Physician-nurse collaboration in the relationship between professional autonomy and practice behaviors.

BACKGROUND: Nurses and physicians are key members of healthcare teams. While physicians are responsible for the diagnosis and treatment of patients, nurses are part of the treatment and the primary practitioners of patient care. Nurses' professional autonomy, collaboration with physicians, and practice behaviors in treatment and patient care practices are interrelated. OBJECTIVES: In the present study, we examined the mediating effect of physician-nurse collaboration on the relationship between nurses' practice behaviors and their professional autonomy. DESIGN: The present study utilized a cross-sectional survey design following quantitative methods. METHODS: This study was conducted in the Istanbul Province of Turkiye from September to October 2022. The sampling method used was a convenience sampling strategy to provide easier access to participants when selecting nurses from different health institutions. The mean age of the 295 nurses was 31.23 years, with ages ranging from 21 to 59 years. The data analysis was conducted using IBM's SPSS 24.0 software package and the Process Macro 4.0 plug-in. ETHICAL CONSIDERATION: Research ethics approval was obtained from the researcher's university. RESULTS: Physician-nurse collaboration is positively associated with practice behaviors and professional autonomy. Nurses' professional autonomy in practice behaviors through physician-nurse collaboration is significant (95% CI [0.043, 0.135]). DISCUSSION: Our results revealed the relationships among physician‒nurse collaboration, professional autonomy, and practice behaviors among nurses. CONCLUSION: Our results provide evidence on the underlying factors of nurses' practice behaviors in patient care and guide the development of an intervention program to enhance this collaboration. Hospital managers can contribute to a collaborative physician‒nurse working environment.

Ethical challenges in health care during collective hunger strikes in public or occupied spaces.

Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician-striker relationship, (2) balancing of medico-ethical principles in medical decision-making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes.

Beatrice Dorothy Wade: Philosopher, Administrator, and Advocate.

Occupational therapist, Beatrice D. Wade, contributed to occupational therapy through her interest in the philosophy of professional autonomy, in educational program administration and curriculum design, in mental health advocacy and in service to the profession as an office holder during her occupational therapy career spanning the years 1925-1971. The purpose of this article is to document her life, work, and contributions and to summarize her impact on current professional autonomy, and philosophy of education and practice.

Intensive Care Unit Nurses' Professional Autonomy: A Scoping Review.

Intensive care unit (ICU) nurses' professional autonomy is a critical factor affecting their ability to sustainably provide high-quality care to patients who are critically ill and to their families. However, in the absence of a systematic or scoping review of ICU nurses' professional autonomy, limited information and evidence are available on this topic. The aim of this scoping review was to clarify the extent and type of evidence on ICU nurses' professional autonomy. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The following research questions were addressed: (1) Which areas of interest and trends regarding ICU nurses' professional autonomy have been explored in studies published in scientific journals? And (2) What is known about ICU nurses' professional autonomy? The data sources included MEDLINE, CINAHL Ultimate, PsycINFO, Cochrane Library, and Ichushi-Web of the Japan Medical Abstracts Society databases. Identified studies were mapped based on their aim, design, methodology, and key findings and categorized according to their focus areas. Of the 734 identified studies, 16 were analyzed. The identified categories were as follows: "relationship between professional autonomy and mental issues," "experiences and processes of exercising professional autonomy," "relationship between professional autonomy and nurse-physician collaboration," "relationship between professional autonomy and demographic characteristics," "concept of professional autonomy," "barriers to professional autonomy," and "team approach to improve professional autonomy." Most studies have focused on the relationship between professional autonomy and mental health issues and nurse-physician collaboration and few included interventions to enable or promote the exercise of professional autonomy, highlighting a research gap. Future research should identify factors that inhibit the professional autonomy of ICU nurses and that can be changed through interventions and should develop educational and organizational change-based interventions to modify the factors.

Autonomia profissional do enfermeiro na atenção primária à saúde: perspectivas para a prática avançada / Professional autonomy of nurses in primary health care: perspectives for advanced practice / Autonomía profesional de los enfermeros en la atención primaria de salud: perspectivas para la práctica avanzada

Objetivo: Descrever como os enfermeiros atuantes na Atenção Primária identificam sua autonomia profissional no desenvolvimento das práticas de Enfermagem. Métodos: Trata-se de uma pesquisa exploratória, descritiva, de abordagem qualitativa. Participaram de entrevistas online 28 enfermeiros que atuam na Atenção Primária de um município do Sul do Brasil, entre o período de outubro de 2020 até fevereiro de 2021. Para tratamento dos dados, foi utilizada a análise de conteúdo temática. Resultados: Emergiram duas categorias: 1) Resolutividade das práticas da Enfermagem; 2) Respaldo nas regulamentações profissionais e evidências científicas. A Enfermagem dispõe de maior autonomia frente à atenção à saúde da mulher, Infecções Sexualmente Transmissíveis e no cuidado à pessoa com feridas, pois no momento da consulta do enfermeiro, despontam habilidades e competências para a tomada de decisão na prática clínica. Em relação à regulamentação para exercício profissional, os profissionais enfatizaram a importância dos protocolos para respaldar as ações. Conclusão: O protagonismo do enfermeiro e sucesso nas experiências indicam um caminho promissor para a discussão e implementação da Enfermagem de Prática Avançada no Brasil. (AU)

Objective: To describe how nurses working in Primary Care identify their professional autonomy in the development of Nursing practices. Methods: This is an exploratory, descriptive research with a qualitative approach. Twenty-eight nurses who work in Primary Care in a municipality in southern Brazil participated in online interviews, between October 2020 and February 2021. For data processing, thematic content analysis was used. Results: Two categories emerged: 1) Resolving nursing practices; 2) Support in professional regulations and scientific evidence. Nursing has greater autonomy in the care of women's health, Sexually Transmitted Infections and in the care of the person with wounds, because at the time of the nurse's consultation, skills and competences for decision-making in clinical practice emerge. Regarding regulation for professional practice, professionals emphasized the importance of protocols to support actions. Conclusion: The role of nurses and success in the experiences indicate a promising path for the discussion and implementation of Advanced Practice Nursing in Brazil. (AU)

Objetivo: Describir cómo los enfermeros que actúan en la Atención Primaria identifican su autonomía profesional en el desarrollo de las prácticas de Enfermería. Métodos: Se trata de una investigación exploratoria, descriptiva, con abordaje cualitativo. Veintiocho enfermeros que actúan en la Atención Primaria de un municipio del sur de Brasil participaron de entrevistas en línea, entre octubre de 2020 y febrero de 2021. Para el procesamiento de datos, se utilizó el análisis de contenido temático. Resultados: Emergieron dos categorías: 1) Prácticas resolutivas de enfermería; 2) Apoyo en normativa profesional y evidencia científica. La enfermería tiene mayor autonomía en el cuidado de la salud de la mujer, Infecciones de Transmisión Sexual y en el cuidado de la persona con heridas, porque en el momento de la consulta del enfermero emergen habilidades y competencias para la toma de decisiones en la práctica clínica. En cuanto a la regulación para la práctica profesional, los profesionales destacaron la importancia de los protocolos para apoyar las acciones. Conclusión: El papel de los enfermeros y el éxito de las experiencias indican un camino promisorio para la discusión e implementación de la Enfermería de Práctica Avanzada en Brasil. (AU)

Actitud de los fisioterapeutas acerca del acceso directo y su implementación a través de un cambio en la política pública en Puerto Rico / Attitude of physiotherapists about direct access and its implementation through a change in public policy in Puerto Rico

Objetivos: Explorar las actitudes de los fisioterapeutas de Puerto Rico: 1) hacia el acceso directo (AD), 2) las implicaciones para la profesión, la práctica y los servicios de salud, y 3) la implementación del AD a través de un cambio en política pública. Métodos: El diseño fue exploratorio transversal, no experimental y con un enfoque cuantitativo. Los participantes eran fisioterapeutas con licencia vigente, mayores de 21 años de edad, con cualquier grado académico en fisioterapia y que actualmente ejercen la práctica en Puerto Rico. Fueron excluidos fisioterapeutas sin experiencia clínica, que estaban completando un grado doctoral transicional o con experiencia ejerciendo con AD. Para abordar los objetivos de investigación, se construyó un cuestionario, cuyo contenido fue validado por 4 fisioterapeutas expertos utilizando el modelo de Lawshe modificado por Tristán. Resultados: Participaron de este estudio 100 fisioterapeutas. El 96% de los participantes estuvo de acuerdo con la implementación del AD en Puerto Rico. El 83% indicó estar preparado para ejercer la profesión por AD. El 55% entienden que fisioterapeutas con grado doctoral están más preparados para ejercer por AD. El 59% indicó que el AD debe estar restringido por nivel educativo y/o experiencia. Conclusión: La actitud de los fisioterapeutas en Puerto Rico respecto al AD resultó ser favorable, independientemente del grado académico, ya que están a favor con incorporar el AD a la fisioterapia, se sienten preparados para ejercer por AD y consideran el AD beneficioso para los pacientes, la práctica y la profesión. (AU)

Objectives: To explore the attitudes of physiotherapists in Puerto Rico: (1) towards direct access (DA), (2) the implications for the profession, practice, and health services, and (3) the implementation of DA through a change in public policy. Methods: The design was cross-sectional exploratory, non-experimental, and quantitative in nature. Participants were licensed physiotherapists, over 21 years old, with any academic degree in physiotherapy, currently practicing in Puerto Rico. Physiotherapists without clinical experience, those completing a transitional doctoral degree, or with experience practicing with DA were excluded. To address the research objectives, a questionnaire was constructed, whose content was validated by 4 expert physiotherapists using the Lawshe model modified by Tristán. Results: One hundred physiotherapists participated in this study. 96% of participants agreed with the implementation of DA in Puerto Rico. However, only 83% indicated being prepared to practice the profession through DA. 55% understood that physiotherapists with doctoral degrees were better prepared to practice through DA. 59% indicated that DA should be restricted based on educational level and/or experience. Conclusion: The attitude of physiotherapists in Puerto Rico towards DA was favorable regardless of academic degree. They are in favor of incorporating DA into physiotherapy, feel prepared to practice through DA, and consider it beneficial for patients, practice, and the profession. (AU)

The effect of sex, age, work experience, education, shift, and ward on nursing autonomy perceptions.

BACKGROUND: In Italy, cultural and professional nursing improvements are reached thanks to the university-based education which marks the clinical competency and the professional autonomy in nursing decision-making. OBJECTIVE: To highlight how Italian nurses perceived their nursing autonomy level in the main action-points highlighted in the Italian regulation law according to sex, age, work experience, education, shift and ward. METHODS: A cohort explorative study was carried out from September 2022 to January 2023 to highlight how Italian nurses perceived their nursing autonomy levels in the main action-points highlighted in the Italian regulation law for the nursing profession according to demographic characteristics, like: gender, age, work of experience, education, shift, ward employment. RESULTS: A total of 403 nurses were enrolled. Significant differences were recorded in: decision-making authority in patient care and shift (p≤0.001) and ward employment (p = 0.045); ability to initiate nursing interventions and education (p < 0.001) and ward employment (p = 0.011); collaboration and communication with healthcare team members and education (p < 0.001) and ward employment (p = 0.010); independence in clinical judgment and critical thinking and shift (p < 0.001); responsibility for the planning and evaluation of nursing care and education (p = 0.005) and shift (p = 0.002) and ward employment (p = 0.013); autonomy in professional development and continuing education and shift (p < 0.001) and ward employment (p < 0.001). CONCLUSIONS: The results highlighted the intricate world both of the healthcare surrounding and the abilities to act autonomously within the multiprofessional staff. Future studies will develop qualitative and phenomenological designs in order to better define in which fields nurses will act their professional autonomy.

'We're at war.' Healthcare workers' experience with organisational change, uncertainty and vaccine hesitancy in 2021 and 2022 during the COVID-19 vaccination programe in Poland.

This article analyses the organisation of the mass COVID-19 vaccination programme in Poland and its consequences for various aspects of the social identity of healthcare workers (HCWs). Based on 31 in-depth interviews with HCWs, our study reveals the following: (1) Certain elements of the programme (inclusion of other healthcare professionals like pharmacists and laboratory diagnosticians as vaccinators) and the provision of additional infrastructure (pharmacies and shopping malls) may prompt scepticism and criticism in physicians and nurses who feel challenged about their professional autonomy and hierarchies; (2) Given the high levels of professional uncertainty, the implementation of the COVID-19 vaccination is forcing HCWs to revise their attitude to medical standards, resulting in specific responses and adaptation strategies (ranging from the active involvement in the programme due to the sense of mission, to more or less evident scepticism); and (3) Confronting vaccine hesitancy, both among patients and other HCWs, contributes to the feeling of helplessness, leading to criticism of policymakers.

Nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents- a qualitative study.

BACKGROUND: Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto's theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. METHODS: This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method. RESULTS: The content analysis generated five categories that were labelled similar to Tronto's five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses' autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto's theory contributes to greater reflectiveness around what may constitute 'good' end-of-life care. CONCLUSIONS: Tronto's care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto's care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what 'good' end-of-life care should be.

Kinesiología como Programa de Investigación. Una Reflexión respecto a Identidad / Physical therapy as a research program. Ideas regarding professional identity

La Kinesiología chilena ha tenido un desarrollo científico sostenido, particularmente durante las últimas décadas. Este desarrollo ha promovido progresivamente el posicionamiento de kinesiólogos y kinesiólogas como profesionales de la salud dentro de la comunidad, los cuales tienen como fundamento el estudio y aplicación de conocimiento relacionado al movimiento humano. Sin embargo, este desarrollo no ha sido azaroso, sino más bien ha respondido a la creciente actividad científica de los integrantes de la comunidad kinesiológica, además de la cada vez más indispensable utilización de información científica para la toma de decisiones clínicas. Por tanto, el presente artículo discute dos formas de analizar el desarrollo de las disciplinas científicas, y plantea que la kinesiología puede considerarse un programa de investigación, definición desde la cual se pueden analizar los desafíos actuales y futuros respecto al dinamismo necesario de la ciencia y el cómo la kinesiología se relaciona con otras disciplinas para potenciar su crecimiento, sin caer en la redundancia y/o repetición disciplinar.

The physical therapy in Chile has had sustained scientific development, particularly during the last decades. This development has progressively promoted the positioning of physical therapists as health professionals within the community, whose foundation is the study and application of knowledge related to human movement. However, this development has not been random, but rather has responded to the growing scientific activity of members of the physical therapy community, in addition to the essential use of scientific information for clinical decision making. Therefore, this article discusses two ways of analyzing the development of scientific disciplines and proposes that physical therapy can be considered a research program, a definition from which current and future challenges can be analyzed regarding the necessary dynamism of science, and how physical therapy relates to other disciplines to enhance their growth, without falling into professional redundancy and/or repetition.

Autonomia do enfermeiro no exercício das práticas de enfermagem na atenção primária à saúde / Nurses autonomy in the exercise of nursing practices in primary health care / Autonomía de las enfermeras en el ejercicio de las prácticas de enfermería en la atención primaria de salud

Objetivo: Compreender a autonomia do enfermeiro quanto as suas responsabilidades normativas legais no exercício das práticas de enfermagem na Atenção Primária à Saúde (APS) do Pará. Métodos: Estudo observacional, de delineamento transversal qualitativo, realizado em três municípios do estado do Pará. A coleta de dados foi realizada de outubro de 2020 a janeiro de 2021. Os participantes foram os enfermeiros da Atenção Primária à Saúde. Foi realizada entrevista, com roteiro semiestruturado. Foi realizada análise temática dos conteúdos, com auxílio da ferramenta IRaMuTeq Resultados: Emergiram cinco categorias temáticas: 1) Autonomia do enfermeiro no contexto da prescrição de outro profissional na APS; 2) Autonomia para prescrição nos programas e exames na APS; 3) Áreas de identificação da autonomia profissional na APS; 4) As práticas preventivas na APS e suas dificuldades; e 5) Limites da prática profissional do enfermeiro na APS. Conclusão: Os enfermeiros da APS do Pará têm práticas de enfermagem individuais com diferentes tipos de autonomia, cujos cuidados colocam em prática com o respaldo dos protocolos e regulamentos técnicos. Contudo, há necessidade de ampliar e fortalecer parcerias com outros atores sociais municipais. (AU)

Objective: To understand the autonomy of nurses regarding their legal regulatory responsibilities in the exercise of nursing practices in Primary Health Care (PHC) in Pará. Methods: Observational study with qualitative cross-sectional design, conducted in three municipalities of the state of Pará. Data collection was carried out from October 2020 to January 2021. The participants were Primary Health Care nurses. Interviews were conducted, with a semi-structured script. A thematic analysis of the contents was performed, with the help of the IRaMuTeq tool. Results: Five thematic categories emerged: 1) Nurses' autonomy in the context of another professional's prescription in PHC; 2) Autonomy for prescription in programs and exams in PHC; 3) Areas of identification of professional autonomy in PHC; 4) Preventive practices in PHC and their difficulties; and 5) Limits of nurses' professional practice in PHC. Conclusion: PHC nurses in Pará have individual nursing practices with different types of autonomy, whose care they put into practice with the support of protocols and technical regulations. However, there is a need to expand and strengthen partnerships with other municipal social actors. (AU)

Objetivo: Comprender la autonomía de los enfermeros en cuanto a sus responsabilidades normativas legales en el ejercicio de las prácticas de enfermería en la Atención Básica a la Salud (APS) en Pará. Métodos: Estudio observacional, con diseño transversal cualitativo, realizado en tres municipios del estado de Pará. La recolección de datos se realizó de octubre de 2020 a enero de 2021. Los participantes fueron enfermeros de la Atención Primaria de Salud. Se realizó una entrevista, con un guión semiestructurado. Se realizó un análisis temático de dos contenidos, con la ayuda de la herramienta IRaMuTeq. Resultados: Emergieron cinco categorías temáticas: 1) Autonomía del enfermero en el contexto de la prescripción de otro profesional en la APS; 2) Autonomía para prescribir programas y exámenes en la APS; 3) Áreas de identificación de la autonomía profesional en APS; 4) Prácticas preventivas en APS y sus dificultades; y 5) Límites del ejercicio profesional de enfermería en la APS. Conclusión: Los enfermeros de la APS de Pará tienen prácticas de enfermería individuales con diferentes tipos de autonomía, cuyo cuidado está sustentado por dos protocolos y normas técnicas. Sin embargo, existe la necesidad de ampliar y fortalecer las alianzas con otros socios municipales. (AU)

Um olhar sobre a autonomia: percepções de enfermeiras sobre suas práticas na atenção primária / A look at autonomy: nurses' perceptions about their practices in primary care / Una mirada a la autonomía: percepciones de los enfermeros sobre sus prácticas en la atención primaria

Objetivo: Analisar a percepção de enfermeiras sobre a autonomia no exercício de suas práticas no contexto da atenção primária à saúde. Métodos: Estudo descritivo de abordagem qualitativa que analisou 108 entrevistas realizadas com enfermeiras(os) das quatro capitais da região sudeste do Brasil. As entrevistas, guiadas por roteiro semiestruturado, foram gravadas e transcritas. Os dados produzidos foram tratados e explorados com auxílio do software NVIVO®. Resultados: A maior parte das participantes eram mulheres, brancas, residiam na mesma cidade onde trabalham, graduaramse em instituições privadas. Foram organizadas duas categorias: repercussões da autonomia e seus desdobramentos para a resolutividade das necessidades em saúde dos usuários; e (des)conhecimento sobre a regulamentação das práticas da enfermeira: desafios para a autonomia. Conclusão: As enfermeiras compreendem a importância da autonomia para suas práticas, mas enfrentam interferências no cotidiano do trabalho, tanto por parte da gestão, da estrutura dos serviços ou da necessidade do uso de protocolos que garantam o exercício de sua atividade profissional de modo autônomo. (AU)

Objective: To analyze nurses' perception of autonomy to exercise their practices in the context of primary health care. Methods: A descriptive study with a qualitative approach that analyzed 108 interviews carried out with nurses from the four capitals of the southeastern region of Brazil. The interviews, guided by a semi-structured script, were recorded and transcribed. The data produced were processed and explored with the help of the NVIVO® software. Results: Most of the participants were women, white, lived in the same city where they work, and graduated from private institutions. Two categories were organized: repercussions of autonomy and its consequences for solving users' health needs; and (lack of) knowledge about the regulation of nursing practices: challenges for autonomy. Conclusion: Nurses understand the importance of autonomy for their practices, but they face interference in their daily work, either by management, the structure of services or the need for protocols that guarantee the exercise of their professional activity. (AU)

Objetivo: Analizar la percepción de autonomía de los enfermeros para ejercer sus prácticas en el contexto de la atención primaria de salud. Métodos: Estudio descriptivo con enfoque cualitativo que analizó 108 entrevistas realizadas con enfermeros de las cuatro capitales de la región sureste de Brasil. Las entrevistas, guiadas por un guión semiestructurado, fueron grabadas y transcritas. Los datos producidos fueron procesados y explorados con la ayuda del software NVIVO®. Resultados: La mayoría de los participantes eran mujeres, de raza blanca, vivían en la misma ciudad donde trabajan y egresaron de instituciones privadas. Se organizaron dos categorías: repercusiones de la autonomía y sus consecuencias para la solución de las necesidades de salud de los usuarios; y (falta de) conocimiento sobre la regulación de las prácticas de enfermería: desafíos para la autonomía. Conclusión: Los enfermeros comprenden la importancia de la autonomía para sus prácticas, pero enfrentan interferencias en su trabajo diario, ya sea por parte de la dirección, la estructura de los servicios o la necesidad de protocolos que garanticen el ejercicio de su actividad profesional. (AU)

Trabalho interdisciplinar e condições de trabalho de enfermeiros que atuam na atenção primária à saúde / Interdisciplinary work and working conditions of nurses working in primary health care / Trabajo interdisciplinario y condiciones de trabajo de los enfermeros que actúan en la atención primaria de salud

Objetivo: Discutir acerca do trabalho interdisciplinar na prática do enfermeiro na Atenção Primária à Saúde e as suas condições de trabalho. Métodos: Pesquisa descritiva, qualitativa, realizada com 45 profissionais Enfermeiros, que atuam na Atenção Primária à Saúde do estado da Paraíba, de dezembro de 2020 a abril de 2021. A coleta de dados foi guiada por um roteiro semiestruturado. Os dados foram interpretados com base na Análise de Conteúdo e discutidos a partir da literatura existente. Resultados: Evidenciou-se que, apesar de os enfermeiros conseguirem firmar parceria com os outros trabalhadores da unidade, usuários e gestão, e sentirem autonomia para realizar procedimentos, existem condições que dificultam suas práticas, como o pouco reconhecimento profissional, os problemas com a gestão, a falta de insumos e a sobrecarga de função. Conclusão: Os enfermeiros na Atenção Primária vêm buscando seu espaço e melhores condições de trabalho que facilitem suas práticas e favoreçam o cuidado ao usuário. Dessa forma, tais profissionais necessitam de visibilidade e reconhecimento social de suas competências técnicas. (AU)

Objective: Discuss about the interdisciplinary work in the practice of nurses in Primary Health Care and their working conditions. Methods: Descriptive, qualitative research, carried out with 45 professional nurses, who work in Primary Health Care in the state of Paraíba, from December 2020 to April 2021. Data collection was guided by a semi-structured script. Data were interpreted based on Content Analysis and discussed from the existing literature. Results: It was evidenced that, although the nurses manage to establish a partnership with the other workers of the unit, users and management, and feel autonomy to carry out procedures, there are conditions that hinder their practices, such as little professional recognition, problems with management, the lack of inputs and the function overload. Conclusion: Nurses in Primary Care have been seeking their space and better working conditions that facilitate their practices and favor user care. Thus, such professionals need visibility and social recognition of their technical skills. (AU)

Objetivo: Discutir sobre el trabajo interdisciplinario en la práctica de los enfermeros en la Atención Primaria de Salud y sus condiciones de trabajo. Métodos: Investigación descriptiva, cualitativa, realizada con 45 enfermeros profesionales, que actúan en la Atención Primaria de Salud en el estado de Paraíba, de diciembre de 2020 a abril de 2021. La recolección de datos fue guiada por un guión semiestructurado. Los datos fueron interpretados con base en el Análisis de Contenido y discutidos a partir de la literatura existente. Resultados: Se evidenció que, aunque los enfermeros logran establecer una sociedad con los demás trabajadores de la unidad, usuarios y gerencia, y sienten autonomía para realizar los procedimientos, existen condiciones que dificultan sus prácticas, como poco reconocimiento profesional, problemas con la gestión, la falta de insumos y la sobrecarga de funciones. Conclusión: Los enfermeros en Atención Básica vienen buscando su espacio y mejores condiciones de trabajo que faciliten sus prácticas y favorezcan la atención al usuario. Por lo tanto, estos profesionales necesitan visibilidad y reconocimiento social de sus habilidades técnicas. (AU)

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study.

BACKGROUND: Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction. METHODS: A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction. RESULTS: Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction. CONCLUSION: Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Attitudes of the public and medical professionals toward nurse prescribing: A text-mining study based on social medias.

Objectives: This study aimed to explore the public and medical professionals' concerns and attitudes toward nurse prescribing using text-mining method to analyze social media data. Methods: Python was used to automatically mine data related to the keywords "nurse prescribing" and "prescription" that were posted on four Chinese internet platforms between January 1, 2017, and November 1, 2022. The four Chinese internet platforms included social media sites such as Zhihu and Weibo, as well as medical forums like Aiaiyi Medical Hotspot and Dingxiangyuan Medicine. We conducted personnel, topic, and sentiment analysis techniques using SnowNLP, Bayesian Latent Dirichlet Allocation (LDA), and BosonNLP. Finally, we conducted content analysis using Nvivo 11 based on the results of the topic and sentiment analysis to obtain comprehensive and insightful results. Results: We acquired 2,823 comments totaling 92,859 words on the four Internet platforms to conduct analysis. The analyze result showed that many public and medical professionals held a negative attitude toward nurse prescribing, and few had a prudent positive attitude. The public is concerned about the impact of nurse prescribing on medical professionals and the competency requirements for nurses. Medical professionals are concerned about the current and future status of nurse prescribing in China and the difficulties in implementing nurse prescribing. Conclusion: Nurses should gradually gain recognition for their expertise and win the acceptance of the public and medical professionals on their ability of nursing prescribing by striving to enhance their professional capacity and self-authorization capabilities. Nurse administrators and educators need to recognize the advantages of nurse prescribing and address the challenges and issues in its implementation through promoting legislation, education, and heightening public awareness of its benefits.

How artificial intelligence is reshaping the autonomy and boundary work of radiologists. A qualitative study.

The application of artificial intelligence (AI) in medical practice is spreading, especially in technologically dense fields such as radiology, which could consequently undergo profound transformations in the near future. This article aims to qualitatively explore the potential influence of AI technologies on the professional identity of radiologists. Drawing on 12 in-depth interviews with a subgroup of radiologists who participated in a larger study, this article investigated (1) whether radiologists perceived AI as a threat to their decision-making autonomy; and (2) how radiologists perceived the future of their profession compared to other health-care professions. The findings revealed that while AI did not generally affect radiologists' decision-making autonomy, it threatened their professional and epistemic authority. Two discursive strategies were identified to explain these findings. The first strategy emphasised radiologists' specific expertise and knowledge that extends beyond interpreting images, a task performed with high accuracy by AI machines. The second strategy underscored the fostering of radiologists' professional prestige through developing expertise in using AI technologies, a skill that would distinguish them from other clinicians who did not pose this knowledge. This study identifies AI machines as status objects and useful tools in performing boundary work in and around the radiological profession.

Autonomy of Nursing Students: Methodological Study of Validation of the PALOP Scale Portuguese Short Version.

The cultivation of critical thinking and decision-making skills promotes student autonomy. Only a few instruments measure nursing students' autonomy, and the PALOP® Scale is one of them. This study aimed to semantically and culturally adapt the PALOP® Scale to European Portuguese and assess the psychometric properties of a short version. A methodological study was conducted with 530 second and fourth-year undergraduate nursing students. Content validity was assessed using exploratory and discriminant factor analysis, and reliability was determined through analyses of internal consistency, temporal stability, and floor and ceiling effects. The analysis of the psychometric properties of a short version of the PALOP®-PT Scale revealed complete agreement (100%) among panel members for content validity. The scale also showed discriminative capacity among second- and fourth-year students (t (528) = -7.907, p < 0.001) with a five-factor structure, with a total explained variance of 57.2%. Reliability analysis showed excellent internal consistency (α = 0.935) and moderate temporal stability (95% ICC (3.1) = 0.520 [0.290-0.693], p < 0.01). The short version of the PALOP®-PT Scale is a promising tool to assess nursing students' perceived autonomy and identify necessary adjustments to their professional identity.

"I didn't know anything, but I learned over time": The process of nurses attaining autonomy in Intensive Care Units / "No sabía nada, con el tiempo lo aprendí": El proceso de los enfermeros de alcanzar la Autonomía en Unidades de Cuidado Intensivos / "Não sabia nada, com o tempo aprendi": O processo de autonomia do enfermeiro em Unidade de Terapia Intensiva

Objective. Understand the social processes experienced by nursing professionals and the meanings underlying autonomy in adult Intensive Care Units in the city of Cartagena (Colombia). Methods. A qualitative study with a grounded theory approach was conducted. Fifteen semi-structured interviews were carried out with nursing professionals, and the analysis was based on the coding technique proposed by Strauss & Corbin. Results. Of the respondents, fourteen were female and one was male, with ages ranging from 23 to 57 years. Experience in intensive care units ranged from 1 to 28 years, and none had postgraduate studies. After thematic analysis, the central category was obtained from four categories: adaptation process, applicability of autonomy exercise, building autonomous competence, and limitations to the exercise of autonomy. Conclusion. Nursing professionals achieve their autonomy through a social process, based on different stages of learning when facing the environment of the units. It is grounded in decision-making and the power to act freely. However, barriers continue to hinder it, including limitations imposed by institutions, protocol-based interventions, social status, and individual differences among professionals.

Objetivo. Comprender el proceso social que viven los profesionales de enfermería y los significados que subyacen a la autonomía en las Unidades de Cuidados Intensivos adultos en la ciudad de Cartagena (Colombia). Métodos. Estudio cualitativo con enfoque de la teoría fundamentada, se realizaron quince entrevistas semiestructuradas en profesionales de enfermería, el análisis se realizó basado en la técnica de codificación propuesta por Strauss y Corbin. Resultados. Los entrevistados eran catorce de sexo femenino y uno de sexo masculino, con edades entre los 23 y 57 años, la experiencia en unidades de cuidados intensivos oscilo entre 1 y 28 años y ninguno conto con estudios de posgrados. Tras el análisis temático se obtuvo la categoría central "Cuando yo entré no sabía, con el tiempo lo aprendí" a partir de cuatro categorías: proceso de adaptación; aplicabilidad ejercicio de la autonomía; construyendo la competencia autónoma; y limitaciones para el ejercicio de la autonomía. Conclusión. El profesional de enfermería logra su autonomía a través de un proceso social, basado en diferentes etapas de aprendizaje al enfrentarse al ambiente de las unidades, se sustenta en la toma de decisiones y el poder de hacer las cosas de forma libre. Sin embargo, existen barreras que la siguen obstaculizando, entre ellas las limitaciones dadas por las instituciones, intervenciones basadas en protocolos, el estatus social y la individualidad entre los profesionales.

Objetivo. Compreender o processo social vivenciado pelos profissionais de enfermagem e os significados subjacentes à autonomia nas Unidades de Terapia Intensiva adulto da cidade de Cartagena (Colômbia). Métodos. Estudo qualitativo com abordagem da teoria fundamentada, foram realizadas quinze entrevistas semiestruturadas com profissionais de enfermagem, a análise foi realizada com base na técnica de codificação proposta por Strauss y Corbin. Resultados. Os entrevistados foram quatorze mulheres e um homem, com idade entre 23 e 57 anos, a experiência em unidades de terapia intensiva variou entre 1 e 28 anos e nenhum possuía pós-graduação. Após a análise temática, obteve-se a categoria central "Quando entrei não sabia, aprendi com o tempo" a partir de quatro categorias: processo de adaptação; aplicabilidade exercício de autonomia; construção de competência autônoma; e limitações para o exercício da autonomia. Conclusão. O profissional de enfermagem conquista sua autonomia por meio de um processo social, baseado em diferentes etapas de aprendizagem diante do ambiente das unidades, baseado na tomada de decisão e no poder de fazer livremente. No entanto, existem barreiras que continuam a dificultá-lo, incluindo limitações dadas pelas instituições, intervenções baseadas em protocolos, status social e individualidade entre os profissionais.

Full practice authority and burnout among primary care nurse practitioners.

BACKGROUND: Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. PURPOSE: Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. METHODS: In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. DISCUSSION: Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant. CONCLUSION: NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.