Patient autonomy

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Objective: to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method: this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results: there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion: the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.
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Questões éticas referentes às preferências do paciente em cuidados paliativos

Questões éticas referentes às preferências do paciente em cuidados paliativos

The respect for patient’s autonomy is an ethical principle recognized in many areas of health care including palliative care, but not always the patient’s preferences are respected. A better understanding of ethical is- sues related to the exercise of patient’s autonomy in Palliative Care is an important step to support ethical judgments in daily practice. Therefore, this study aimed to identify and analyze ethical issues related to pa- tient preferences recognized by professionals in the daily life of a Palliative Care team under the framework of Casuistry. Eleven practitioners were interviewed. The main ethical issues identified are: respect for patient autonomy, veracity and right to information, communication skills, conspiracy of silence, participation in the deliberation process, choice of place of treatment and death.
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Rev. Col. Bras. Cir.  vol.41 número5

Rev. Col. Bras. Cir. vol.41 número5

The principle of patient autonomy is a cornerstone of bioethics. According to this concept, patients should be given the power to make decisions related to their treatment. It is an important component of modern medical ethics, which has received much interest in current literature. However, the rate of participation of patients and their willingness to participate are variable according to the cultural, social and family environments in which they are inserted. The aim of this paper is to promote a brief descriptive review on autonomy, the preferences of patients and the use of informed consent as an instrument for the exercise of autonomy in literature, and to stress the lack of debate, as well as the pressing need for discussion of these current issues nationwide.
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Uso abusivo e dependência de drogas lícitas: uma visão bioética

Uso abusivo e dependência de drogas lícitas: uma visão bioética

The undue consumption of legal drugs, particularly medications, increases significantly worldwide. This study aims at addressing issues involving medications abusive use and addiction, from bioethics’ perspective. It consists of a critical review from the SciVerse Scopus and Virtual Health Library (VHL) databases. After reading the selected material, some bioethical dilemmas were identified in professional-patient relationship, in research with humans and, finally, in the interests of the mar]et. We conclude that the main findings refer to the power of media influence defining patterns of medications consumption, to the loss of patient autonomy when he becomes abusive or dependent user, interfering in his trust relationship with the health professional, besides the economic interests of pharmaceutical companies related to clinical trials and the manipulation due to personal interests of some health professionals.
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Bio-ethical principles of medical law with an emphasis on the law of Iran

Bio-ethical principles of medical law with an emphasis on the law of Iran

In recent years, a change has occurred in medical from a paternalistic model to patient's autonomy. Medical paternalism was based on this idea that the doctor knows best in case of patient's own interest even compared to patient him/herself, but the patient autonomy is based on the assumption that a patient with legal capacity must have an almost absolute right to refuse medical treatment. However, it is wrong to consider patient autonomy as a superior value in all medical decisions. Patient autonomy is a negative right to prevent forced interventions, but the patients do not have the right to demand any type of medical treatment in all circumstances and with whatever means or ask for a treatment which is contrary to the clinical judgment of doctors or is morally rejected by legislators or considered to be illegal like simulation and female circumcision.
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Rev. Bras. Ginecol. Obstet.  vol.38 número1

Rev. Bras. Ginecol. Obstet. vol.38 número1

Abstract Objective Patient autonomy has great importance for a valid informed consent in clinical practice. Our objectives were to quantify the domains of patient autonomy and to evaluate the variables that can affect patient autonomy in women with chronic pelvic pain. Methods This study is a cross sectional survey performed in a tertiary care University Hospital. Fifty-two consecutive women scheduled for laparoscopic management of chronic pelvic were included. Three major components of autonomy (competence, information or freedom) were evaluated using a Likert scale with 24 validated affirmatives. Results Competence scores (0.85 vs 0.92; p ¼ 0.006) and information scores (0.90 vs 0.93; p ¼ 0.02) were low for women with less than eight years of school attendance. Information scores were low in the presence of anxiety (0.91 vs 0.93; p ¼ 0.05) or depression (0.90 vs 0.93; p ¼ 0.01).
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LOCAL BORROWING AUTONOMY AS PART OF FISCAL DECENTRALIZATION PROCESS

LOCAL BORROWING AUTONOMY AS PART OF FISCAL DECENTRALIZATION PROCESS

When analyzing the fiscal decentralization process, an important component is the local governments’ autonomy, which can be described by spending and tax autonomy, as well as by borrowing autonomy. To avoid excessive local public debt, all the EU Member States have imposed some restrictions for local governments in accessing loans. In the context of the current sovereign debt crisis, the control over sub-national borrowing becomes increasingly important. Romania, scoring 1,85 points on the Borrowing Autonomy Index granted local governments limited borrowing power, yet higher than some more developed countries such as Ireland, United Kingdom or Denmark. In the case of the EU Member States considered for our analysis we observe that between sub-national tax autonomy (Crâúneac, Heteú and Miru 2011) and borrowing autonomy is a strong connection observed among some Member States like France and Sweden. However, between the degree of decentralization, expressed by sub-national governments share in total public spending, and borrowing autonomy there is no direct relationship, some states with high degree of decentralization giving local authorities limited borrowing autonomy.
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IMPLICATIONS OF AUTONOMY IN LEARNING MANAGING IN VIRTUAL ENVIRONMENT

IMPLICATIONS OF AUTONOMY IN LEARNING MANAGING IN VIRTUAL ENVIRONMENT

Fonseca   (1998,   p.   315)   recalls   that   teachers   accuse   students   of   not   having   consistent   training   actions   and   therefore   it   would   interfere   with   the   conduction   of   autonomous   learning   management.  However,  according  to  the  author,  the  teacher  is  the  instructor  of  the  future  and   has  the  obligation  to  prepare  students  to  think,  to  learn  how  to  be  flexible,  in  other  words,  to  be   able  to  survive  in  our  village  of  accelerated  information.    Therefore,  it  is  the  role  of  educators  to   plan   their   training   activities   with   the   focus   on   mediation   and   education   process   so   that   the   teaching  role  connect  to  the  availability  of  content  and  the  interests  and  needs  of  learners.   We  do  not  take  the  importance  of  content,  even  because  it  is  the  raw  material  for  knowledge   construction,  but  it  is  necessary  to  review  the  aims  and  methods  for  valuing  learning.  Thus,  it  is   understood   that   teaching   will   contribute   to   the   construction   of   autonomy   of   thought   and   learning  self-­‐regulation.  However,  the  contents  systematized  in  textbooks  need  to  be  seen  as  a   source   of   information   that   disputes   space   with   so   many   other   sources.   This   diversity   brings   different  challenges  for  teachers  and  exposes  the  student  to  new  challenges  for  the  construction   of  learning.  As  strange  or  challenging  as  it  may  seem  to  the  teachers  trained  through  manuals,   this  "lack  of  logic"  in  unstructured  information  requires  students  to  learn  how  to  learn  in  order  to   be   able   to   continue   the   knowledge   construction.   Moreover,   today's   society   demands   from   students  to  be  able  to  develop  strategies  to  solve  unforeseen  facts,  uncertainties  or  unexpected   with  the  information  available  and  the  scope  of  their  learning  competencies  (Morin,  2001).  Thus,   it  can  be  said  that  autonomy  is  built  through  the  learning  process  and  is  an  exercise  of  power   activation  through  the  knowledge  and  the  ability  to  use  them  today.    
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The relationship of autonomy and integrity in medical ethics

The relationship of autonomy and integrity in medical ethics

There can be no question of the impor- tance of the sociopolitical, legal, and moral emphasis on autonomy in pro- tecting the patient’s right of self-deter- min[r]

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Participation and relative autonomy in the EBC’s Curator’s Council

Participation and relative autonomy in the EBC’s Curator’s Council

This paper aims to analyze the acting of the Curator’s Council of Empresa Brasil de Co- municação (EBC), the main space of civil society participation of the communication company of public service in the country. From the analysis of documents, it seeks to analyze the profile of the actors who take part of the Curator’s Council and the segments of civil society they represent, reflecting on the relative autonomy of the organism. In addition, it is adopted a content analysis of the debates about the EBC work plans in order to think about the participation of the actors in the deliberations of the Curator’s Council. In this sense, it is adopted a maximalist perspective of participation, understanding that it goes beyond the interaction with the content, in the media sphere. Similarly, it is understood the limitations of the representation process and, therefore, the proposal is to reflect on what groups can take part of this space, since the beginning of EBC until today. Furthermore, it is understood that the process of participation of civil society and the autonomy of the Curator’s Council reflect on the relative autonomy of the enterprise as a whole.
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Autonomy in the post mortem organ donation in Brazil

Autonomy in the post mortem organ donation in Brazil

In this case, the authors argue, the resolution would be contrary to the current Transplantation Law, which determines family authorization. In his words, the manifestation of organ donation in ADW would generate a clash of institutes and, in addition, would denature the ADW, since they are, in essence, a legal business, with inter vivos effects, with the main objective to guarantee the autonomy of the subject to the treatment to which she/he will be subjected in the event of termination of life  36 . In

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Autonomy development and the classroom: reviewing a course syllabus

Autonomy development and the classroom: reviewing a course syllabus

We started by presenting the concept of teacher autonomy that underlied V1. After reviewing more recent literature we assumed the original definition of teacher autonomy could still inform V2, but we realized that placing a focus on teachers’ autobiographical narratives would possibly be a good decision to give voice to the teachers. Based on this latter assumption, we showed that V2 still deals with course planning and materials preparation but there is a shift in focus. Teacher students’ stories, identities and context of work became the starting point and not aspects to be considered while we deal with the contents and pedagogical activities within the course. This seems to have made a difference concerning the opportunity to give teachers a voice in the development of their autonomy. We also explained within the paper that some aspects that were not looked at properly in V1 received more attention in V2. Teacher students’ views concerning language, language teaching/learning and education are dealt with in the first unit of the module. Participants are requested to read some texts about those topics and to reflect about their own positions in relation to them. They are also requested to include their thoughts about that in the autobiographical narratives they are writing.
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of nursing care in the perspective of professional autonomy

of nursing care in the perspective of professional autonomy

The teaching strategy considered by nurses as the most important was the one developed in groups. Regarding the tools in the pursuit of knowledge, they highlighted: sharing of experiences with colleagues, doing courses and studying books. It was noticed that nurses used group strategies to strengthen their knowledge in the search for professional nursing autonomy, which is gained through knowledge acquisition and group actions. Therefore, we consider that developing continuing education activities to ensure improvements in nursing care is essential.

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Repositório Institucional da UFPA: A model for the enhancement of autonomy

Repositório Institucional da UFPA: A model for the enhancement of autonomy

The data collected in the project has yielded papers, dissertations, and conference presentations, but more has to be done. Some research results have already come to light (Castro & Magno e Silva 2007; Costa, A.C., 2005; Magno e Silva 2004, 2006; Moreira 2007; Nascimento 2007; Niwa & Santos 2005; Piedade 2004; Porto 2005). In the first semester of 2007, the project hosted monthly coloquia, on themes like affect in language learning, awareness and self-monitoring strategies, narrative studies, and the teachability of autonomy, all of which gathered some public and proved to be important for studies development. Whenever there is an opportunity for presenting workshops, giving lectures or other academic activities, members of the group have taken a stand. We have also tried to extensively participate in local, national and international events, failing to attend only because of time or funding constraints.
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Towards Autonomy, Self-Organisation and Learning in Holonic Manufacturing

Towards Autonomy, Self-Organisation and Learning in Holonic Manufacturing

The proposed adaptive control splits the control evolution into alternative states: stationary state, where the behaviour of the system uses coordination levels and the supervisor role to get global optimisation of the production process, and the transient state, triggered with the occurrence of disturbances and presenting a behaviour quite similar to the heterarchical approach in terms of agility to react to disturbances. In stationary state the autonomy factor of each operational holon is {Low}, allowing the operational holon to follow the schedule proposals sent by the supervisor holon. In this state, aiming the global production optimisation, the holons are organised in a federated architecture, with the supervisor holons interacting directly with the task holons during the operation allocation process. The supervisor holon, as coordinator, elaborates optimised schedule plans that proposes to the task holons and to the operational holons under its coordination domain [10]. The operational holons see these proposals as advices, having enough autonomy to accept or reject the proposed schedule. After the allocation of the manufacturing operations, the task holons interact directly with the operational holons during the execution of the operations, such as to ask for availability of space in the buffer.
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PATIENT SAFETY AND HEALTHCARE-ASSOCIATED INFECTIONS

PATIENT SAFETY AND HEALTHCARE-ASSOCIATED INFECTIONS

Health care-associated infections affect hundreds of millions of people each year worldwide. No health-care system is spared. The WHO World Alliance for Patient Safety has chosen the prevention of health care-associated infection as the first Global Patient Safety Challenge. Success relies more on the willingness of human nature to change and accept changes than on systems and economic constraints.

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MAKING SENSE OF AUTONOMY IN INFORMATION ONLINE JOURNALISM IN CHIAPAS

MAKING SENSE OF AUTONOMY IN INFORMATION ONLINE JOURNALISM IN CHIAPAS

Este artículo es producto de una investigación hecha en el 2010, en la que se analizó la influencia del EZLN en la elaboración de un sentido autonómico en el periodism[r]

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Abstract Autonomy in the post mortem organ donation in Brazil

Abstract Autonomy in the post mortem organ donation in Brazil

4º da Lei nº 9.434, de 4 de fevereiro de 1997, que dispõe sobre a remoção de órgãos, tecidos e partes do corpo humano para fins de transplante e tratamento [Internet]. Diário Oficial d[r]

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Abstract Autonomy in the post mortem organ donation in Brazil

Abstract Autonomy in the post mortem organ donation in Brazil

Altera dispositivos da Lei nº 9.434, de 4 de fevereiro de 1997, que dispõe sobre a remoção de órgãos, tecidos e partes do corpo humano para fins de transplante e tratamento [Internet].[r]

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Assessment Of Patient Problems Encountered With Total Hip Replacement At Baghdad Teaching Hospitals

Assessment Of Patient Problems Encountered With Total Hip Replacement At Baghdad Teaching Hospitals

[6] Arden, NK.; Kiran, A.; Judge, A.; Biant, LC.; Javaid, MK.; Murray, DW.; Carr, AJ.; Cooper, C.; Field, RE.: What is a good patient reported outcome after total hip replacement?, National Library of Medicine, Vol. 19(2), 2011, pp: 155-62.

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