Why autonomy is important in nursing

Conclusions: Authority of total patient care, the power to make decisions in a relationship with the patient and next of kin and the freedom to make clinical judgements, choices and actions seem to be connected to the meaning of autonomy in nursing practice.

Relevance to clinical practice: To gain autonomous practice, nurses must be competent and have the courage to take charge in situations where they are responsible. This study shows the challenges in handling this autonomous practice. Abstract Aim: To illuminate the meaning of nurses' experiences of autonomy in work situations. To many, physician autonomy means that physicians should have complete freedom to provide treatments for patients according to their best judgment.

Autonomy is important because we need to make sure that the patient is actively involved in their diagnosis and treatment — and not just deferring to their Doctor. And, increased autonomy at work is known to show an increase in the motivation levels, creativity and happiness of employees. Managers are also realizing that supporting autonomy is essential as it equates to optimal productivity from reports due to their willingness to perform and complete tasks.

Decisions involving more gradual changes in patient condition led to nurses to seek the support of other healthcare professionals Braaten, Autonomy in nursing practice supports important interventions such as patient ambulation thus is clearly important to the nurse decision-making process.

Begin typing your search term above and press enter to search. Press ESC to cancel. Skip to content Home Philosophy What does patient autonomy mean? It distracts attention from other important aspects of and challenges to autonomy in health care. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy. Personal autonomy is widely valued: most people think it is preferable to somehow be their own person and shape their own lives than to live under the control of others.

In this paper, we highlight some limitations of prevailing ideas about the principle of respect for autonomy and argue that relational understandings of autonomy offer useful additional insights for clinical contexts. These understandings highlight the importance of social relationships for autonomy capability. Considerations of respect for autonomy in health care contexts tend to focus on situations in which decisions need to be made about health care interventions.

A principle of respect for autonomy is also invoked in discussions about confidentiality, fidelity, privacy and truth-telling, 1 but is most strongly associated with the idea that patients should be allowed or enabled to make autonomous decisions about their health care. Various criticisms have been made about this construal of the principle of respect for autonomy. They most strongly indict those understandings that put more emphasis on offering and allowing choice than on enabling informed decision-making—most notably the idea that respect for autonomy obliges clinicians to tell patients about health care options then stand back and abide by their choices.

The concerns we outline below also apply most strongly to simplified understandings of respect for autonomy that emphasise the value of independence. The idea that patients should be offered options and allowed to make voluntary choices about potentially life-changing health care interventions is important. It undoubtedly discourages some inappropriate paternalism and protects some patients from unwanted intervention, for example, by permitting individuals to decline surgery that they consider more burdensome than beneficial.

A strong focus on decisions may impair clinical recognition of what limited autonomy some patients have. These patients may feel abandoned rather than autonomous if their clinicians refuse to do more than inform them about options and insist that they choose.

A strong focus on decisions can lead to neglect of other situations in which patients have problems with autonomy. In institutional care, for example, procedures are often standardised to ensure efficient completion of patient care tasks.

Residents who are imposed on by these procedures may fear to challenge those on whose care they depend. In antenatal settings, for example, women are sometimes required to shift their priorities, change their lifestyles and submit to judgemental monitoring by health professionals in the name of health promotion.

More relational understandings of autonomy encourage attention to these issues. What marks them out is that in seeking to assess and explain personal autonomy, they take seriously the ideas that individuals are always located within interpersonal relationships and broader social environments, and that these are pervasively influential.

Because relational understandings of autonomy accept the pervasiveness of social influences, they de-emphasise independence. The question of what is genuinely our own remains difficult, but relational accounts recognise that we may have multiple, dynamic self-identities because we belong to several social groups and have diverse roles within these. It is widely recognised that illness can affect autonomy by challenging life plans, necessitating changes in relationships and disrupting self-identities.

Significantly, relational accounts direct us to consider health care interactions and health services among the social processes and contexts that can exacerbate or alleviate the implications of illness for autonomy. They suggest that clinical interactions can support the autonomy of people with challenging symptoms, diagnoses or treatments by helping them to form, maintain or re-establish self-identities that they are comfortable with, and to deal with emotions and social stigma.

Relational thinking also suggests that dismissive and negatively judgemental comments can impair autonomy as well as signify disrespect. Relational accounts can enrich thinking about treatment decision-making. They encourage consideration of whether and how clinicians inform patients about a menu of options, but also about which options are un available and why. Clinicians might, for example, draw attention to the values and interests behind advertisements for lifestyle drugs and beauty-enhancing surgical procedures, and encourage people to consider these against their own values.

Because they highlight the socially shaped and situation-specific nature of autonomy capability, relational accounts can facilitate nuanced assessments of the forms of support clinicians might offer people usually deemed incompetent and people who struggle with particular decisions. We previously suggested that recommendations about screening are more likely to be autonomy-supportive if accompanied by honest and meaningful explanations of their basis, facilitation of personal assessments of their appropriateness, opportunities for discussion and clear scope to reasonably decline recommended tests.

Because relational thinking often supports intervention as promoting autonomy, there is a danger that misunderstandings and misappropriations of ideas derived from relational accounts could encourage the kinds of inappropriate paternalism that ethical norms of respect for autonomy are meant to protect against. Relational understandings of patient autonomy could underpin an enriched specification of the principle of respect for autonomy.

They facilitate recognition of potentially oppressive aspects of health care regimens, and they support the development of respectful, bilateral relationships that enable patients to develop and exercise self-governance skills, both within and beyond health care encounters. Relational accounts render all communication with patients potentially significant for their autonomy, and treat any interactions that belittle or undermine patients as potentially problematic.

In this sense, they are demanding on clinicians. However, we think they will resonate positively with the values and practices of the countless clinicians who strive to act with integrity 2 and recognise the importance of relationships for good quality care.

They could reinvigorate thinking about autonomy in health care, and they warrant serious consideration in discussions about clinical ethics. The authors receive salary support from their respective universities. Conflict of interest statement None of the authors are aware of any conflicts of interest, financial or otherwise, that could, either directly or indirectly, purposefully or inadvertently, affect the development or reporting of their scholarly activity.

National Center for Biotechnology Information , U. J Gen Intern Med.