Clinical autonomy and nurse/physician collaboration in emergency nurses

Aim: To investigate clinical autonomy and Nurse/Physician collaboration among emergency nurses and the relationship between these concepts, personal characteristics and organisational influences. Background: Nurses have been identified as having a significant role in addressing the challenges of providing modern healthcare. Emergency nurses have reported competence in a wide range of emergency care skills. However, there is evidence that Emergency Department (ED) nurses may have lower levels of clinical autonomy than other areas of practice. Levels of clinical autonomy appear to be influenced by levels of collaboration with physicians and the organisations in which nurses work Methods: A descriptive correlational study using a survey design with a purposive convenience sample of 141 ED staff nurses (response 70.9%) from 3 EDs in Ireland. Data were collected using the Dempster Practice Behaviours Scale (DPBS) the Nurse/Physician Collaboration Scale (NPCS) and the newly developed Organisational Influences on Nursing Scale. Demographic information was also sought from participants. Results: Participants were largely female (87%), relatively young (mean age 35.57, SD=7.83) and educated to degree level (48%) or higher (31%) with 40% posessing specialist emergency nursing qualifications. Participants reported moderate levels of clinical autonomy and Nurse/Physician collaboration. No relationships were found between sample characteristics and clinical autonomy and Nurse/Physician collaboration among emergency nurses. Relationships were found between levels of clinical autonomy and Nurse/Physician collaboration (r=-0.395, n=100, p<0.001), and organisational influence on nursing (r=0.455, p<0.001) and also between Nurse/Physician collaboration and organisational influence on nursing (r=-0.413, p<0.001). Discussion: Clinical autonomy of nurses has been linked with quality outcomes in healthcare. The quest for quality in modern healthcare in a challenging environment should acknowledge that strategies need to focus beyond education and skills provision and include essential elements such as Nurse/Physician collaboration and the organisational influence on nursing to ensure the greater involvement of nurses in patient care.

Migration: A Heideggerian analysis

The phenomenon of migration has been widely researched by the social sciences. Theories regarding the migrant have been developed in terms of the oppressive social context that is often encountered, proposing different alternatives to understand and overcome such oppression. Through the current project, an alternative view is presented that first, questions the accuracy of the social theories of migration and second, proposes an alternative understanding of this experience. Martin Heidegger’s phenomenology of Being offers a contextualized view of existence that nonetheless includes elements of our experience that are shared due to a common mode of being. I use Heidegger’s philosophy in order to broaden the understanding of the migrant’s experience analyzing those elements that he identifies as shared (for instance: human sociability, a desire for a home, the uncanny, etc.) and comparing them with common issues raised by migrants (identity, homesickness, belonging, etc.). In this way, I intend to present a more complete picture of the experience of migration that considers both empirical evidence of individual migrants and an existential analysis that incorporates the defining elements of our world and our existence as crucial means to understand any experience, including that of migration.