Level Of Professional Autonomy Research Articles

Genetic counselors outside of the genetics clinic: Roles, practices, and ethico‐legal implications in light of lagging legal recognition across Canada

AbstractAdvances in medical genetics have led to a significant increase in demand for genetic services and expertise across almost all medical specialties. Genetic counselors (GCs) in Canada play key roles in genetic services both within and outside of the Genetics Clinic, while not being regulated or legally recognized as healthcare professionals (HCPs) in most provinces. Understanding whether GCs outside of the “traditional” Genetics Clinic influence patient care, their level of professional autonomy and supervisory structure is, therefore, important. In this study, we explore the current landscape of GC practice outside of the Genetics Clinic by describing positions, determining the professional scope of practice, as defined by the Canadian Association of Genetic Counselors (CAGC) and Canadian Board of Genetic Counseling (CBGC) core competencies, and by elucidating associated ethico‐legal implications. An online survey was developed and distributed to GCs working with patient‐related data in Canada in positions outside of the Genetics Clinic through the CAGC ListServ and accessed between March 5 and April 9, 2021. Thirty GCs were included in the study, with 16/30 in public healthcare system positions. Most respondents held roles with direct (11/30) and indirect (14/30) impact on patient care and management, and the majority reported performing their primary roles with minimal supervision (56%) or complete independence (36%). Most roles (22/25) elicited by respondents were considered to be within the GC scope of practice, except for administrative tasks and special projects. GCs were the only genetics‐trained professional(s) in 8/30 of respondents' workplaces. The results of the current study support the value of GCs translatable skillset in positions beyond the Genetics Clinic, and outline ethico‐legal implications for GCs, regulated HCPs, patients, and health institutions in the absence of legal recognition, including medical‐legal liability and title protection. This study provides evidence in support of regulation of GCs as HCPs.

The contribution of professional autonomy in advancing ethical behaviour: A narrative review of studies in nursing.

This article explores moral disagreements between nurses and physicians; specifically, we aim to analyse professional nurses' practice in navigating these conflicts. Nurses face morally challenging situations while caring for patients when their views on treatments and care may contradict those of physicians. It is important that nurses represent patients' perspectives and are partners in the care decision-making process. A narrative review was conducted by including peer-reviewed articles in English. A literature search was conducted using the Web of Science database and Google Scholar search engine from 1 December 2021 to 10 February 2022. A total of 27 articles published between 2009 and 2021 were included in the analysis. The following themes were explored in this article: areas in which moral disagreements occur and how these disagreements shape physician-nurse relationships, differences in the status of professional autonomy in nursing in the Baltic states and Nordic countries, and potential directions for nurses' involvement in the decision-making process regarding moral disagreements in nursing practice. Moral disagreements between nurses and physicians most often occur in situations related to treatment and/or care strategies as well as end-of-life decisions. Nurses' participation in the decision-making process and physicians' willingness to consider nurses' perspectives play a fundamental role in navigating moral conflicts because nurses possess a body of knowledge about their patients that differs from that of physicians. This knowledge is just as worthy as physician knowledge. Considering the level of professional autonomy in specific regions, nurses' involvement in decision-making regarding particular patients' care in the Baltic states seems to be relatively low compared to that in the Scandinavian countries, where nurses have a much wider space for independent decision-making. Complex moral situations that require the input of both physicians and nurses must be examined and addressed. Several processes may assist in fostering nurses' contributions to decision-making, among which training to effectively deal with morally complex situations and creating an atmosphere conducive to collaboration between physicians and nurses are particularly important.

Development of Self-Efficacy Tools for Parents and Professionals Caring for Children and Young People with Lymphedema (ILF Parent SE and ILF Professional SE).

Background: Self-management is a key aspect of lymphedema treatment and self-efficacy is a key factor linked to long-term adherence to treatment. The study aimed to generate self-efficacy scales to support the care of children and adolescents with lymphedema to support self-management. Methods and Results: Parents of children with lymphedema and the professionals caring for them were recruited during a lymphedema educational camp. Six individual semistructured focus groups were undertaken in Italian, French, and English (three for parents and three for professionals) with simultaneous translation. Scale item generation was developed using interpretative phenomenological analysis and adopted Bandura's self-efficacy concept. Two self-efficacy tools were developed from research with 26 parents and 14 professionals. The parental tool (ILF parent SE) has 6 domains and 44 items: school; home and leisure; understanding the condition and treatment, and managing child and parent emotions. The professional tool (ILF Professional SE) has 4 domains and 21 items. This scale has two parts; the first indicates the level of professional autonomy in decision making, and the second covers assessment and treatment, patient understanding, and managing emotional reactions. Both tools adopt a 0- to 100-point scale using a 10-unit interval with 0 (cannot do) through to 100 (high certainty of being able to do). Initial face validity has been undertaken. Conclusion: Self-efficacy has emerged as a complex issue faced by parents and professionals involved with children and young people with lymphedema. By being able to assess the challenges parents face in self-efficacy individualized programs can be developed that will assist families in managing this complex disease and lead to greater well-being. Increased professional self-awareness will help the development of mentorship programs to support professionals dealing daily with the stress of managing a rare disease in which the outcome may be uncertain.

Autonomy and the instrumental music teacher: negotiating culture in professional practice

ABSTRACTThis study provides valuable insights concerning the nature of professional practice in instrumental teachers working in a range of professional contexts in the UK. Using Bourdieu’s conceptual tools of habitus, field and capital, the analysis explores the way in which individuals negotiate the field of instrumental music education, revealing high levels of professional autonomy and specific understandings of the role of the contemporary professional musician. The findings demonstrate the extent to which musicians’ understandings and practices are culturally determined and perpetuated, highlighting the relationship between specific aspects of the field of instrumental teaching and learning and understandings of professional identity. The perception and experience of professional identity revealed in this study suggest a need to revise understandings of the role and identity of the professional musician in the context of contemporary portfolio careers in music. Using an explanatory sequential research design to combine data from a national survey of instrumental teachers with findings from eighteen individual case study interviews and one focus group, the research prioritises the lived experience of participants in generating understanding of professional lives and identities in this context.

Correlation of happiness and professional autonomy in Iranian nurses.

Happiness and professional autonomy in nurses increase job satisfaction, reduce turnover and improve the quality of healthcare services. The present study aimed to examine the correlation between happiness and professional autonomy in Iranian nurses. This descriptive-correlational study was conducted on 371 nurses in 2017. The participants were selected via two-step random sampling. Data were collected using the Oxford Happiness Inventory and Dempster Practice Behaviors Scale within the score ranges of 0-87 and 30-150, respectively. Data analysis was performed in SPSS version 16. Mean score of happiness among nurses was 43.1 ± 13.3 and the mean score of professional autonomy was 96.4 ± 13.5. According to Pearson's correlation coefficient, professional autonomy had a positive, significant correlation with happiness (r = 0.481; p < 0.001). In addition, the results of regression analysis indicated that professional autonomy could predict 23% of the happiness variance in the nurses (p < 0.001). According to the results, the level of happiness in Iranian nurses was favourable, whereas the level of professional autonomy was moderate. Considering the significant correlation between happiness and professional autonomy, attention should be paid to the simultaneous enhancement of these variables to improve the efficiency of nursing care.

Libertad de prensa y conflicto armado en Colombia: Un análisis desde la autonomía profesional percibida por los periodistas colombianos.

Este artículo describe la autonomía profesional percibida por los periodistas colombianos en el contexto del conflicto armado interno. Se trabajó con una muestra de 546 periodistas colombianos que diligenciaron el cuestionario de Autonomía Profesional creado por expertos del proyecto internacional «Worlds of Journalism Study» y complementado con temas relacionados con las víctimas del conflicto, la pobreza, el orden público, el medio ambiente, las minorías raciales, la corrupción, el crimen organizado y las guerrillas. La información fue recolectada entre 2013 y 2014, años en los cuales se desarrolló buena parte del proceso de paz entre el gobierno colombiano y las Fuerzas Armadas Revolucionarias de Colombia (FARC-EP). Los hallazgos permitieron establecer que la autonomía periodística en Colombia se ejerció en este periodo a partir de dos niveles: producción y publicación noticias, siendo este último nivel en donde los periodistas percibieron mayores restricciones en su autonomía, especialmente a la hora de informar sobre el gobierno, las fuerzas armadas, el crimen organizado, la corrupción y las élites políticas, económicas y religiosas.

Relationship between autonomy and moral distress in emergency nurses.

Reducing nurses' autonomy can impair their decision-making and ability for appropriate interventions. Lowered independence hinders ethical reasoning, which may lead to moral distress. This descriptive correlation study investigates the relationship between professional independence and moral distress in 173 nurses working in emergency departments in Tabriz, Iran. Data were collected using questionnaires designed to assess professional autonomy and moral distress and analysed using descriptive and inferential statistics via the SPSS 13 software. The level of professional autonomy among emergency nurses was low (83.2±16.9), and moral distress, moderate (7.43±3.52). A statistically significant negative relationship was reported between professional independence and the frequency of moral distress (p=0.018). Bivariate analysis related professional autonomy with the frequency and intensity of moral distress. Multiple regression analysis showed that age significantly predicted moral distress (frequency, intensity, and total scores). Lack of autonomy hinders nurses from functioning effectively and efficiently in practice and even can lead to moral distress. Increasing professional independence and the use of experienced nurses as mentors in emergency settings to support younger nurses can help with the reduction of moral distress.

Analyzing the professional practice context using three lenses: An essential step for responding strategically

In the face of increased external controls on their practice and increased accountability obligations, health professionals such as occupational therapists must be able to act strategically with other stakeholders to reach consensus about service quality and the accompanying level of professional autonomy. Such strategic action requires certain competencies, including that of analyzing the context in which one’s practice take place. In this article, we argue that the following three approaches, or lenses, should be used in this analysis: (1) accountability, (2) ethics, and (3) professional-as-worker. Individually, each lens offers a useful perspective, however, using all three permits a comprehensive and conceptually clear analysis. We present both the distinctive characteristics and complementary elements of the three lenses.

Educational needs for palliative care of Italian undergraduate students

This article was migrated. The article was not marked as recommended. Background. Since most of the clinical training is carried out within the academic departments, the future physicians may not feel prepared to deal with clinical situations typical of primary care.Aim of the study was to evaluate how students of the last year of course of the School of Medicine assess their level of professional autonomy with respect to different clinical situations of primary care. Methods. Anonymous questionnaire about ten primary care clinical cases. The students were required to self-assess the degree of preparation for an autonomous treatment for each clinical case on a scale of four levels. Results. In 124 questionnaires the percentage of students who claim to be able to manage the various clinical situations in full autonomy or with a limited specialist integration varies from 54% and 90% with the exception of the scenario "palliative care" (14%). Conclusions. Students, who are at the end of their course of study feel poorly adequate to deal with the settings of palliative care, a problem that has not been considered sufficiently during their training experience. Direct experience in various setting represents an essential component for an all-round training.

Öğretmenlerin Sahip Oldukları Mesleki Özerklik Düzeyine İlişkin Algıları

The aim of this study is to gain an understanding about teachers’ common perception of their level of professional autonomy and of its consequences. For this purpose, this qualitative phenomenological study consisted of ten participants who varied in terms of school type, teaching field and gender and served as teachers in the schools of Konya Provincial Directorate of National Education. Results shed light onto the participants’ common meaning about teacher autonomy and its consequences. In the eyes of participants, a teacher’s autonomy is a state of being free from interventions that limit their professional preferences in some dimensions of their area of expertise. Participants need this sort of professional autonomy in order to help their students reach the acquisitions defined by the ministry of national education. In this context, what participants consider necessary are as follows: (a) being able to use the learning materials of their choice, (b) being able to apply disciplinary sanctions of their choice, (c) being able to make their students repeat a course or a grade level when it is necessary. According to participants shared perception, teachers’ lack of sufficient professional autonomy produces two adverse outcomes: (a) teachers fail to be beneficial to their students as needed, and (b) the teaching profession loses its prestige.

From control to autonomy? Journalism awards and the changing journalistic profession in Taiwan

In most professional fields, award giving often symbolizes the establishment of professional standards by acknowledging and promoting exemplary practices. Theoretically, awards also serve as an important indicator of the level of professional autonomy in a specific field. In Taiwan, numerous journalism awards have been established over the last 50 years under the claim of enhancing news quality. Yet these awards do not necessarily signify a high level of journalistic autonomy in Taiwan; instead, they have become an implicit control mechanism through which the government operates to shape news production to further its political agenda. Previous studies on Taiwan's news media during the Martial Law era often focused on the restrictions imposed on the media, analyzing the oppressive methods employed by the government to undermine the freedom of the press. This study, however, examines how the government uses award giving to establish and exemplify its journalistic preferences and thus control news production. Specifically, this study reviews the history of the major journalism awards established in Taiwan since the 1950s with a focus on three aspects in each historical period: (1) the characteristics of the award organizers; (2) the objectives of establishing the awards; and (3) the genre of the winning works.

Policy, organisation and practice of specialist old age psychiatry in England.

To describe and compare service arrangements in old age psychiatry across England according to three broad domains: (i) levels of professional autonomy; (ii) degree of community orientation (delivery of and links with community services) and (iii) degree of integration between health and social care provision. Cross sectional survey of consultants in old age psychiatry in England. Potential respondents were sourced from the Royal College of Psychiatrists and Regional Advisers in Old Age Psychiatry. A self-administered postal questionnaire was piloted and refined. The questionnaire domains listed above reflect core policy issues for older people's services, covering the domains above. There is marked variation in the deployment and use of professional staff in old age psychiatry, ranging from open access to multidisciplinary assessment to services only accessible by clinician referral. Patterns of linkage with primary care are likewise variable with only half of services providing the types of support recommended by the Audit Commission (2000). Community orientation was evident to a considerable extent in support to care homes and assessment practices. Links between health and social care appeared strongest in terms of liaison and training. There was less evidence of more formal integration through shared management of staff or for links with intensive home support for those with dementia. The data provide a unique picture and benchmark of the configuration of old age psychiatry, a core element of mental health care in old age, after some 25 years of development in the UK. There appears to be substantial variation on all three domains of comparison.

Nurses' Perspectives on the Distinctive Aspects of Providing Nursing Care in a Congregational Setting

As the number of parish nurses grow, it is important to understand the unique attributes of providing nursing care in a congregation. Through a focus group and interviews, this qualitative research study¹ explored this question with 17 parish nurses participating in a hospital-sponsored, volunteer health ministry program. Content analysis revealed the nurses felt they had the greatest impact through health promotion and prevention, advocacy, health education, and health counseling, including psychosocial support and spiritual care. The nurses appreciated the unique opportunities afforded by the congregational setting including integrating faith and health in nursing practice, the more relaxed environment, the opportunity for long-term rela-tionships, and the level of professional autonomy. Challenges were experienced from the client's autonomy, the impact of religious beliefs, the nurse's worship experience, and time constraints. This study demonstrates that parish nurses can provide a valuable adjunct to the traditional care system as they practically and conceptually integrate faith and health.

Nurses' Perspectives on the Distinctive Aspects of Providing Nursing Care in a Congregational Setting

As the number of parish nurses grow, it is important to understand the unique attributes of providing nursing care in a congregation. Through a focus group and interviews, this qualitative research study¹ explored this question with 17 parish nurses participating in a hospital-sponsored, volunteer health ministry program. Content analysis revealed the nurses felt they had the greatest impact through health promotion and prevention, advocacy, health education, and health counseling, including psychosocial support and spiritual care. The nurses appreciated the unique opportunities afforded by the congregational setting including integrating faith and health in nursing practice, the more relaxed environment, the opportunity for long-term rela-tionships, and the level of professional autonomy. Challenges were experienced from the client's autonomy, the impact of religious beliefs, the nurse's worship experience, and time constraints. This study demonstrates that parish nurses can provide a valuable adjunct to the traditional care system as they practically and conceptually integrate faith and health.

Dealing with Dave's Dilemmas: Exploring the ethics of pedagogic practice

Dealing with ethical dilemmas is part of the real, everyday life of a university lecturer. However, the literature on ethics in higher education largely focuses on the broad social agenda, academic freedom and issues connected with research. Using an auto-ethnographic case study about a 'day in the life' of a new university lecturer as a basis for discussion, the paper reports the reactions of two focus groups, representing newly appointed and more experienced academic staff, respectively. Applying Forsyth's taxonomy of ethical ideology, it is suggested that there are marked differences in approach between staff in dealing with ethical dilemmas. Experienced staff, accustomed to higher levels of professional autonomy, were more inclined to argue for a 'situationist' position, while inexperienced staff, inculcated into a more rule-bound culture, tended to adopt an 'absolutist' or 'exceptionist' stance.

Characteristics of physicians with participatory decision-making styles.

To identify physician and practice characteristics associated with a physician's propensity to involve patients in diagnostic and treatment decisions, or participatory decision-making style. A representative cross-sectional sample of patients participating in the Medical Outcomes Study characterized each physician's style by using a self-reported questionnaire. A single averaged style score was generated for each physician. Style scores were compared among physicians who differed in age, sex, minority status, specialty, primary care training or training in interviewing skills, satisfaction with professional autonomy, and practice volume. Solo practices, multispecialty groups, and health maintenance organizations in Boston, Chicago, and Los Angeles. 7730 patients sampled over 9 days from the practices of 300 physicians. Physicians were practicing general internal medicine, family medicine, cardiology, and endocrinology. Participatory decision-making style was measured using a three-item scale on a questionnaire that was completed by patients after their office visit. Physician and practice characteristics were reported by physicians on self-administered questionnaires. Among patients of physicians who were rated in the lowest (least participatory) quartile, one third changed physicians in the following year; among patients of physicians who were rated in the highest quartile, only 15% changed physicians. Higher scores were associated with greater patient satisfaction. Physicians who had had primary care training or training in interviewing skills scored higher than those without such training. Physicians in higher-volume practices were rated as less participatory than those in lower-volume practices. Physicians who were satisfied with their level of professional autonomy were rates as more participatory than those who were dissatisfied. Participatory decision-making style is influenced by physicians' background, training, practice volume, and professional autonomy. Because participatory decision-making style is related to patient satisfaction and loyalty to the physician, cost-containment strategies that reduce time with patients and decrease physician autonomy may result in suboptimal patient outcomes.

Teacher Education for Further Education Staff in Northern Ireland: evaluating a competence‐based approach

ABSTRACT The author explains how the mandatory requirement in Northern Ireland for teacher education for lecturers in further education colleges was met by a competence‐based programme devised at the University of Ulster. There is an evaluation of the programme which has been in operation for three years and a presentation of the model of competence which has been introduced to meet the needs of lecturers in the revised programme. The new model seeks to provide opportunities to develop necessary teaching skills while enabling lecturers to progress towards the level of professional autonomy required in the contemporary context of delayered organisations where the ability to manage culture and reconstruct institutional climate are essential attributes for a successful lecturer.