Autonomous Practice Research Articles

Job satisfaction in nursing: A qualitative inquiry into novice and experienced nurses' perspectives

AimTo explore factors associated with job satisfaction between novice and experienced nurses. BackgroundJob satisfaction is crucial for better quality of patient care and nurses’ job engagement in clinical setting. However, job dissatisfaction is commonly reported from clinical nurses leading to poorer patient outcomes and high turnover rate. Job satisfaction at different professional stages may have different expectations. Knowledge about factors influencing job satisfaction of junior and senior nurses is inadequate. DesignA phenomenological study was conducted using face-to-face individual interviews. MethodSemi-structured interviews were conducted and audio-recorded. The Herzberg’s Two-Factor Theory was used to understand the phenomena. Purposeful sampling was used to select eligible nurse participants who were working in hospital settings. ResultsEight participants, consisting of four junior and four senior nurses, with clinical experience ranging from 1 to more than 25 years, were selected in this study. Four main themes related to job satisfaction were identified: "supportive working environment," "autonomy in practice," "professional training for competence enhancement," and "heavy workload and insufficient manpower." These themes highlighted the common aspects that contribute to job satisfaction among nurses according to the Herzberg’s Two-Factor Theory. ConclusionThe findings of this study contribute to our understanding of the factors that influence job satisfaction among both novice and experienced nurses. While four themes highlighting common aspects of their needs have been identified, it is important to acknowledge that novice and experienced nurses may have their own unique perspectives within these aspects. According to Herzberg's Two-Factor Theory, job satisfaction factors can be complex and diverse. To enhance job satisfaction among nurses, hospital policymakers and senior management should be attentive to identify factors that have an impact on job satisfaction of nurses at different stages of their clinical experience. Developing a strategic plan to meet the needs of nurses based on their experience levels should take into consideration the disparities in work environment and responsibilities, ultimately job satisfaction can be improved, leading to better overall patient care.

Exploring the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting: An in-depth qualitative investigation

BackgroundUtilizing the nursing process within clinical settings serves to enhance the scientific stature of the nursing field. Nonetheless, various research findings suggest that nursing internship students encounter difficulties when it comes to implementing the nursing process and may lack the necessary proficiency. ObjectivesThe aim of this investigation is to identify the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting. DesignA qualitative content analysis. ParticipantsNursing internship students and their faculty mentors from the Isfahan School of Nursing and Midwifery. MethodsIn this study, individual interviews were conducted with 13 participants. The data for this study were gathered through these semi-structured interviews and subsequently analyzed using the Granheim and Lundman method. To ensure the validity and reliability of the data, the evaluative criteria of Lincoln and Guba were employed. ResultsThe obstacles unveiled in this study can be categorized into three primary domains, each with its own subcategories: 1-Student role ambiguity (1-1 Lack of practical autonomy; 1–2 Insufficient proficiency in the nursing process; 1–3 Motivational deficiency). 2- Organizational Challenges (2-1 Shortage of nursing staff; 2-2 Suboptimal interpersonal dynamics); And 3- Gradual Erosion of the Nursing Process. ConclusionRecognizing the paramount importance of the nursing process in enhancing patient care quality is universally accepted. Therefore, it is imperative to systematically identify and tackle the challenges associated with its application. This study highlights that these challenges stem from various factors, including the multifaceted roles assumed by nursing students, organizational shortcomings within healthcare institutions, and the neglect or erosion of the nursing process in specific clinical settings. Addressing these issues is crucial for ensuring the effective utilization of the nursing process within the nursing profession and for optimizing patient care outcomes.

Exploring Embedded Contextual Factors and Their Contribution to Facilitating Autonomous Learning

This study delves into the influence of contextual factors on learner autonomy, highlighting that autonomous learning can be manifested differently due to contextual factors. This study engaged in exploring the learners’ attitudes and learning practices to understand whether contextual factors facilitate learner autonomy in the university context. This study examined contextual factors, e.g., peer interaction, teachers’ role, the curricular context, and prior learning experience, with a view to accomplishing its mission. Data was collected from 20 English language learners using semi-structured interviews, and thematic analysis was employed to analyze the data sets. The findings reveal that peer interaction facilitates autonomous learning through cooperation. Teachers’ authoritarian roles seem to impede the development of learner autonomy. The curricular context tends to be obstructive since it prioritizes rote learning and delimits opportunities for autonomous practices. Participants’ prior experiences of teacher-dependent and rote learning appear to impede their current autonomous learning. The findings of this study implicate that school curricula should create ample opportunities from the early levels of education to maximize learning potential through autonomous learning.

Designing for student autonomy combining theory and clinical practice – a qualitative study with a faculty perspective

BackgroundAlthough extensive research exists about students’ clinical learning, there is a lack of translation and integration of this knowledge into clinical educational practice. As a result, improvements may not be implemented and thus contribute to students’ learning. The present study aimed to explore the nature of clinical faculty members’ learning related to how they apply research about student autonomy.MethodsA course, “Designing learning for students’ development of autonomy in clinical practice” was conducted for faculty responsible for students’ clinical education. Within the frame of the course the participants designed a project and planned how they would implement it in their clinical context. Fourteen clinical faculty members participated in the study. The participants’ interpretation of the educational intervention, which combines complex theory with the equally complex clinical practice, was explored by studying how the participants’ approaches and understanding of the facilitation of autonomy were manifested in their projects. The projects in the form of reports and oral presentations were analyzed using qualitative content analysis together with an abductive approach.FindingsOne identified domain was “Characteristics of the design and content of the projects”. This domain was signified by two themes with different foci: Preparing the soil for facilitating student autonomy; and Cultivating opportunities for students to actively strive for autonomy. A second identified domain, “Embracing the meaning of facilitating autonomy” was connected to participants understanding of theories underlying how to support the development of autonomy. This domain contained two themes: Connection between activities and autonomy is self-evident and Certain factors can explain and facilitate development of autonomy.ConclusionEducation directed to strategic clinical faculty members to develop evidence-based approaches to student learning can be productive. To succeed there is a need to emphasize faculty members individual understanding of actual research as well as learning theories in general. Faculty trying to reinforce changes are dependent on their own mandate, the structure in the clinic, and recognition of their work in the clinical context. To achieve a potential continuity and sustainability of implemented changes the implementation processes must be anchored throughout the actual organization.

"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

Exploring the impact of time allocation on students’ writing performance: A quantitative study

Many educational institutions have been conducting writing assessments to measure students’ ability in writing, yet little is known about whether time restriction and learning strategies are contributing factors to students’ performance. In Indonesian educational institutions, writing assessments serve as a means to measure students’ proficiency in articulating thoughts in the target language, providing teachers with insights into their linguistic ability. The objective of this study is to determine whether allocating extra time for timed academic essays will substantially enhance the quality of students' writing. Additionally, this study seeks to uncover the correlation between students' L2 learning strategies and their writing performance. This study used a quantitative design. The main instruments were questionnaires and writing tests collected at two parallel classes of a private university in Indonesia, comprising of 50 students in total as the study participants. The quantitative methods used independent t-tests and Spearman’s rho correlation to analyze the data. The result showed that time limit had a significant effect on writing performance (t(34.6)= 3.185, p= .003). Another result indicated minimal to no correlation between writing scores and autonomous learning practices. In conclusion, this study offers valuable and practical implications in the writing assessment industry that there should be a re-evaluation in the administration of writing assessment in educational institutions in Indonesia that truly reflects students’ writing ability.

Learner Autonomy Transfer: The Need for Explicit Teacher Training

Autonomous learning in EFL refers to learner involvement, reflection and target language use. Teachers play a vital role of mediators and facilitators in self-regulated method. Thus, their perception of self-regulated practices dictates their implementation of this approach. While research has predominantly focused on inadequate management of autonomous learning in school mostly due to lack of appropriate teacher training, this study examined whether novice teachers who were exposed to extensive autonomous practices were likely to implement this method in their teaching. Twelve novice teachers were interviewed to examine their perception of learner autonomy and their management of this method. It was found that three-thirds of the respondents experienced a gap between familiarity with autonomous learning and a favorable attitude to this approach and their deficient integration of self-regulated learning. Although learner-related and institution-oriented factors played a role in this gap, it was mostly caused by the respondents’ not being genuinely autonomous. This may be due to indirect exposure rather than explicit introduction of the learner autonomy approach. The insights of this research may assist curriculum designers and heads of teacher training programs to rethink course composition to guarantee the transfer of methodologies into EFL classes.

The influence of educational reform on the self-perceived readiness to practice of newly registered pharmacists in Ireland

Abstract Introduction Newly registered pharmacists serve important roles in our healthcare system. Investigation of their readiness to practice confirms whether their education has furnished them with the knowledge, skills and competencies to be practice-ready. In 2015, a five-year integrated master’s programme in Pharmacy replaced a 4 + 1 model and included integrated learning with dispersed experiential learning placements. Factors known to influence self-perceived readiness to practice are prior experiential learning, education, placement environment and preceptor relationship. Aim This study examined the self-perceived readiness to practice of newly registered pharmacists in their first year of qualification and the influence of educational reform. Methods The participants were newly registered pharmacists who had completed the undergraduate Pharmacy programme within the State. Participants were identified using the Pharmaceutical Society of Ireland’s database of newly qualified registrants. An email was circulated to registrants inviting them to participate in a cross-sectional online survey consisting of 25 items. Variables were self-perceived abilities to perform practice-related competencies (on a five-point Likert scale), relationship with preceptor, placement experience, and demographic information. Three cohorts were surveyed. The first cohort (2020) were graduates from the last year of the 4 + 1 programme. The second (2021) and third (2022) cohorts were graduates from the new five-year integrated programme. All analyses were performed using SPSS 24.0 (SPSS Inc, Chicago, IL, USA) and Microsoft Excel. Results Of 458 registrants, 71 completed the survey (response rate=15%). A greater proportion of females (65%, n=46) than males (31%, n=22) responded to this survey, with 4% (n=3) not disclosing a gender. Most respondents (83%, n=59) had undertaken a community pharmacy placement, while others had either a hospital placement (11%, n=8) or a mixed setting placement (5%, n=4). Participants perceived that they were adept at performing practice-related competencies. Participants agreed that they developed fruitful relationships with preceptors and had positive experiences on placement; when asked about preceptor feedback, there was a positive response: 55% for (n=17), 83% for 2021 (n=15), and 95% for 2022 (n=21). A curriculum effect was observed, as graduates from the post-reform cohort declared readiness to practice in more areas than pre-reform graduates, e.g. in leadership: (58% for 2020 [n=18], 61% for 2021 [n=11], and 73% for 2022 [n=16]), communication (58% for 2020 [n=27], 61% for 2021 [n=16], and 73% for 2022 [n=21]), and recommending drug therapies (77% for 2020 [n=24], 72% for 2021 [n=13], and 95% for 2022 [n=21]). Conclusion This study found that most respondents self-perceived themselves as ready for autonomous practice. Whilst this study found that the pharmacists surveyed were ready to practice, they may still lack practical skills. This study suggests adopting an integrated curriculum that incorporates experiential learning is supportive of readiness to practice and has a positive impact on self-perceived readiness to practice, placement setting, and preceptor relationships. The repeated cross-sectional nature of the study is a strength, but a limitation is the low response rate and there may be response bias by participants. This research seeks to contribute to curriculum development to support students in their transition to professional practice.

Variability in Surgical Case Volume Performed During ACGME-Accredited Orthopaedic Foot and Ankle Fellowship Training.

Previous studies have demonstrated a positive correlation between case volume and outcomes in foot and ankle surgery. This study elucidates surgical case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic foot and ankle fellowship training in the United States. The ACGME provided case logs for orthopaedic residents and foot and ankle fellows (2018-2021). Variabilities in reported fellowship case volumes were defined as the fold-difference between 90th and 10th percentiles. Reported case volumes were compared between training cohorts with parametric tests. Case logs from 65 orthopaedic foot and ankle fellows and 3146 orthopaedic residents were included. Fellows reported 1.3- to 1.5-fold more foot and ankle cases during fellowship training than during residency training (P < .001). On average, orthopaedic foot and ankle fellows reported 405.4 cases and most were arthrodesis (17%), forefoot reconstruction (17%), mid/hindfoot reconstruction (13%), tendon repair/transfer (12%), and trauma ankle hindfoot (11%). Case categories with the highest variabilities were amputation (14.8-fold difference), infection/tumor (11.6-fold difference), arthroscopy (9.2-fold difference), and calcaneus (8.7-fold difference). Case volume benchmarks can assist trainees and faculty during orthopaedic foot and ankle training. More research is needed to determine case minimum requirements needed for autonomous practice in foot and ankle surgery. Level III.

The salience of genomic information to reproductive autonomy: Australian healthcare professionals’ views on a changing prenatal testing landscape

Genomic testing in prenatal care is rapidly advancing and it is now possible to obtain an entire fetal genome via a blood test administered in early pregnancy. In the pursuit of reproductive autonomy, more tests are being offered to more people, for an ever-increasing range of indications. Health professionals who provide pregnancy care are at the vanguard of prenatal testing, yet their views on the impact of technology advancements remain under-explored. Qualitative interviews with Australian healthcare professionals revealed that they value prenatal testing for its information-giving potential. However, the rationale underpinning testing reveals a tension between professionals’ desire for certainty and patients’ expectation that they will be reassured. Coupled with the greater salience of genomic information over other forms of knowledge in prenatal care, we suggest that the unchecked pursuit of information by way of genomic technologies in prenatal testing may paradoxically constrain reproductive autonomy in practice.

Advanced Practice Nurses and Their Roles in Swiss Cancer Care: A Cross-Sectional Study

ObjectivesTo examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system. MethodsA cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses. ResultsThe participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching). ConclusionsThis study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified. Implications for Nursing PracticeMore systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care.

Formal leadership perceptions about the autonomy of Pharmacy: a SWOT analysis

Introduction: Autonomy is considered a vital principle of professionalism. In recent years, despite important advances, the Pharmacy and pharmacists' autonomy has been questioned due to conflicts that jeopardize the consolidation of this profession in the division of work in health. Objective: to understand the construct of autonomy based on perceptions of formal leaders associated with professional organizations. Methods: A qualitative study was conducted through interviews with key informants. The data obtained were submitted to content analysis. Results: Perceptions about the autonomy in pharmaceutical practice were categorized according to strengths, weaknesses, opportunities, and threats to this construct. Conclusion: The findings allowed us to understand the autonomy of pharmaceutical practice in Brazil, generate hypotheses about the future of Pharmacy, and build strategies to maintain its occupational status.

Efecto del proyecto ECHO en la desmonopolización de la atención médica

Efecto del proyecto ECHO en la desmonopolización de la atención médica

Development of entrustable professional activities for family medicine in South Africa.

South Africa is undergoing a significant shift towards implementing enhanced workplace-based assessment methodologies across various specialist training programmes, including family medicine. This paradigm involves the evaluation of Entrustable Professional Activities (EPAs) through comprehensive portfolios of evidence, which a local and national clinical competency committee then assesses. The initial phase of this transformative journey entails the meticulous development of EPAs rooted in discrete units of work. Each EPA delineates the registrar's level of entrustment for autonomous practice, along with the specific supervision requirements. This concise report details the collaborative effort within the discipline of family medicine in South Africa, culminating in the consensus formation of 22 meticulously crafted EPAs for postgraduate family medicine training. The article intricately outlines the systematic structuring and rationale behind the EPAs, elucidating the iterative process employed in their development. Notably, this marks a groundbreaking milestone as the first comprehensive documentation of EPAs nationally for family medicine training in Africa.

The effects of dental hygienist autonomy on dental care utilization.

We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use with the 2001-2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001-2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework applied to selected states, we find that relaxing supervision requirements to provide dental hygienists moderate autonomy results in an increase in total dental visits due to greater use of preventive dental care. However, the use of dental treatment decreases when states adopt the highest level of autonomy. Both sets of estimates increase in magnitude when we subset the sample to dental care provider shortage areas. In support of these findings, we show that dental visits shift to dental hygienists in shortage areas when states expand the scope of practice of hygienists, and that there is an increase in tasks performed by hygienists, such as cleanings and dental exams.

Understanding rural pharmacists' perspectives: lived experiences and insights associated with rural recruitment and retention.

Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities. The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention. The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns. The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities also require innovative approaches to address concerns among potential candidates. Lastly, efforts to enable and support social connections such as schooling and spousal employment, while building community connection and a sense of rural community belonging, remain essential to recruit and retain pharmacists. Rural pharmacist recruitment and retention is complex, requiring a multi-pronged approach to implement practical solutions. Given this complexity and the unique features of each rural community, solutions require whole-of-community ownership to create innovative solutions. Recognition of specific advantages and challenges can address key driving factors for pharmacist recruitment and retention in rural communities.

Do employees and firms benefit from autonomous work practice? Curvilinear effects on collective turnover and productivity of firms

The present study focuses on the opportunity dimension of the ability–motivation–opportunity framework and explores the implications of autonomous work practice (AWP) for the collective turnover and productivity of firms. Given the trade-offs between the costs and benefits of AWP and its potential double-edged sword effects, we adopt the interdisciplinary perspective on job design (i.e. mechanistic and motivational models) as basis to theorize the curvilinear effects of AWP. We further hypothesize the interaction between AWP and work flexibility, consistent with the internal fit perspective of strategic human resource management. The current framework is validated by analyzing multisource, time-lagged data collected from 1,240 firms over a two-year period. The analysis confirms the hypothesized curvilinear effects of AWP, in which collective turnover is low only when the level of AWP is moderate. The detriment of a high level of AWP on increasing collective turnover is amplified for firms with low work flexibility. By contrast, firm productivity is high when the AWP level is either low or high, and the benefit of a high level of AWP on increasing productivity is pronounced for firms with high work flexibility.

Die Literaturautonomie im deutschen Rechtssystem. Grenzen, Widersprüche und literaturtheoretische Potenziale

Abstract So far, the question regarding literature’s autonomy has predominantly been discussed from a poetological and historical perspective, with legal manifestations and possibilities of aesthetic autonomy usually being neglected by literary theory. However, in no other area than in (German) jurisprudence it becomes more evident that the concept of an autonomous literary practice, or more precisely the attempt to guarantee it legally, is highly challenging and therefore comes with restrictions. On the one hand, literary practice is legally regarded as a free and autonomous social subsystem. On the other hand, it can easily lead to violations of fundamental rights, meaning that the freedom of art cannot be considered unrestricted and autonomous on a closer look. In the following, the legal challenges of guaranteeing an unregulated literary practice will be discussed based on two fundamental legal rights, namely the freedom of art and copyright laws. The discussion proves to be significant for literary studies as well, as the legal tensions that are connected to the concept of literary autonomy have an influence on the practice of literature and thus also affect its theoretical reflection in literary studies and criticism. Because autonomy can mean several things, it is necessary to define the term ›autonomy‹ as used in this article first. After clarifying the concept of autonomy for the literary context, the focus lies on the legal discourse: The legal regulations in Germany regarding freedom of art and copyrights are first presented individually. Following this, the respective difficulties in guaranteeing the aforementioned legal rights are explained. A closer look will reveal that collisions are unavoidable, and that freedom of art and copyright laws sometimes even happen to be mutually exclusive. The challenges of literature’s autonomy in legal terms becomes particularly apparent by presenting the following two potential conflicts: The first conflict concerns collisions between freedom of art and a legal right of constitutionally similarly high rank, such as personal rights. The second potential conflict demonstrates why the freedom of art can hardly ever be reconciled with copyright provisions. The first case illustrates that the freedom of literary practice sometimes collides with other legal interests and can therefore be restricted, while the second one proves that a self-contradiction within the legal system exists when it comes to the notion of unrestricted autonomy. The first conflict is discussed by revisiting the decision of the German Federal Constitutional Court regarding Maxim Biller’s novel Esra in 2007. The decision, albeit highly controversial, helps to understand why legal barriers are sometimes imposed on works of literature. Additionally, the Esra case shows the legal difficulties of enforcing a ban on novels without fundamentally calling into question the freedom of art. This is also demonstrated by the votes of the dissenting judges at the Federal Constitutional Court which further illustrate the irresolvable challenge between guaranteeing not to impose any legal restrictions on the practice of art, but sometimes doing so whenever the freedom of art collides with personal rights. As a second example, the potential conflict that can arise when using the technique of literary collage or any other that involves adopting elements of existing literary or non-literary texts is discussed. Such a case is even more likely to result in a legal dilemma as there generally is a tension between freedom of art and copyright laws: although copyright laws can be subsumed under freedom of art and even serve as supportive of it, insofar as they aim at protecting the author as the intellectual owner of a work, they are not always beneficial to the freedom of art. This is best exemplified by the aesthetic technique of literary collage, for which the implementation of elements from other texts and media is characteristic and thus might easily conflict with copyright provisions. The example of literary collage demonstrates that without legal regulations some aesthetic practices might run the risk of infringing the respective copyrights as soon as an existing work of art is utilized partially for a new one. This article concludes that the notion of literary autonomy shows to be self-contradictory when discussed from a legal perspective. This observation is not irrelevant for literary theory, insofar as literary autonomy, understood as an unregulated literary practice, thwarts its promise of freedom. As this article argues, the idea of literary autonomy therefore needs revision in literary studies, not least because of its challenging legal dimension.

Practices and Perceptions of Teacher Educators on Learner Autonomy

This study explores practices and perception of English language teacher educator on learner autonomy. It aimed to identify the ways through which teacher educators practice autonomy in students learning and encourage them be autonomous. Using qualitative narrative inquiry research design, the data were collected through interviews with the five English language teacher educators teaching at undergraduate level, of Far Western University, Nepal. The findings of the study highlight a shared understanding of learner autonomy, emphasizing independent learning, self-direction, and responsibility. Teacher educators stress the pivotal role of instructors in promoting autonomy, advocating for a shift from traditional to student-centered methods. Despite a common understanding, challenges persist, including psychological factors, institutional constraints, and socio-cultural beliefs. The study also suggests the need to address these challenges through targeted strategies for successful promotion of learner autonomy in English language classrooms. Moreover, the study shows that even though it is challenging, teacher educators are making efforts to encourage students be autonomous in providing choices, goal-setting, encouraging self-evaluation, finding out the resources, preparing assignments, having class presentations into classroom practice using different strategies.

Collaborative drug therapy modification (CDTM): Facilitators, barriers, and perceptions of individual pharmacist participation in Georgia

BackgroundGeorgia Board of Pharmacy (BOP) regulations permit pharmacists to engage in collaborative drug therapy modification (CDTM) with physicians, allowing them to perform patient assessments, adjust pharmacotherapy, and order laboratory tests. Pharmacist-led CDTM can positively affect health outcomes leading to reduced healthcare expenditures. CDTM is underutilized, with < 1% of Georgia pharmacists holding an active license to practice CDTM. Objective(s)The objective of this study was to examine CDTM licensed pharmacists’ perceptions of facilitators and barriers in providing CDTM. MethodsGeorgia-licensed CDTM pharmacists were invited to participate in a 60-minute qualitative interview. Interview questions were developed from electronic survey responses. The interview was designed to elicit information regarding perceived benefits and barriers to CDTM implementation. Guided by the Consolidated Framework for Implementation Research, thematic analysis was applied to identify themes using ATLAS.ti software to code. Themes were described qualitatively and prevalence of each was reported. ResultsNine interviews were conducted, and data saturation was achieved at interview 6. After resolution of discrepancies, 100% coding agreement was reached among 2 independent researchers. Nine themes were identified, and each was categorized as a facilitator or barrier to establishing pharmacist-led CDTM in Georgia. Themes associated with facilitating were (prevalence %) (1) practice autonomy (100), (2) personal attributes (100), (3) having support (100), and (4) institutional logistics (88). Barrier themes included issues concerning (5) the Georgia BOP (100), (6) pharmacist autonomy (88), (7) lack of provider status (88), (8) institutional restrictions (75), and (9) personal development (e.g., confidence) (22). ConclusionFacilitators to the establishment of pharmacist-led CDTM exist and pharmacists can capitalize on these to create successful CDTM programs. Barriers are varied, and it may be difficult to systematically address individual barriers such as pharmacist autonomy and personal development. Barriers associated with institutional restrictions, the Georgia BOP, and lack of provider status can likely be removed or addressed by policy.