Self-perceived Autonomy Research Articles

Participation and autonomy, independence in activities of daily living and upper extremity functioning in individuals with spinal cord injury

Improvements in care and rehabilitation have resulted in a higher proportion of people living with spinal cord injury (SCI), which calls for an increased focus on participation and autonomy. This observational cross-sectional study investigated the impact of SCI on autonomy and how it correlates to activity performance and upper extremity functioning. A total of 25 adults (mean age 58 years) with chronic cervical or thoracic SCI were included. Self-perceived autonomy was measured with Impact on Participation and Autonomy questionnaire, independence in activities of daily living (ADL) with Spinal Cord Independence Measure, upper extremity functioning with Action Research Arm Test (ARAT) and kinematic measures of the drinking task. The results showed that most participants perceived injury-related restrictions in outdoor autonomy (80%), family role (76%), and in indoor autonomy (72%). Independence in self-care (r = 0.72), mobility (r = 0.59) and upper extremity kinematics of movement time (r = 0.63) and smoothness (r = 0.49) were correlated to indoors autonomy. Social life autonomy was correlated to self-care (r = 0.50) and ARAT (r = 0.41). In conclusion, autonomy was perceived restricted after SCI in several major life areas and correlated with independence in ADL and upper extremity functioning. The aspects of autonomy should be considered more in goal setting and clinical decision-making.

Enhancing Physicians' Autonomy through Practical Trainings.

In medical emergencies adherence to standardized clinical protocols is crucial to ensure a better outcome for patients. Newly qualified physicians may play several roles in serving the National Health Service (substituting general practitioners, on-call duty, working in emergency rooms, etc.) in Italy. In these situations, the physician may have to manage critical patients autonomously. Moreover, newly qualified physicians may show a considerable deficiency in routine medical activities. In fact, many universities do not provide a practical simulation training programme, which is why a substantial number of students only face clinical emergencies when they start working after graduation. A cross-sectional study was performed by engaging medical doctors. Both experienced physicians and newly licensed physicians (graduated less than 24 months ago) were included in the study. A questionnaire was distributed to each participant during SIMED's Courses from June 2021 to December 2022. The questionnaire consisted of two sections. The first one analyzed participation in standardized practical courses on medical emer-gencies (Basic Life Support, Advanced Cardiac Life Support, International Trauma Life Support and a course on Advanced Airway Management). The second section analyzed the perceived autonomy of health professionals in the management of five different work settings, using a 5-point likert scale. 2,168 questionnaires were analyzed, of which 68.7% were from newly qualified doctors and 31.3% from more experienced doctors. The highest rate of physicians who undertook training courses was achieved for the basic life support course (77.5%) and the lowest rate for the advanced trauma course (15.9%). Physicians perceive themselves the highest autonomy in Primary Care setting (63.1%), while in the Emergency Department they perceive themselves with less autonomy (24.0%). In the analyzed sample, experienced physicians show a higher percentage of autonomy than newly qualified doctors (31.4% vs 8.1%) in all scenarios.

Narrative medicine pinpoints loss of autonomy and stigma in Parkinson's disease.

Parkinson's disease characteristics can create a self-perceived sense of stigmatization and disapproval by others, thereby affecting self-perceived autonomy. This study investigated the metaphors related to the loss of autonomy and stigma in stories and drawings of Parkinson's disease. We compare a contemporary first-person illness narrative and -drawing from a person with Parkinson's disease, with two novels (Jonathan Franzen's The Corrections and Claudia Piñeiro's Elena Knows), a graphic novel (Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's), a non-fiction book (Oliver Sacks' Awakenings) and a first-person illness narrative (John Palfreman's The Bright Side of Parkinson's). Metaphors in the patient narrative, novels, and non-fiction work were reviewed and a list of themes or categorizations common to 2 of the metaphors was generated. Parkinson's disease metaphors indicate a 'Parkinson's prism' thereby depicting extreme experiences (24.4%) like a 'fall by mischance', a 'tantrum of selfish misery' or a 'bottomless darkness and unreality' (Table 1). Both novels signify a sense of 'betrayal and disconnection' in the Parkinson's disease experience while non-fiction of Parkinsonism depicts a space in which one feels 'caged and deprived'. This makes the Parkinson's disease narrative a chaos story that could influence the decision to initiate treatment and treatment adherence. We conclude that narrative medicine can help to focus the medical consultations with affected individuals on issues that matter most to them, thereby improving self-perceived autonomy and stigma. As such, it is a critical component of the much-needed move towards personalized medicine in Parkinson's disease, achieved through the reciprocity of thinking with stories.

A Multilevel Investigation of the Association between Collective Psychological Ownership as Psychosocial Resources and Social Workers’ Turnover Intention

Abstract Using a multilevel approach and a nationally representative sample of 5,478 social workers from 813 social service organisations in China, this study investigated the association between collective psychological ownership (CPO), an emerging construct of psychosocial resources characterised by sharedness, and social workers’ turnover intention by controlling for psychological demands (i.e. emotional exhaustion and role ambiguity) and psychological resources (i.e. self-perceived autonomy, self-perceived and composite person–organisation value congruence, and self-perceived and composite social support). The results showed that CPO conceptualised as both individual- and organisational-level psychosocial resources were negatively associated with social workers’ turnover intention. The findings of the study will draw implications for keeping social workers and other helping professionals in their organisations by practicing co-workers’ shared agency and joint actions defined in terms of collective decision-making and hardship endurance.

The management of job autonomy in a fintech: the employees' point of view

The present study examined the perceived job autonomy of technology professionals working full time in an innovative organisation that provides services and products based on the new digital technology. For that, a single case study was conducted in a Brazilian fintech company. Results suggest that the opportunity to express points of view and ideas is critical to the employees' self-perceived autonomy and therefore to their motivation. The control of employees' activities and initiatives is accomplished through soft mechanisms such as organisational culture, communication, and orientation. These control mechanisms are not contradictory to the self-perception of autonomy, quite the contrary; they are perceived as autonomy promoters.

Mechanisms underpinning the association between physical activity and mental health in adolescence: a 6-year study

BackgroundPhysical activity (PA) can promote mental health, but the mechanisms underpinning this association are not well-established. This study examined if perceptions of three basic psychological needs (autonomy, competence, relatedness) and moderate-to-vigorous physical activity (MVPA) mediate the association between number of years participating in PA and mental health in adolescence.MethodsParticipants included 937 children (55% female) age 10–11 at inception of the longitudinal MATCH study, who provided data every 4 months over 6 years. Mediation analyses were used to assess the natural direct effect of number of years of PA participation (cycles 1–15) during late childhood and adolescence on later mental health (cycle 16), measured with the Mental Health Continuum-Short Form (MHC-SF), and the natural indirect effect through each of self-perceived autonomy, competence and relatedness, and self-report MVPA (cycle 15).ResultsIn single mediator models, indirect effects of autonomy, competence, relatedness and self-report MVPA were statistically significant. In joint mediation models (each of three models including one basic psychological need and MVPA), autonomy, competence and relatedness mediated 71, 27, and 51% of the association respectively; MVPA mediated 27–31% of the association. In the mediation model including all four mediators, relatedness mediated the largest proportion of the association, followed by autonomy and MVPA.ConclusionResults support developing strategies to encourage adolescents to engage and remain involved in PA. This could foster perceptions of autonomy, competence, and relatedness as well as MVPA, which in turn may enhance mental health.

The management of job autonomy in a fintech: the employees’ point of view

The present study examined the perceived job autonomy of technology professionals working full time in an innovative organisation that provides services and products based on the new digital technology. For that, a single case study was conducted in a Brazilian fintech company. Results suggest that the opportunity to express points of view and ideas is critical to the employees' self-perceived autonomy and therefore to their motivation. The control of employees' activities and initiatives is accomplished through soft mechanisms such as organisational culture, communication, and orientation. These control mechanisms are not contradictory to the self-perception of autonomy, quite the contrary; they are perceived as autonomy promoters.

Does Perceived Resident Operative Autonomy Impact Patient Outcomes?

We investigated the association of perceived trainee autonomy with patient clinical outcomes following colorectal surgery. This was a prospective multi-institutional study that consisted of surgery trainees completing a survey tool immediately after participating in colorectal resections to rate their self-perceived autonomy and case characteristics. Self-perception of autonomy was classified as observer, assistant, surgeon, or teacher. The completed trainee surveys were linked with patient information available through each hospital's internal NSQIP directory. The primary outcome was death and serious morbidity (DSM) and secondary outcome was 30-day readmissions. Separate mixed effects regression models were used to examine the association between perceived trainee autonomy and DSM or 30-day readmissions. Fixed effects were used to control for the effects of the training environment. The models were constructed to adjust for patient and trainee characteristics associated with each outcome independently. This study was conducted at 7 general surgery training programs (5 academic medical centers and 2 independent training programs) with general surgery or colorectal surgery services. This study included a total of 63 residents and fellows rotating on surgery services that performed colorectal resections at the included 7 general surgery training programs from January until March 2016. The 63 trainees that participated in this study completed 417 surveys with over a 95% response rate. National Surgical Quality Improvement Program (NSQIP) patient records were available for 67% (n = 273) of completed surveys. The clinical year of the trainees were 6.1% PGY 1/2, 36% Post graduate year (PGY) 3, 40.9% PGY 4/5, and 17% fellows. Residents perceived their participation in the case to be that of an observer in 9.2% of surveys, an assistant in 51.6% of surveys, and the surgeon/teacher in 39.3% of surveys. About 50% of patients were male, 80% were White, the majority had an American Society of Anesthesiologists classification of 3, almost half had prior abdominal surgery, and over 80% of surgeries were elective. The primary operation types performed were laparoscopic (40.3%) and open (35.9%) partial colectomies. The rate of DSM in patients was approximately 24% when trainees perceived their role as observers, 23% when trainees perceived their role as assistants, and 18% when trainees perceived their role as surgeons/teachers. After adjustment for patient, trainee, and training environment, we found that the perceived level of trainee autonomy of a surgeon/teacher was associated with a 4-fold lower rate of DSM (odds ratio: 0.23, confidence of interval: 0.05-0.97, p = 0.045) compared to observers. The rate of readmissions was approximately 20% when trainees perceived their role as observers, 14% when trainees perceived their role as assistants and 9% when trainees perceived their role as surgeons/teachers. After adjustment for patient, trainee, and training environment, we found that the perceived level of trainee autonomy of a surgeon/teacher was significantly associated with a 10-fold lower rate of 30-day readmissions (odds ratio: 0.09, confidence of interval: 0.01-0.70, p = 0.022) compared to observers. There was an association between increased perceived trainee autonomy and improved patient outcomes, suggesting that when trainees identify with an increased role in the operation, patients may have improved care. Further research is needed to understand this association further.

Phenomenological Analysis into Students’ Self-Perceived Autonomy and Out-Of-Class Learning

Autonomy researchers have employed qualitative approaches to investigate a variety of issues. Ethnographies, case studies, language learning histories, (auto)biographies, among others, are featured in the literature. Some of these approaches fall under the umbrella of narrative research (Barkhuizen, Benson, & Chik, 2014; Early & Norton, 2012), which is emerging strongly in the L2 learning research (Barkhuizen, 2013; Benson 2014). This paper discusses another approach that has not been widely featured in autonomy or L2 learning research, phenomenology. “Phenomenology is a philosophical approach to the study of experience” (Smith, Flowers, & Larkin, 2009, p. 11). Phenomenology seeks “to determine what an experience means for the persons who have had the experience and are able to provide a comprehensive description of it” (Moustakas, 1994, p. 13). Phenomenological research was employed to explore the phenomenon of ‘institutionalised L2 learning and possibilities for autonomy in Trinidad & Tobago’ with thirty students in the context of a BA in Spanish programme. Students’ self-perceived autonomy emerged from the analysis and shed light on the sociocultural phenomena that enabled or hindered students’ development and exercise of autonomy. The paper illustrates how phenomenological research can be a valuable qualitative approach to explore sociocultural phenomena in learner autonomy.

Health and economic correlates of autonomy among older people in Peru, Mexico and China: The 10/66 INDEP study

Background: While autonomy is highlighted as central to older people’s wellbeing, there has been little empirical research to inform a measurement approach, support construct validity, or establish its determinants. We aimed to study the health and economic correlates of self-perceived autonomy among community-dwelling older people in Peru, Mexico and China, using a hypothesis-driven approach. Methods: Cross-sectional household surveys in urban and rural catchment areas in each country, comprising household, informant, and older person interviews, to elicit household income and older residents’ autonomy, unmet needs, and quality of life. Households, all with older residents, were selected from previous waves of the 10/66 Dementia Research Group’s comprehensive surveys of ageing and health. Results: Among 937 older respondents in 754 households, diminished autonomy was associated with older age, marital status, lower education, and lower household income. Physical, cognitive and mental morbidities, functional impairment and dependence were strongly and independently associated with diminished autonomy, explaining the effect of age. Controlling for these variables, an older person’s current total income was inversely associated with diminished autonomy (Count Ratio per fifth of total income 0.86, 95% CI 0.81-0.91). Autonomy was positively correlated with wellbeing and life satisfaction, supporting construct validity. Counter to hypotheses, less autonomy was associated with fewer unmet needs in rural sites. Conclusions: The effects of income insecurity, disability and dependence upon autonomy should be tested prospectively to confirm causal direction. Social pensions, and measures to support the rights of frail and dependent older people may be effective policy instruments for promoting autonomy. While the negative impact of diminished autonomy upon older people’s welfare is supported, the association in rural sites between more autonomy and more unmet needs should be further investigated; efforts to promote autonomy may need careful cultural nuancing, to support rather than subvert traditional family care systems.

Student perceptions of their autonomy at University

Learner autonomy is a primary learning outcome of Higher Education in many countries. However, empirical evaluation of how student autonomy progresses during undergraduate degrees is limited. We surveyed a total of 636 students’ self-perceived autonomy during a period of two academic years using the Autonomous Learning Scale. Our analysis suggests that students do not perceive themselves as being any more autonomous as they progress through University. Given the relativity of self-perception metrics, we suggest that our results evince a “red queen” effect. In essence, as course expectations increase with each year, each student’s self-perceived autonomy relative to their ideal remains constant; we term this the “moving goalpost” hypothesis. This article corroborates pedagogical literature suggesting that providing students with opportunities to act autonomously and develop confidence is key to developing graduates who have the independence that they need in order to be successful in the workplace.

Home-care nursing staff in self-directed teams are more satisfied with their job and feel they have more autonomy over patient care: a nationwide survey.

The aims of this study were: (1) To examine whether working in a self-directed team is related to home-care nursing staff's job satisfaction; (2) To assess the mediating effect of self-perceived autonomy over patient care; (3) To investigate the moderating effect of educational level on the association between autonomy over patient care and job satisfaction. Self-directed teams are being introduced in home care in several countries. It is unknown whether working in a self-directed team is related to nursing staff's job satisfaction. It is important to gain insight into this association since self-directed teams may help in retaining nursing staff. A cross-sectional study based on two questionnaire surveys in 2014 and 2015. The study involved 191 certified nursing assistants and registered nurses employed in Dutch home-care organizations (mean age of 50). These were members of the Dutch Nursing Staff Panel, a nationwide panel of nursing staff working in various healthcare settings. Self-direction is positively related to nursing staff's job satisfaction. This relationship is partly mediated by autonomy over patient care. For certified nursing assistants and registered nurses with a bachelor's degree, a greater sense of autonomy over patient care in self-directed teams is positively related to job satisfaction. No significant association was found between autonomy over patient care and job satisfaction for registered nurses with an associate degree. This study suggests that home-care organizations should consider the use of self-directed teams as this increases nursing staff's job satisfaction and may therefore help to retain nursing staff in home care.

Validation of the Argentine Spanish version of Transition Readiness Assessment Questionnaire for adolescents with chronic conditions.

The transition of adolescents with chronic conditions to adult follow-up care is an increasingly complex process. Patients need to acquire knowledge and skills that ensure continuity of their care. The goal of this study was to validate the Argentinian Spanish version of the Transition Readiness Assessment Questionnaire (TRAQ) 5.0 tool in adolescents and young adults with chronic conditions. Descriptive, crosssectional, quantitative study. Patients with chronic conditions aged 14 years or older treated at Hospital Garrahan were included. The TRAQ is made up of 20 items divided into 5 subscales (Managing Medication, Appointment Keeping, Tracking Health Issues, Talking with Providers, Managing Daily Activities), and is designed to be self-administered. Patients completed the TRAQ, as well as an opinion survey about its use and a self-perceived autonomy scale; their physicians answered a scale about patients' health impairment due to the condition. Sociodemographic, clinical and TRAQ-related variables were recorded. A total of 191 patients participated. The majority of patients (96.3%) understood the TRAQ 5.0 questionnaire and completed it correctly, in self-administered modality, in a short time (median: 5 minutes), with little or no help (81%). Patients who live in poverty or have a lower education level than the one expected for their age needed more help. Internal consistency (Cronbach's alpha) for the overall score was 0.81. Construct validity was demonstrated by testing different hypotheses (all p < 0.05): discrimination by age ≥ 16 years (3.01 vs. 3.34), sex (women: 3.38 > men: 3.12) and having plans for the future (without plans: 3.01 < with plans: 3.34); correlation with self-perception scale (r= 0.49). The TRAQ 5.0 tool is available for use in Argentinian adolescents with chronic conditions.

Bilateral effects of hospital patient-safety procedures on nurses' job satisfaction.

The aim of this study was to examine how hospital patient-safety procedures affect the job satisfaction of hospital nurses. Additionally, we investigated the association between perceived autonomy and hospital patient-safety procedures and job satisfaction. Recently, measures for patient safety have been recognized as an essential requirement in hospitals. Hospital patient-safety procedures may enhance the job satisfaction of nurses by improving the quality of their work. However, such procedures may also decrease their job satisfaction by imposing excessive stress on nurses because they cannot make mistakes. The participants included 537 nurses at 10 private hospitals in Japan (The surveys were collected from March to July 2012). Factors related to hospital patient-safety procedures were demonstrated using factor analysis, and the associations between these factors and nurses' self-perceived autonomy and job satisfaction were examined using structural equationmodelling. Five factors regarding hospital patient-safety procedures were extracted. Additionally, structural equationmodelling revealed statistically significant associations between these factors and the nurses' self-perceived autonomy and job satisfaction. The findings showed that nurses' perceived autonomy of the workplace enhanced their job satisfaction and that their perceptions of hospital patient-safety procedures promoted their job satisfaction. However, some styles of chief nurses' leadership regarding patient safety restrict nurses' independent and autonomous decision-making and actions, resulting in a lowering of job satisfaction. This study demonstrated that hospital patient-safety procedures have ambiguous effects on nurses' job satisfaction. In particular, chief nurses' leadership relating to patient safety can have a positive or negative effect on nurses' job satisfaction. The findings indicated that hospital managers should demonstrate positive attitudes to improve patient safety for nurses' job satisfaction. In addition, policymakers in the hospitals should consider that chief nurses' leadership styles may reduce autonomy and suppress nurses' job satisfaction.

Regional resources buffer the impact of functional limitations on perceived autonomy in older adults with multiple illnesses.

Retaining perceptions of autonomy is a key component of successful aging. Perceived autonomy refers to the capacity to make and enact self-directed decisions. These perceptions are often threatened in older adults with multiple illnesses, when functional limitations resulting from these illnesses impede the enactment of self-directed decisions. Regional resources (in Germany specifically at the level of administrative districts) might counteract these impediments of autonomy. Economically stronger districts can provide more-concrete support resources for older adults, buffering the negative effect of functional limitations on self-perceived autonomy. This study assessed participants aged over 65 with 2 or more chronic conditions. In total, N = 287 provided data (Mage = 73.3, SD = 5.07), and n = 97 were women. Gross domestic product (GDP) per capita was used as a proxy measure of administrative district wealth in Germany. Hierarchical multilevel regression analyses with cross-level interactions were conducted. Results suggest that the detrimental effect of functional limitations on perceived autonomy is less pronounced for participants residing in higher GDP districts. Conversely, for participants in lower GDP districts, the effect is exacerbated. This finding suggests that districts with greater financial resources might be better able to invest in supports that promote and facilitate autonomy and, thus, provide a buffer against threats to individual perceived autonomy.

An assessment of variables affecting transition readiness in pediatric rheumatology patients.

BackgroundWe sought to identify which adolescent patient characteristics might lead to subjective reported independence in accessing medical care when patients transition from pediatric to adult medicine.MethodsPediatric and adult rheumatologists were asked which pediatric patient characteristics they believed would improve transition to adult medical care. Based on these responses, a questionnaire was created and administered to 76 teenage/young adult patients in a pediatric rheumatology clinic. The first set of questions included demographic, disease features, and life skills questions. The second set of questions pertained to self-reported independence in managing medical care. Data was analyzed to see if there were any significant associations between an individual’s response to demographic, disease feature, or life skills questions and the independence outcome questions.ResultsIn our study, older age correlated with self-reported independence in almost all questions asked regarding accessing medical care. Other patient characteristics that were associated with increased self-perceived autonomy included having a younger parent, having a family member with a similar disease, longer disease duration, having a comorbid non-rheumatic diagnosis, and having had a summer job.ConclusionsThe patient characteristics that we found associated with self-reported independence in obtaining medical care should be considered when determining which patients might be more likely to make a successful transition.

Autonomous home-care nursing staff are more engaged in their work and less likely to consider leaving the healthcare sector: A questionnaire survey

BackgroundThe need for home care is rising in many Western European countries, due to the ageing population and governmental policies to substitute institutional care with home care. At the same time, a general shortage of qualified home-care staff exists or is expected in many countries. It is important to retain existing nursing staff in the healthcare sector to ensure a stable home-care workforce for the future. However, to date there has been little research about the job factors in home care that affect whether staff are considering leaving the healthcare sector. ObjectiveThe main purpose of the study was to examine how home-care nursing staff's self-perceived autonomy relates to whether they have considered leaving the healthcare sector and to assess the possible mediating effect of work engagement. Design, setting and participantsThe questionnaire-based, cross-sectional study involved 262 registered nurses and certified nursing assistants employed in Dutch home-care organisations (mean age of 51; 97% female). The respondents were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings (67% response rate). MethodsThe questionnaire included validated scales concerning self-perceived autonomy and work engagement and a measure for considering pursuing an occupation outside the healthcare sector. Logistic regression and mediation analyses were conducted to test associations between self-perceived autonomy, work engagement and considering leaving the healthcare sector. ResultsNursing staff members in home care who perceive more autonomy are more engaged in their work and less likely to have considered leaving the healthcare sector. The positive association between self-perceived autonomy and considering leaving, found among nursing staff members regardless of their level of education, is mediated by work engagement. ConclusionIn developing strategies for retaining nursing staff in home care, employers and policy makers should target their efforts at enhancing nursing staff's autonomy, thereby improving their work engagement.

Effects of a dyadic music therapy intervention on parent-child interaction, parent stress, and parent-child relationship in families with emotionally neglected children: a randomized controlled trial.

Work with families and families at risk within the field of music therapy have been developing for the last decade. To diminish risk for unhealthy child development, families with emotionally neglected children need help to improve their emotional communication and develop healthy parent-child interactions. While some researchers have investigated the effect of music therapy on either the parent or the child, no study has investigated the effect of music therapy on the observed interaction between the parent and child within the field of child protection. The purpose of this study was to investigate the effect of a dyadic music therapy intervention on observed parent-child interaction (mutual attunement, nonverbal communication, emotional parental response), self-reported parenting stress, and self-reported parent-child relationship in families at risk and families with emotionally neglected children, ages 5-12 years. This was a randomized controlled trial study conducted at a family care center in Denmark. Eighteen parent-child dyads were randomly assigned to receive 10 weekly music therapy sessions with a credentialed music therapist (n = 9) or treatment as usual (n = 9). Observational measures for parent-child interaction, self-reported measures for parenting stress and parent-child relationship were completed at baseline and 4 months post-baseline assessment. Results of the study showed that dyads who received music therapy intervention significantly improved their nonverbal communication and mutual attunement. Similarly, parents who participated in dyadic music therapy reported themselves to be significantly less stressed by the mood of the child and to significantly improve their parent-child relationship in terms of being better at talking to and understanding their children than parents who did not receive music therapy. Both groups significantly improved in terms of increased positive and decreased negative emotional parental response, parenting stress and stress in general. There were no significant between group differences in self-perceived autonomy, attachment, and parental competence. The dyadic music therapy intervention examined in this study improved emotional communication between parent and child and interaction after 6 to 10 sessions and can be considered as a viable treatment alternative or supplement for families at risk and families with emotionally neglected children.

Heterogeneity in Subjective Wellbeing: An Application to Occupational Allocation in Africa

Using an extraordinarily rich panel dataset from Ghana, this paper explores the nature of self-employment and informality in developing countries through the analysis of self-reported happiness with work and life. Subjective job satisfaction measures allow assessment of the relative desirability of different jobs in ways that, conditional wage comparisons cannot. By exploiting recent advances in mixed (random parameter) ordered probit models, the distribution of subjective well-being across sectors of employment is quantified. There is little evidence for the overall inferiority of the small firm informal sector: there is not a robust average satisfaction premium for formal work vs. self-employment or informal salaried work, and owners of informal firms that employ others are on average significantly happier than workers in the formal private sector. Moreover, the estimated distribution of parameters predicting satisfaction reveal substantial heterogeneity in subjective well-being within sectors that conventional fixed parameter models, such as standard ordered probit models, cannot detect: Whatever the average satisfaction premium in a sector, all job categories contain both relatively happy and disgruntled workers. Specifically, roughly 67, 50, 40 and 59 percent prefer being a small-firm employer, sole proprietor, informal salaried, civic worker respectively, than formal work. Hence, there is a high degree of overlap in the distribution of satisfaction across sectors. The results are robust to the inclusion of fixed effects and alternate measures of satisfaction. Job characteristics, self-perceived autonomy and experimentally elicited measures of attitudes toward risk do not appear to explain these distributional patterns.

Malpractice in Geriatrics: Are We Surviving?

The need for home care is rising in many Western European countries, due to the ageing population and governmental policies to substitute institutional care with home care. At the same time, a general shortage of qualified home-care staff exists or is expected in many countries. It is important to retain existing nursing staff in the healthcare sector to ensure a stable home-care workforce for the future. However, to date there has been little research about the job factors in home care that affect whether staff are considering leaving the healthcare sector.The main purpose of the study was to examine how home-care nursing staff's self-perceived autonomy relates to whether they have considered leaving the healthcare sector and to assess the possible mediating effect of work engagement.The questionnaire-based, cross-sectional study involved 262 registered nurses and certified nursing assistants employed in Dutch home-care organisations (mean age of 51; 97% female). The respondents were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings (67% response rate).The questionnaire included validated scales concerning self-perceived autonomy and work engagement and a measure for considering pursuing an occupation outside the healthcare sector. Logistic regression and mediation analyses were conducted to test associations between self-perceived autonomy, work engagement and considering leaving the healthcare sector.Nursing staff members in home care who perceive more autonomy are more engaged in their work and less likely to have considered leaving the healthcare sector. The positive association between self-perceived autonomy and considering leaving, found among nursing staff members regardless of their level of education, is mediated by work engagement.In developing strategies for retaining nursing staff in home care, employers and policy makers should target their efforts at enhancing nursing staff's autonomy, thereby improving their work engagement.