Professional Autonomy Research Articles

Clinical decision support system to optimise symptom management in palliative medicine: focus group study

ObjectivesSuboptimal symptom control in patients with life-limiting illnesses is a major issue. A clinical decision support system (CDSS) that combines a patient-reported symptom assessment scale (SAS) and guideline-based individualised recommendations...

Faculty wellness in academic medicine: Addressing stressors in the workplace.

Burnout is widely regarded as a syndrome resulting from chronic occupational stress. While physician burnout has been the subject of extensive research, physician wellness has been proposed as an alternative framework for understanding physician distress. The purpose of this qualitative study was to understand the organizational context of faculty wellness within an academic health care system. Semi-structured interviews were conducted with 24 chairs of clinical and non-clinical departments in a US university school of medicine. Chairs described several system-level factors perceived to interfere with faculty wellness such as a stricter regulatory environment, the loss of professional autonomy, the up or out promotion system, limitless hours, and the rise of shadow work. While all chairs articulated some degree of responsibility for the wellness of their faculty, some said they lacked the skills or knowledge of resources to fully engage in this role. Findings from this study are consistent with recent research on physician burnout, which has pivoted from describing burnout as an individual responsibility to including the professional, organizational, and societal factors which likely contribute to physician job satisfaction and well-being. As health care organizations, including academic medical centers, move toward systems-based solutions for physician occupational health, it will be incumbent upon organizational leaders to make administrative decisions favoring physician wellness.

Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review

BackgroundDemand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AimThis review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. MethodsA comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FindingsTwenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. ConclusionInsights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.

Validating a model for indicating the professionalisation of social work in China

Summary The social work profession has developed at an unprecedented rate in the past decade in China. This article addresses the much-debated question of whether the international standards of social work can be applied in the Chinese context. Employing Weiss-Gal and Welbourne’s conceptual framework of the professionalisation of social work, this study aimed to identify validated indicators to define social work professionalisation in China. A questionnaire with 11 indicators was designed, and responses were received from 748 social workers in Guangzhou. Formative measurement was adopted as an analytic strategy. Findings Five of the 11 indicators were validated: perception of public recognition, perceived adequacy of the knowledge base, involvement in professional organisations, congruence with ethical standards, and perception of professional autonomy. Contrarily, six indicators had no significant impact on social work professionalisation in China: public recognition in terms of qualification levels, professional education, satisfaction with professional organisations, monopoly (self-perception and entrance criteria) and prestige and remuneration. Applications This study extends the application of Weiss-Gal and Welbourne’s conceptual framework to China. Utilisation of this framework suggests that social work professionalisation in China may diverge from international standards in social work, while the professionalisation measures for social work implemented by the Chinese governments may be ineffective. In particular, this study highlights the continuing challenges for the development of social work in China and provides evidence of the need to strengthen the professional power of Chinese social work.

Standardization and Professional Knowledge in Integration Work

Since the 1970s, the government in Sweden has developed many activities aimed at facilitating immigrants' integration processes and their sense of belonging; one such activity that emerged in the 2010s is civic orientation. This activity is characterized by a high degree of standardization of both processes and content. The intention is for local activities and participants to adjust to general levels and standards. But even though standards can be seen as a solution for a set of problems, one must consider that standards do not perform any tasks by themselves; their functions depend on organizational routines, resources available, and staff members' use of the standards. Therefore, one must consider how integration workers handle standards and how they bridge standards of routines and procedures with participants, immigrants, responses, and needs. The interest in this study concerns how such a dilemma intervenes at the local level and what it means for professional knowledge and autonomy. This study takes place at an integration unit in Sweden where integration workers meet in workshops to interpret standards and find ways to adapt them to local needs. The results show how cultural and pedagogical awareness form the basis for professional knowledge and how this also creates a space for action but also how standards form a structure through which expectations and demands are understood and form arguments and interaction patterns.

Transcultural Impact of Learning to Teach Sport Education on Preservice Teachers’ Perceived Teaching Competence, Autonomy, and Academic Motivation

Purpose: To compare the impact of the experience of learning to teach sport education on preservice teachers’ (from Spain, Chile, and Mexico) perceived professional competence, autonomy, and academic motivation and to explore participants’ perceptions of their country’s sociocultural and curricular aspects that may influence sport education implementation. Method: Framed by the “pedagogy of dialogue” and a “living the curriculum” approach, three consecutive miniseasons on alternative invasion games were enacted (n = 30 lessons). A quasi-experimental pre- and posttest mixed-methods design was followed, with a total of 163 preservice teachers. The quantitative data on preservice teachers’ teaching competence, autonomy, and academic motivation were collected through three validated questionnaires. Focus group interviews and field notes were used to gather qualitative information. Results: The main quantitative analysis exposed no relevant differences among the transcultural sample of preservice teachers related to the analyzed variables. Qualitative analysis showed the power of contextual factors to filter preservice teachers’ understanding of the model. Conclusions: The dialogical nature of the approach and the miniseason structure allowed the preservice teachers to achieve a better understanding of the pedagogy of sport education and to optimize their motivation to use it in the future. The rigidity of the national curriculum and the custodial nature of school reality, however, present strong barriers to this end.

Challenges of Collective Inertia and Scarcity to Technological and Vocational Education Universities

The massification of higher education institutions in Taiwan, typically in universities of science and technology, creates competition for resources and currently threatens foreclosures in Taiwan’s higher education system. To answer this challenge amid global competition among universities, the Ministry of Education (MOE) implemented the World-Class Research University Project, creating the initiative for higher education institutions to quickly gain world-class status with the reasonable belief that strong global visibility would attract much needed international resources to supplement local ones. However, the race for global reputation has created highly stressful environments for faculty members to publish research papers in highly regarded international journals. In highlighting fundamental paradoxes of the system and the rationale behind them, this paper attempts to stimulate a much-needed reflection that might pave the way for rational and empirical efforts to transform higher education in Taiwan. This paper also reveals that the emphasis on speed-up achievement has overwhelmed the original academic missions of higher education and placed academics in a scarcity mindset with quantity drowning essence. The primary mechanism for keeping the current system is the collective inertia that limits academics from breaking out of the mould of habitual approaches. This paper discusses all sorts of findings, reported events, theoretical ideas, and inherent contradictions in relation to Taiwan universities in an attempt to frame the essential background on the problems in terms of scarcity mindset and inertial thinking. Finally, the paper provides some suggested solutions. The reflection in this paper may inspire faculty members in higher technological and vocational education programs to lead school administration and industry development with practical and updated knowledge. It is crucial to revitalising faculty members’ educational enthusiasm through building professional autonomy and self-efficacy.

Barriers of Professional Autonomy among Arab-Speaking Countries during Covid-19 Pandemic

Objectives: The aims of the study are to determine barriers of nursing autonomy among Arab-Speaking countries during Covid-19 pandemic and to determine difference in professional autonomy levels among Arab-Speaking countries and work place. Methods: Data collected from December 12 2020 to March 15 2021 by Google form survey. Cross-sectional design was used in the present study .A purposive sample of 708 nurses who had met the study's inclusion criteria were targeted. Data were analyzed through the use of IBM-Statistical Package for Social Sciences (SPSS) version 17, in which descriptive and inferential statistical measures were employed. Results: The results of the study showed no deference in professional autonomy among Arab speaking countries P =0.826 and work place (P=0.826). Most common barriers of professional autonomy are absence of law protecting professional duties(35.6%) which was perceived by of the study subjects, followed by the policy of health (30.4%),followed by hospital administration style (26.4%) and domination or physicians authority (29.9%). Conclusion: Most common barriers of professional autonomy are absence of law protecting professional duties, the policy of health care sector, domination of physician’s authority and hospital administration style. This result reflects highlights the importance of removing all obstacles to upgrade nurse’s professional autonomy in the covered Arab-speaking counties.

A qualitative meta-synthesis on how autonomy promotes vaccine rejection or delay among health care providers.

In spite of the overwhelming evidence that highlights the effectiveness of routine vaccination, an increasing number of people are refusing to follow recommended vaccination schedules. While the majority of research in this area has focussed on vaccine hesitancy in parents, there is little research on the factors that promote vaccine hesitancy in health care providers (HCPs). Identifying factors that promote vaccine hesitancy in HCPs is essential because it may help broaden our understanding of vaccine hesitancy in patients. Therefore, the goal of this investigation was to review 21 studies and examine how professional autonomy and risk perception may promote vaccine acceptance, rejection and delay in physicians and nurses. We found that vaccine hesitant nurses and physicians shared similar views towards vaccines; both groups believed that their decision to vaccinate was separate from their role as an HCP. This belief comprised of three themes: decisional autonomy, personal risk perception and alternatives to vaccination. Both groups believed that mandatory vaccine policies reduced their ability to decide whether vaccination was in their best interests. We argue that decisional autonomy may weaken risk perception of disease, which in turn may encourage beliefs and behaviours that reinforce a 'hero persona' that reduces appropriate preventive and hygiene measures. We employ the Health Belief Model to discuss the crucial role that risk perceptions may play in reinforcing autonomy in vaccine hesitant physician and nurses. We conclude this paper by providing a set of recommendations that aim to improve the decision-making process surrounding mandatory vaccinations for HCPs.

The Impact of Specific Social Factors on Changes in Education in Serbia

The political and economic changes that followed the adoption of the Strategy for the Development of Education in Serbia 2020 essentially betrayed the basic ideas and intentions of the strategy, creating a systematic threat to education and its role in the development of Serbia. This created an almost experimental situation for analysing the impact of political and social factors on changes in education. In the sphere of politics, new trends have emerged (centralisation of power; marginalisation of democratic institutions; encouraging foreign investment in companies with a low technological level, etc.) that strongly influenced changes (‘reforms’) in education (great centralisation in education, the strong influence of politics on education, imposing of some lower-level forms of education, reducing professional autonomy, etc.). The basic mechanism of transferring the general policy to education is changing the role of the most important national institutions in defining and implementing education policy: the National Education Council, the National Council for Vocational and Adult Education, the National Council for Higher Education, and the National Accreditation Body. The adoption of new education laws (2017) radically changed their status and competencies, resulting in a reduction of their independence and professionalism and strengthening the role of the ministry, through which the influence of the ruling political regime is transferred. Also, the role of the Chamber of Commerce in education has been strengthened. Such a system endangers the autonomy of educational institutions and teachers, as well as the quality of education. Consequently, these changes have a clear impact on the country’s development and its international position.

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

BackgroundHigh quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement.MethodsWe used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis.ResultsFour different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres.ConclusionsProfessionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.

Physiotherapists' perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study.

BackgroundThere are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists.Subjects and methodsAn observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents.ResultsThe findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups.ConclusionMore efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

Physician Leadership in the Employed Universe

Physicians are increasingly becoming employed by hospitals and health systems. While associated with less professional autonomy, such employment offers physicians the opportunity to become leaders within a vertically integrated healthcare environment. Multidisciplinary care teams, led by physician champions, can impact care for a large swath of patients and establish clinical excellence. Successful teams can improve outcomes, increase professional satisfaction, and potentially set physicians on a path to becoming leaders within their health system.

Factors related to plateauing among Yogo teachers

Objectives The purpose of this study was to identify the factors related to plateaus to support the career development of Yogo teachers (school nurses).Methods In March 2017, 1,000 elementary, junior high, and high schools in Tokyo, Kanagawa, Saitama, and Chiba prefectures were stratified and randomized. Questionnaires were sent to 1,000 Yogo teachers in each school. Plateaus among Yogo teachers were analyzed by hierarchical multiple regression analysis and path analysis by creating a conceptual framework that leads to plateauing through work engagement from professional autonomy (innovative behavior), social support in the workplace, and work-related stressors.Results Data from 335 Yogo teachers were included in the analysis. The path analysis indicated that the factors that influenced content plateau among Yogo teachers were work engagement, self-learning of professional autonomy (innovative behavior), and years of experience. Work engagement was influenced by self-learning, pursuit of better practice, informational support, instrumental support, emotional support, role ambiguity, and job position. The developed model was a substantial fit to the data: CFI=1.00, RMSEA=0.00, SRMR=0.01. The coefficient of determination was R2=0.41 for the content plateau phenomenon and R2=0.45 for work engagement. Factors that influenced hierarchical plateau among Yogo teachers were work engagement, self-learning, education, job position, and the absence of a school counselor. Work engagement was influenced by self-learning, pursuit of better practice, informational support, instrumental support, emotional support, role ambiguity, and job position. The model was a substantial fit to the data: CFI=1.00, RMSEA=0.00, SRMR=0.01. The coefficient of determination was R2=0.25 for the hierarchical plateau phenomenon and R2=0.45 for work engagement.Conclusions This study found that the low plateau phenomenon among Yogo teachers was associated with high self-learning of professional autonomy (innovative behavior) and work engagement. To prevent the plateau phenomenon, it is necessary to support them to enhance self-learning, create a conducive work environment, and consider training for Yogo teachers that takes into account their years of experience.

How rural nurses in Southern New Zealand navigate their ethical landscape-A qualitative study.

To explore rural nurse experiences of ethical issues and their management of these as a first step in a programme of work to address rural nurses' ethical needs. This study was qualitative, using mixed qualitative techniques to gather data, which was analysed using a general inductive approach. Primary health care in 2 regions of Aotearoa New Zealand. Eleven nurses working in the West Coast (District Health Board) region and 9 working within the Southern District Health Board region. Participants took part in either a focus groups or an interview with members of the research team. To document ethical issues that confronted these rural nurses and how they navigated these issues. Three themes were identified: 'Signals and Silences,' 'One and Other' and 'Frustrations and Freedoms.' A continuous thread through these themes was the concept of phronesis, or what is sometimes called practical virtue. This practical virtue largely developed through their own experiences, rather than through educational or health system specific support or resources. We found that rural nurses' deal with specific issues related to the rural setting, such as resourcing and isolation, while maintaining a relationship with the communities they serve and their professional autonomy. Additionally, we discovered the ways in which rural nurses deal with the ethical issues they encounter to be practically focussed. However, rural nurses need supportive leadership not only to sustain the moral agency they demonstrate but also to further develop their ethical decision-making practices. The provision of a clinical ethics tele-service delivering both training opportunities and an on-call consult support service would provide a potential solution.

Research and Developing of Evaluation Information System Using B/S Structure and SQL Server Technology

The paper analyses the status quo of the construction of the teaching staff of undergraduate colleges and universities in Jilin Province, expounds the irrational structure of the teaching staff, the low professional autonomy of teachers, the instability of the teaching staff, the lack of humane care for teachers in society and schools, and the teaching staff. Poor management and other issues. Based on the actual needs of undergraduate colleges in Jilin Province, this thesis uses the. NET framework, ASP.NET and SQL Server technology to develop a university teacher management information system based on the B/S structure. The system includes basic teacher file management, discipline construction management, the functions of teaching and research management, scientific research management, faculty management and system management have reached the goal of networked and electronic management of the school’s teacher information. The purpose of the thesis is to improve the construction level of teachers in private colleges and universities in Jilin Province.

Renewing creative work for business innovation: Architectural practice in the trading zone

AbstractHow do organizations in creative industries renew creative work for business innovation? What challenges do they experience in the process? Drawing on an eight‐month ethnography in an architectural practice, this article suggests that renewal of creative work takes place in two main trading zones: a creative business trading zone of managers and architects trading with the conception of architectural practice as a business, and a creative process trading zone of architects and process facilitators trading with the process of architectural design. We show how resolving challenges within and moving across trading zones enables managers and architects to renew the architectural design process and establish renewal as a business innovation. The study advances the understanding of innovation in creative industries by proposing trading zones as arenas for negotiating art‐business tensions and ‘tools’ for renewing creative work, to make way for business innovation while preserving the autonomy of the creative professionals.

Autonomy for ourselves: development and validation of Teachers’ Professional Autonomy Questionnaire (TEPAQ)

ABSTRACT Despite their experience, teachers continuously need to develop themselves professionally as the recency of the knowledge they acquire in teacher education programmes wears off in time – which means they need to be autonomous enough take responsibility for their own professional learning. This study, therefore, defines ‘teachers’ professional autonomy’ as teachers’ capability, motives, and time to develop themselves professionally in collaboration with their colleagues; and it proposes Teachers’ Professional Autonomy Questionnaire (TEPAQ) to measure the construct. First, two focus group interviews were conducted with 15 novice and experienced teachers, and an item pool was written. This initial version of TEPAQ was subjected to expert feedback sessions and piloting. The main data were gathered from 375 EFL (English as a foreign language) teachers working at state and foundation universities in 36 cities and 7 regions of Turkey. Following exploratory and confirmatory factor analyses and reliability analyses, TEPAQ was finalised with 5 factors and 23 items. TEPAQ can be used individually by teachers or institutionally by teacher educators or administrators with an aim to evaluate the strengths and weaknesses regarding teachers’ or teacher trainees’ professional autonomy and the areas they need support and assistance to take responsibility for their professional learning.

Moral distress, organizational climate, and the risk of burnout among oncology physician assistants.

11018 Background: Moral Distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care and has been associated with burnout. Advances have been made in our understanding of burnout in the oncology (Onc) workforce but our understanding of MD remains limited. This study was initiated to explore associations between moral distress, burnout, and the organizational climate (OC) for Onc Physician Assistants (PAs). Methods: A national survey of onc PAs was conducted in 2020. MD and Burnout were assessed with the Maslach Burnout Inventory and the Measure of MD – Healthcare Professionals (MMD-HP). To assess OC, the Nurse Practitioner Primary Care OC Questionnaire (NP-PCOCQ) was revised for Onc PAs and assessed professional visibility (PV), administrative relations (AR), physician relations (PR), and professional autonomy and support (PAS). A robust Poisson regression model was used to estimate risk ratios (RR) for burnout associated with MD and OC variables. Results: Respondents who completed the survey included 146 Onc PAs that were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical Onc (73%). Mean MMD-HP score was 71.5 and burnout was reported by 39.7% of PAs. MMD-HP scores did not differ based on specialty, practice setting or practice type. PCOCQ subscale scores were lower for PAs with burnout vs. without burnout (p=0.003 to p < 0.001). Increasing levels of MD were associated with increased levels of emotional exhaustion (p<0.001), depersonalization (p<0.001) and a higher overall rate of burnout. For Low, Medium and High MMD, burnout rates were 10%, 44% and 66% respectively (p<0.001). Risk of burnout was associated with increasing levels of MD, which remained when adjusted for the PCOCQ subscales. An interaction model with the PCOCQ subscales and the association between burnout and MD was not significant. Conclusions: Higher levels of MD and unfavorable organizational climate are associated with Onc PA burnout. The relationship between MD and burnout does not appear to be moderated by organizational climate. Additional research is needed to identify potential moderators of the MD/Burnout relationship. Risk Ratio estimate for Burnout.[Table: see text]

Job stress and its relationship with nurses' autonomy and nurse-physician collaboration in intensive care unit.

To determine nurses' job stress and its relationship with professional autonomy and nurse-physician collaboration in intensive care unit (ICU). Low professional autonomy, high job stress and lack of nurse-physician collaboration can affect nursing care in ICU and the main reasons ICU nurses leave the occupation or transfer to other clinical units. A cross-sectional, correlational study was conducted on 398 nurses in teaching hospitals in Urmia, Iran, in 2020. Data were collected using the Dempster Practice Behaviors Scale, the Health and Safety Executive tool and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. The mean job stress (115.53±12.42) and professional autonomy (102.19±11.88) of ICU nurses were 'moderate', and nurse-physician collaboration (74.25±5.10) was 'good'. There was a positive relationship between professional autonomy and job stress (r=.506) and nurse-physician collaboration (r=.242). Professional autonomy was a predictor of job stress in nurses (p<.000), and work experience in ICU can cause job stress in nurses (p=.024). Increasing nurses' professional autonomy causes an increase in job stress and improves nurse-physician collaboration in ICU. Nursing managers should implement practical strategies to improve nurses' autonomy, enhance nurse-physician collaboration and decrease their job stress.