professional organizations, encouraging their dissemination, implementation and evaluation.

The purpose of this study was to identify the most important contemporary professional nursing values for nursing clinicians and educators in Taiwan. Nursing values are constructed by members of political and social systems, including professional nursing organisations and educational institutions. Nurses' personal value systems shape the development of these professional values. An understanding of nurses' perceptions of professional values will enable the profession to examine consistencies with those reflected in existing and emerging educational and practice environments. A qualitative descriptive study was conducted using the focus-group discussion method. A purposive sample of 300 registered nurses in Taiwan, consisting of 270 nursing clinicians and 30 faculty members, participated in 22 focus-group interviews. Data were analysed using a systematic process of content analysis. Six prominent values related to professional nursing were identified: (a) caring for clients with a humanistic spirit; (b) providing professionally competent and holistic care; (c) fostering growth and discovering the meaning of life; (d) experiencing the 'give-and-take' of caring for others; (e) receiving fair compensation; and (f) raising the public's awareness of health promotion. Four background contexts framed the way participants viewed the appropriation of these values: (a) appraising nursing values through multiple perspectives; (b) acquiring nursing values through self-realisation; (c) recognising nursing values through professional competency and humanistic concerns and (d) fulfilling nursing values through coexisting self-actualisation. A conceptual framework was developed to represent this phenomenon. The most important professional nursing values according to the perspectives of nurses in Taiwan were identified. These values reflect benefits to society, to nurses themselves and to the interdisciplinary team. Nurses' awareness of their own values and of how these values influence their behaviour is an essential component of humanistic nursing care. Nursing educators need to develop better strategies for reflection and integration of both personal and professional philosophies and values.

SummaryWe investigated the effect of financial incentives on performance in a professional organization. Whereas agency theory treats tangible rewards such as money as a potentially powerful motivator for improving performance, the professional control perspective posits that the motivational effects of financial incentives will depend on the intended recipients attitudes toward the incentives relative to their professional values. The study setting was a large network of physician practices that adopted a financial incentive program to improve physician performance in the management of diabetic patients. Consistent with agency theory, performance did improve following the introduction of the incentive. However, consistent with the professional control perspective, physicians' psychologically based attitudes toward the incentive program regarding its impact on their own work autonomy and the importance of the performance goals moderated the effect of the incentive on performance. Study findings indicate that agency theory and professional control are complementary theoretical perspectives for understanding how professionals will respond to the imposition of performance‐related financial incentives. In terms of practice, pay‐for‐performance programs aimed at professional organizations should be designed to take into account the values and goals of an organization's professionals to maximize the effect of financial incentives on performance. Copyright © 2012 John Wiley & Sons, Ltd.

ASE – Home for All Cardiovascular Ultrasound Users

BackgroundPotentially inappropriate prescribing (PIP) has been linked with adverse health outcomes and increased healthcare costs. Feedback interventions targeting PIP have shown promising results. However, translation from research to everyday practice remains a challenge. With the Normalisation Process Theory (NPT) as overarching framework, we aimed to explore the implementation processes performed by general practices in a real-life, quality improvement intervention using feedback on practice-level prescribing.MethodsAll 376 general practices in the Central Denmark Region received a prescribing feedback intervention targeting selected types of PIP. Six months later, they received an evaluation questionnaire, to which 45% responded. Among 102 practices reporting to have made changes in response to the intervention, we conducted individual, semi-structured interviews with ten GPs. Maximum variation was sought in terms of baseline prescribing status, implementation activities, practice type and geographical location. The interviews were analysed thematically using NPT.ResultsThe implementation processes in general practice reflected the four NPT constructs. Key motivators for implementation included the GPs’ professional values and interests, but pragmatic considerations were also of importance (coherence). A collective versus an individual approach to the engagement and planning of the implementation process (cognitive participation) was observed. Similarly, a distinction was evident between practice-level actions involving the entire practice team as opposed to individual-level actions performed by the individual GP (collective action). Several challenges to the implementation processes were identified, including patient influences and competing priorities at multiple levels (reflexive monitoring). Additionally, internal evaluation and normalisation of new practices occurred in varying degrees.ConclusionNPT provided a useful framework for understanding implementation processes in general practice. Our results emphasise that clear professional aims and feasible content of interventions are key for GP motivation. This may be ensured through cooperation with GPs’ professional organisation, which may strengthen intervention legitimacy and uptake. Two main implementation strategies were identified: practice-level and GP-level strategies. Intervention developers need to recognise both strategies to deliver intervention content and implementation support that promote sustainable improvements in prescribing practice. Competing demands and patient influences remain important challenges that need to be addressed in future studies to further facilitate the reduction of PIPs.

Professional nursing practice entails more than the employment of technical skills while caring for patients. It also includes participation in professional organizations and involvement in the community. While there is evidence of the need for RN-BSN programs to provide learning activities that will promote sustained professionalism in the baccalaureate nurse, there is a paucity of literature describing such activities. This article describes the case report of one university’s use of curricular changes in the RN-BSN program through inclusion of clinical activities to enhance professional development and values. The responses of RN-BSN students to these clinical experiences demonstrate engagement and interest in both professional nursing organization and civic meetings, as well as personal satisfaction as a result of their involvement in these experiences. Nursing faculty teaching in RN-BSN programs should find these comments inspiring, and be motivated to incorporate some of these clinical activities into their curriculum to promote sustained professionalism in RN-BSN students after graduation.

The correlates of social determinants to ethico-moral values on professional development of Saudi nursing students

Editorial

A professional society, organization, or association offers members the opportunity to advance their knowledge and skills and to maintain their certification through organizational activities. By definition, professional societies are formed when a group of individuals with shared interests collaborate to achieve professional goals. Cited benefits of membership in a professional society include being a key resource for maintaining professional values and standards; providing opportunities for continuing education, professional development, networking, and collaboration; providing support for challenging issues; and promotion of the profession. A PubMed search found that some health care education programs report the benefits of student membership in their professional societies, although there are little published data on student membership in professional societies for medical imaging programs.

Professional societies engage in activities with the aim of nurturing highly talented early career members of their field. Little is known about the value of honorary fellowship awards given annually by professional societies. Following up on the only known prior study of this topic, authors queried fellowship awardees in one psychiatric society to better understand the perceived value of honorary fellowships and other outcomes, such as subsequent involvement in professional societies. The authors queried former participants in the Laughlin and Psychiatry Resident-In-Training Examination® (PRITE®) Programs regarding their fellowship experiences and their subsequent involvement in The American College of Psychiatrists and other psychiatry membership organizations. The authors obtained frequency data and analyzed responses using t-tests and chi-squared tests. Associations between the outcomes and demographic characteristics such as age, gender, and fellowship type was tested. Responses were gathered from 143 individuals who had participated in the Laughlin Fellowship and 22 in the PRITE Fellowship. Respondents felt that that the fellowship experience had been helpful professionally. Laughlin fellows were older and more likely to have assumed a leadership role in professional organizations (60% vs 36%, p = 0.04). Laughlin fellows also more strongly endorsed professional recognition as a benefit at the time of receiving their award. Survey respondents reported increased participation in professional organizations and assumed leadership roles in The College and other professional organizations subsequent to the fellowship experience. On the whole, fellows were generally positive about their experiences. Many respondents became involved with The College subsequent to their fellowship, but a larger proportion became involved with other organizations, including in leadership roles. Professional societies with early career programs such as the Laughlin Fellowship and the PRITE Fellowship appear to identify and support future leaders as intended, but these leaders may engage more with other professional societies.

One of the most promising avenues for the development of professional values is involvement in professional student organizations. A convenience sample of baccalaureate social work students (n = 482) was drawn from 15 institutions. Regression analyses revealed several predictors of involvement in social work student organizations, including student mentorship, involvement in other student organizations, and type of institution (public/private). These results suggest that involvement in professional student organizations (e.g., social work, nursing, law) may be amenable to interventions such as structured educational/social events and peer mentorship programs which, in turn, may help in the development of professional values.

Background and Purpose. Collaborative health care is a process in which multiple medical providers manage the care of a patient jointly. Collaborative health care has developed as a way to achieve quality patient-centered care. Evolution of health care delivery systems has lead to interprofessional care that requires analysis and understanding of each health disciplines' model of care in order to determine common and discrete clinical strategies. The purpose of this article is to identify opportunities for collaboration between physical therapist and physician assistant practice through linkage of excellence, professional duty, and social responsibility in their professional core values, educational approach, and specialized practice issues. Methods and Materials. Information was drawn from published materials in the physical therapy, physician assistant, and health care literature, as well as the professional organizations in or related to physical therapist and physician assistant professions. Summary of Literature. Comprehensive reviews of physical therapist and physician assistant practice were conducted. Analyses of each profession and editorials on the evolution of the practice patterns for each profession have been published through out the 20th century and most recently in the early part of the 21st century. The literature has evolved as the focus of health care has shifted to address the best needs of the patient. Conclusion. This article links the professional core values and specialized practice issues of physical therapists and physician assistants. The article provides discussion of interprofessional education and collaborative patient-centered care by physical therapists and physician assistants. Key Words: Core values, Health care delivery systems, Interdisciplinary care, Interprofessional collaboration, Professionalism. INTRODUCTION Health Care Delivery Systems Collaborative health care is a process in which multiple medical providers manage the care of a patient jointly. Collaborative health care has developed as a model for quality patient-centered care. The model of collaboration and teamwork in health care has been in existence throughout the 20th century as it is well-defined in the literature.14 The main concepts for collaboration were outlined by D'Amour et al1 in their comprehensive literature review of interprofessional collaboration. The authors identified the 5 underlying health care concepts of collaboration prevailing in the literature: sharing, partnership, power, interdependency, and process. Utilizing these health care concepts, interprofessional collaboration is reaching new levels of popularity in the 21st century.4 The transformation of health care models from care for illness to wellness and prevention has renewed interest in cost-controlled, yet comprehensive, patient care. Due to escalating health care costs, delivery systems have evolved from traditional care to managed-care models. Traditional fee-for-service models focused on treating patients after onset of illness. Comprehensive managed-care models emphasize the importance of keeping people healthy, while promoting screening for early treatment of health problems, and containing costs by maximizing provider efficiency and preventing illness.5 The evolution from traditional care to comprehensive managed-care models has led to the treatment of patients by multiple providers with a range of training and philosophical approaches.4 Two such members of the health care team are physical therapists and physician assistants. Both health care professionals have distinct, yet integral, roles in patient care. The purpose of this article is to identify opportunities for collaboration between the physical therapist (PT) and physician assistant (PA) practices through practical linkage of excellence, professional duty, and social responsibility in their core values, educational approach, and professional practice issues. …

Abstract: A basic principle associated with competent evaluation practice asserts that evaluators should possess the education, abilities, skills, and experience needed to undertake the tasks proposed in an evaluation. For those training evaluators this also means teaching professional dispositions, because an individual’s dispositions (i.e., beliefs and values) influence how they will act as professionals. Personal dispositions held by individual evaluators at times conflict with the values and beliefs of their professional organization. Competent evaluators must be able to manage personal dispositions in ways that allow professional values and positions to guide their practice. In order for evaluation educators to teach evaluator competencies, we must understand the underlying dispositions associated with each competency. We must also identify which dispositions are essential for professional practice. This article discusses the issue of dispositions and the challenges of helping evaluators develop positive professional dispositions.

Advocacy Will Overcome Barriers to Better Care, Robinowitz Says

There is a dearth of sociologically informed literature on Irish journalists. In her seminal paper, Kelly (1983) laid out the factors influencing the production of news in a general context, acknowledging in her analysis the limited range of research on the Irish media. She highlighted the ideological and personal preferences of journalists on the one hand, and their professional values and practices on the other as key determinants of the news agenda. However, to date no systematic study of Irish journalists has addressed these twin concerns. Drawing on data obtained from a national survey of daily news journalists in the Republic of Ireland conducted in the late 1990s, this paper offers some insight into the class position, political orientation and value system of a key group of ‘meaning producers' in Irish society. In particular, the article seeks to provide insight into the professional culture of Irish journalists and their views on the relationship between the messenger, the message and the audience. This focus is apposite, given the central role played by Irish news journalists in bringing to public attention the variety of political, financial and religious scandals that engulfed Irish society in recent years. The paper concludes that Irish journalists are in the main more liberal in their views than either the professional organisations they work for or the audiences they serve.