The status of professional autonomy and its predictors in clinical nurses in Iran.

AIM: The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran. DESIGN: The study used an analytical cross-sectional design. METHODS: A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software. RESULTS: The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5-15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47-1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56-3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60-7.99) of having high professional autonomy compared to clinical nurses. CONCLUSION: Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses. NO PATIENT OR PUBLIC CONTRIBUTION: This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated.

Two Randomized Controlled Trials to Help Teachers Develop Physical Education Students' Course-Specific Grit-Perseverance and Mental Toughness.

Adopting both a self-determination theory perspective and a proactive, asset-oriented approach to coping with stressors, we propose a hypothesized model to explain physical education students' year-long development of course-specific grit-perseverance (Study 1) and mental toughness (Study 2). In both studies, we used a randomized controlled trial research design with longitudinally assessed dependent measures (four waves) to test a hypothesized model in which teacher participation in an autonomy-supportive teaching workshop (experimental condition) would increase students' T2 perceived autonomy-supportive teaching and T2 perceived autonomy-supportive classmates, both of which would increase T3 need satisfaction, which would then explain longitudinal gains in students' T4 grit-perseverance (Study 1) and mental toughness (Study 2). In both Study 1 (57 teachers, 3,147 students) and Study 2 (38 teachers, 2,057 students), a multilevel structural equation modeling analysis showed that the hypothesized model fit the data very well. We conclude that the developmental roots of grit-perseverance and mental toughness can emerge proactively out of the asset-oriented experiences of interpersonal support and psychological need satisfaction that are central to self-determination theory.

Ethical Considerations and Equipoise in Cancer Surgery.

The changing landscape of cancer surgery requires ongoing consideration of ethical issues to ensure patient-centered care and fair access to treatments. With technological advancements and the global expansion of surgical interventions, healthcare professionals must navigate complex ethical dilemmas related to patient autonomy, informed consent, and the impact of new technologies on the physician-patient relationship. Additionally, ethical principles and decision-making in oncology, especially in the context of genetic predisposition to breast cancer, highlight the importance of integrating patient knowledge, preferences, and alignment between goals and treatments. As global surgery continues to grow, addressing ethical considerations becomes crucial to reduce disparities in access to surgical interventions and uphold ethical duties in patient care. Furthermore, the rise of digital applications in healthcare, such as digital surgery, requires heightened awareness of the unique ethical issues in this domain. The ethical implications of using artificial intelligence (AI) in robotic surgical training have drawn attention to the challenges of protecting patient and surgeon data, as well as the ethical boundaries that innovation may encounter. These discussions collectively emphasize the complex ethical issues associated with surgical innovation and underscore the importance of upholding ethical standards in the pursuit of progress in the field. In this study, we thoroughly analyzed previous scholarly works on ethical considerations and equipoise in the field of oncological surgery. Our main focus was on the use of AI in this specific context.

Patient Autonomy in Medical Education: Navigating Ethical Challenges in the Age of Artificial Intelligence.

The increasing integration of Artificial Intelligence (AI) in the medical domain signifies a transformative era in healthcare, with promises of improved diagnostics, treatment, and patient outcomes. However, this rapid technological progress brings a concomitant surge in ethical challenges permeating medical education. This paper explores the crucial role of medical educators in adapting to these changes, ensuring that ethical education remains a central and adaptable component of medical curricula. Medical educators must evolve alongside AI's advancements, becoming stewards of ethical consciousness in an era where algorithms and data-driven decision-making play pivotal roles in patient care. The traditional paradigm of medical education, rooted in foundational ethical principles, must adapt to incorporate the complex ethical considerations introduced by AI. This pedagogical approach fosters dynamic engagement, cultivating a profound ethical awareness among students. It empowers them to critically assess the ethical implications of AI applications in healthcare, including issues related to data privacy, informed consent, algorithmic biases, and technology-mediated patient care. Moreover, the interdisciplinary nature of AI's ethical challenges necessitates collaboration with fields such as computer science, data ethics, law, and social sciences to provide a holistic understanding of the ethical landscape.

The development of surgical ability during pediatric urology fellowship and its evolution in the early years of practice.

BACKGROUND: North American Pediatric Urology fellowship programs underwent a structural change in 2021 that allows more flexibility in training. Given this opportunity as well as widespread concern about the development of contemporary surgical trainees, it is prudent to understand in detail the current state of preparedness of pediatric urology fellowship graduates for independent practice. OBJECTIVE: The study aimed to determine recent pediatric urology graduates' reported levels of comfort both at graduation and following the start of clinical practice in performing select index procedures. We also queried the aspects of training and clinical practice perceived to be the most valuable for the development of surgical confidence. STUDY DESIGN: Graduates of ACGME approved pediatric urology fellowships from 2016 to 2021 were surveyed. Index procedures were described via brief case vignettes. Respondents were asked to indicate their comfort level with each index procedure following fellowship graduation and at the current time point. Comfort levels were defined by the degree of support that respondents would seek from senior colleagues in preparation for case booking. Respondents were also asked about the most helpful operative settings during training and factors contributing to high and low comfort. RESULTS: Fifty-three pediatric urologists (49%) completed the survey out of 109 invited. Most respondents practiced at an academic center. Perceived comfort was very high for low complexity procedures. The responses varied more widely for procedures of moderate and significant complexity (Figure). Across the cohort, there was a substantial increase in comfort between graduation and the current time point for all procedures queried. The most highly valued operative settings in fellowship were those offering real or simulated independence. Respondents most often attributed high comfort to robust case volumes and overall surgical skill gained in fellowship. DISCUSSION: New pediatric urology faculty differ widely in surgical confidence, particularly for more complex procedures. There is meaningful growth in the confidence and self-perceived independence of pediatric urologists during their initial years of practice. The early years are a critical time of continuing maturation and development that should be supported with structured systems of mentorship. Future challenges include low case volumes for rare conditions and the centralization of complex care. CONCLUSION: These findings will provide valuable context for pediatric urology fellowship directors as they evaluate and redesign their programs under the new, more flexible structure. There are opportunities to formalize early practice mentorship to support the growth of new faculty.

Understanding frailty and its opposites from community-dwelling older peoples' perspectives: A phenomenological qualitative study.

Background: the global population is ageing. As older people become more susceptible to frailty, an increase in frailty prevalence is also expected. Although frailty has been defined before in research, older peoples' perceptions of frailty do not always coincide with those used in research or medical settings. Further exploring community-dwelling older people's viewpoints regarding frailty is essential for tailored care and policy. Aim: the aim of this study was to explore the perspectives of Dutch community-dwelling older people regarding frailty and its opposing concepts. Methods: a phenomenological qualitative study was conducted for which we carried out semi-structured interviews with independently living older people aged ≥65. Following the interviews, the participants filled out the Tilburg Frailty Indicator. Results: the different domains of frailty: 'physical', 'psychological', and 'social', were recognized by participants. In addition, other aspects, such as financial capacity and digital functioning, have been identified. Four aspects of the meaning of frailty were identified in the category of other frailty definitions: 'dependency', 'frailty as getting hurt', 'frailty as prone to deterioration', and 'frailty as experiences of loss and sacrifice'. Participants also described the opposites of frailty, which could also be distinguished according to the 'physical', 'psychological', and 'social' domains. In addition, participants mentioned the following concepts as opposing frailty: 'vitality', 'resilience', 'independence', 'autonomy', and 'ambition'. Conclusion: we found that frailty and its opposites share similar aspects, including physical, psychological, and social dimensions. Additionally, older people perceived cognition as an essential aspect of frailty. The psychological dimension seemed more dominant in concepts opposed to frailty, which raises opportunities to focus on the positive aspects and build on older people's (psychological) capabilities in managing frailty and its consequences. Based on these findings, policymakers and care professionals should consider the perspectives of older people regarding frailty and its opposing concepts.

Beyond delinquency and drug use: Links of peer pressure to long-term adolescent psychosocial development.

This study examined the predictors and sequelae of exposure to peer pressure from close friends in adolescence. Adolescents (99 female; 85 male) were followed from age 13 to 24 utilizing peer, parent, and romantic partner reports and observational data. Participants who were exposed to high levels of peer pressure as teens were more likely to experience higher levels of coercive behavior from romantic partners (as reported by those partners), as well as lower levels of parent-reported functional independence. All findings held even after accounting for baseline levels of teen assertiveness. Adolescents at risk for increasing exposure to peer pressure were characterized by poor-quality parent and peer relationships, as well as baseline deficits in ability to assert autonomy. Results suggest that exposure to peer pressure, aside from its potential effects on deviant or risky behavior, may reflect a powerful threat to the autonomy development process as adolescents transition from parents to peers as primary sources of support and interaction.

Patient Perspectives on AI for Mental Health Care: Cross-Sectional Survey Study.

BACKGROUND: The application of artificial intelligence (AI) to health and health care is rapidly increasing. Several studies have assessed the attitudes of health professionals, but far fewer studies have explored the perspectives of patients or the general public. Studies investigating patient perspectives have focused on somatic issues, including those related to radiology, perinatal health, and general applications. Patient feedback has been elicited in the development of specific mental health care solutions, but broader perspectives toward AI for mental health care have been underexplored. OBJECTIVE: This study aims to understand public perceptions regarding potential benefits of AI, concerns about AI, comfort with AI accomplishing various tasks, and values related to AI, all pertaining to mental health care. METHODS: We conducted a 1-time cross-sectional survey with a nationally representative sample of 500 US-based adults. Participants provided structured responses on their perceived benefits, concerns, comfort, and values regarding AI for mental health care. They could also add free-text responses to elaborate on their concerns and values. RESULTS: A plurality of participants (245/497, 49.3%) believed AI may be beneficial for mental health care, but this perspective differed based on sociodemographic variables (all P<.05). Specifically, Black participants (odds ratio [OR] 1.76, 95% CI 1.03-3.05) and those with lower health literacy (OR 2.16, 95% CI 1.29-3.78) perceived AI to be more beneficial, and women (OR 0.68, 95% CI 0.46-0.99) perceived AI to be less beneficial. Participants endorsed concerns about accuracy, possible unintended consequences such as misdiagnosis, the confidentiality of their information, and the loss of connection with their health professional when AI is used for mental health care. A majority of participants (80.4%, 402/500) valued being able to understand individual factors driving their risk, confidentiality, and autonomy as it pertained to the use of AI for their mental health. When asked who was responsible for the misdiagnosis of mental health conditions using AI, 81.6% (408/500) of participants found the health professional to be responsible. Qualitative results revealed similar concerns related to the accuracy of AI and how its use may impact the confidentiality of patients' information. CONCLUSIONS: Future work involving the use of AI for mental health care should investigate strategies for conveying the level of AI's accuracy, factors that drive patients' mental health risks, and how data are used confidentially so that patients can determine with their health professionals when AI may be beneficial. It will also be important in a mental health care context to ensure the patient-health professional relationship is preserved when AI is used.

Children's beliefs about the emotional consequences of norm adherence and violation.

What behaviors make people happy? In the current studies, we investigated 4- to 7-year-old children's (N = 148) emotion attributions for people who follow or violate a conventional norm when doing so aligns or conflicts with other psychological motivations. In Study 1, we tested whether children believe people are happier when they desire (vs. do not desire) adhering to (vs. violating) a norm. In Study 2, we tested whether children believe people are happier when freely choosing (vs. being told) to adhere to (vs. violate) a norm. In both studies, children predicted the highest happiness levels for people who followed norms even when doing so conflicted with other psychological motivators (e.g., wanting or freely choosing to do something). Children also explained their emotion attributions by making reference to norms more often than to desires or personal choices. Results are discussed in terms of implications for children's own norm adherence and early socialization practices in Western cultures.

Autonomous Planetary Liquid Sampler (APLS) for In Situ Sample Acquisition and Handling from Liquid Environments.

Many natural and artificial liquid environments, such as rivers, oceans, lakes, water storage tanks, aquariums, and urban water distribution systems, are difficult to access. As a result, technology is needed to enable autonomous liquid sampling to monitor water quality and ecosystems. Existing in situ sample acquisition and handling systems for liquid environments are currently limited to a single use and are semi-autonomous, relying on an operator. Liquid sampling systems should be robust and light and withstand long-term operation in remote locations. The system components involved in liquid sampling should be sterilisable to ensure reusability. Here, we introduce a prototype of a liquid sampler that can be used in various liquid environments and may be valuable for the scientific characterisation of different natural, remote, and planetary settings. The Autonomous Planetary Liquid Sampler (APLS) is equipped with pre-programmed, fully autonomous extraction, cleaning, and sterilisation functionalities. It can operate in temperatures between -10 °C and 60 °C and pressure of up to 0.24 MPa (~24 m depth below mean sea level on Earth). As part of the control experiment, we demonstrate its safe and robust autonomous operation in a laboratory environment using a liquid media with Bacillus subtilis. A typical sampling procedure required 28 s to extract 250 mL of liquid, 5 s to fill the MilliQ water, 25 s for circulation within the system for cleaning and disposal, and 200 s to raise the system temperature from ~30 °C ambient laboratory temperature to 150 °C. The temperature is then maintained for another 3.2 h to sterilise the critical parts, allowing a setup reset for a new experiment. In the future, the liquid sampler will be combined with various existing analytical instruments to characterise the liquid solution and enable the autonomous, systematic monitoring of liquid environments on Earth.

Disease characteristics influence the privacy calculus to adopt electronic health records: A survey study in Germany.

Background: The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients' intention to use the EHR. Objective: This study aims to validate the privacy calculus model (PCM) regarding EHRs and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions. Methods: An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with N = 241 participants, aged 18 years and older residing in Germany with no previous experience with the diseases mentioned in the respective medical reports. Participants were randomized (single-blinded) into four groups in parallel: high stigma and acute time course (n = 74), high stigma and chronic time course (n = 56), low stigma and acute time course (n = 62) and low stigma and chronic time course (n = 49). The data were analyzed using structural equation modeling with partial least squares. Results: The model explains R² = 71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease's time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention. Conclusions: The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. The need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts.

Building independence in self-care and household tasks: a qualitative study with adolescents with cerebral palsy and their caregivers.

PURPOSE: Adolescents with cerebral palsy (CP) may experience limitations in self-care and household tasks. The aim of the study was to understand the process of building independence in self-care and household tasks from the perspective of adolescents and their caregivers. MATERIALS AND METHODS: We conducted a qualitative study with a phenomenological approach with 10 adolescents (15-17 years old) and 11 caregivers from a transition service in Brazil. Semistructured, remote interviews were conducted with each participant. The interviews were recorded for transcription and content analysis. RESULTS: Two thematic categories emerged: (1) "Thinking about independence" and (2) "Possible ways to foster independence." The first category was divided into three subcategories: "Expectations and the desire to be independent," "Obstacles to independence," "Concerns about the future." The second category was divided into four subcategories: "People and places," "Opportunities for practice," "Personal attitude" and "Adaptations that facilitate." CONCLUSION: Adolescents' independence in several everyday activities involves physical, socioemotional and environmental aspects. Enabling opportunities for practice, an adapted environment, support from rehabilitation services and developing collaborative relationships with caregivers are elements that may favor the independence of adolescents with CP.

The relationship between adolescents and their caregivers is important in building independence.Interventions centered on educational practices for caregivers of adolescents with cerebral palsy should be encouraged.Environmental facilitators include support from families, friends and therapists.Collaborations among therapists, caregivers and adolescents may promote autonomy.

Autonomy and freedom of choice: A mixed methods analysis of the endorsement of SRHR and its core principles by global agencies.

Based on an adapted version of the conceptual framework used by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR), this study sought to analyse to what extent seven global agencies, five of which belong to the UN family and the other two closely linked, incorporate women's autonomy and freedom of choice in accessing services into their SRHR policies, and how they operationalize these in their global SRHR programmes that target women and adolescent girls. Twenty-nine SRHR-related policy documents published in 2013-2020 and 17 independent evaluations of global SRHR programmes in the same period were analysed. They were found to fall short of considering women's individual autonomy and choice as the two core principles of SRHR. By ignoring autonomy and choice, global SRHR programmes missed the opportunity to incorporate activities that could enhance the emancipatory empowerment of women and girls to improve their sexual and reproductive wellbeing. The study identified concrete aspects on which global agencies, in view of their respective mandates, could have pronounced themselves more explicitly and might have been more effective in implementing SRHR programmes. In light of the international gender equality and women's empowerment discourse this suggests that donor countries could hold global agencies more accountable, bilaterally or jointly, for their SRHR performance, in particular their active endorsement and application of SRHR core principles.

Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa.

Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive in utero treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term. This approach poses considerable physical, social, psychological, and financial challenges for pregnant patients and their families. Furthermore, fetal vessel rupture may lead to severe hypoxic-ischemic injury and consequent neurodevelopmental impairment. Finally, babies delivered early due to vasa previa may face both the short- and long-term consequences of prematurity. Recently, fetoscopic laser photocoagulation using a single-port fetoscope has emerged as a potential therapeutic option for patients with types II and III vasa previa. This innovative approach aims to reduce hospital stays, increases the chance of successful vaginal delivery, and potentially allows pregnancies to reach full term, providing lifelong benefits for the infant. Preliminary clinical studies on human subjects have demonstrated promising results concerning the feasibility, safety, and efficacy of this intervention for a subset of patients with types II and III vasa previa. After reviewing the current state of the art, we argued that offering fetoscopic laser photocoagulation in specialized centers under IRB supervision meets the ethical obligations of beneficence and non-maleficence for both pregnant and fetal patients, as well as the autonomy-based obligations for pregnant patients.

Ethics of Dynamic and Differential Pricing for Cosmetic Procedures.

Patient demand for procedures has increased in the evolving landscape of cosmetic dermatology. This has been fueled, in part, by social media and the growing normalization of cosmetic enhancements; however, this has led some patients to have potentially unrealistic expectations, placing undue pressure on dermatologists to meet these often unrealizable demands. This pressure is further exacerbated by patients who are seen as difficult, demanding, and time-consuming and who may require extensive counseling. Physicians may adopt dynamic or differential pricing strategies to offset the additional time and effort these patients require. We discuss the ethical concerns surrounding these pricing strategies in the cosmetic sphere, highlight the importance of transparency in pricing, and offer suggestions to promote clarity and fairness in cosmetic dermatology practices.

The relationship between attitudes towards professional autonomy and nurse-nurse collaboration: A cross-sectional study.

AIM: This study aimed to determine the relationship between attitudes towards professional autonomy and nurse-nurse collaboration among nurses. BACKGROUND: Professional autonomy is crucial for nurses in today's complex and ever-changing healthcare environment. Therefore, attitudes towards professional autonomy may result in effective collaboration among nurses, one of the nursing roles and responsibilities. METHODS: This descriptive, cross-sectional study was conducted with 685 nurses in four private hospitals affiliated with a university. Descriptive tests, correlation analysis and hierarchical regression analysis were used. An ethics committee approved this study, and the STROBE Statement guidelines for cross-sectional studies were followed. RESULTS: Significant predictors for nurse-nurse collaboration were identified as job-related independence, autonomous clinical judgement and working unit from control variables. CONCLUSION: This study's results provided valuable insights for nurse managers to enhance nurses' attitudes towards professional autonomy and foster collaborative work environments. IMPLICATIONS FOR NURSING: Nurse managers can increase nurses' participation in decision-making processes and allow them to recognize their autonomy and that of their colleagues.