Current paper provides the concept analysis of autonomy. The literature review regarding the issue is presented. The researchers demonstrate that autonomy is crucial in different spheres of social life. It allows both making more responsible decisions and advocating the interests of patients in the optimal way. All modern effective nursing organizations pay much attention to respecting autonomy in all its forms. The paper provides information on antecedents and consequences of autonomy. The relevant case examples are examined as well. Moreover, the paper outlines the key characteristics and attributes of the concept. The analysis demonstrates that nurses have to meet legal, professional, and ethical requirements to generate the maximum possible results. Nurses should maintain their autonomy and be able to neutralize the negative impact of other providers. It is also important to ensure patient autonomy and provide patients with the reliable information that may guide their actions and choices. The spheres of concept application are specified.
There are large numbers of concepts in nursing that have a crucial meaning for understanding the complexities of the discipline, as well as the mutually interrelated functions of different healthcare providers. The selected concept is autonomy because it plays a crucial role in nursing for several reasons. First, it includes a number of broad philosophical implications of respecting the individual’s rational choices based on his/her preferences and needs. Second, it helps regulate the degree of interventions that are admissible and inadmissible for nurses and other professionals. Third, autonomy may refer both to nurses’ autonomy and patient autonomy. In general, it serves as one of the indicators of nurses’ professionalism and qualification. Finally, autonomy refers not only to the nurses’ professional level but also to their ethical obligations and responsibilities. Thus, the concept includes legal, professional, and ethical aspects. For this reason, it is necessary to evaluate it in detail. The desired results may be achieved only if nurses are able to integrate all the concepts in their practice.
Aims and Purposes of Analysis
It is reasonable to specify the major objectives and purposes of analysis precisely. They are as follows:
1. It is necessary to specify the meaning of autonomy in the nursing profession.
2. The implications of autonomy regarding nurses and patients should be provided.
3. The major elements of ensuring autonomy should be identified.
4. It is necessary to clarify further implications of acting in accordance with the principles of autonomy.
It is reasonable to provide the literature review to analyze the concept of autonomy in detail. Skar (2010) provides the extensive discussion of autonomy in nursing practice. The author defines autonomy as the process of making decisions and the ability of acting in accordance with one’s choices and professional knowledge (Skar, 2010). Moreover, the role of autonomy is especially high under the modern conditions of rapid changes in all spheres of social life. The core elements of nursing cannot be integrated without relying on the principles of autonomy. Skar (2010) stresses that the principles of autonomy may be realized adequately only if a nurse possesses the necessary qualification, as well as has the moral courage to act according to such principles. The nursing practice often includes different ethical dilemmas when all moral principles and prescriptions cannot be implemented simultaneously. For such reason, nurses should have a clear set of moral priorities that may allow selecting the optimal strategy under the existing restrictions.
Campos, Ribeiro, and Depes (2014) stress the role of autonomy in nursing even at the stage of obtaining the basic set of nursing knowledge while being a student. They utilize the framework of problem-based learning to verify the impact of autonomy on the effectiveness of nursing learning. The effectiveness is understood in a broad sense as the combination of theoretical knowledge and practical skills. The process of learning is highly important for nurses at all stages of their development. However, it cannot be realized completely without understanding and respecting one’s autonomy. Nurses can reach the highest qualification only if all their actions and strategies are rational and are based on the complete understanding of their social functions. Nurses should not only follow formal instructions and regulations but contribute to the realization of the basic ethical principles to the maximum possible extent (Campos, Ribeiro, & Depes, 2014). Even at the stage of learning, nurses should comprehend their mission and responsibility. It will allow them making better decisions and improving their attitude towards others.
Wulff et al. (2013) examine the problem of autonomy in relation to nursing home residents. The authors demonstrate that the principles of autonomy may be difficult to apply when dementia exists. It is often present among the elderly people (Wulff et al, 2013). However, it seems that the authors’ analysis is only a specific case of a broader set of questions related to patient autonomy. Nurses should respect patients’ autonomy as patients should be able to make their independent responsible decisions regarding their health. Nurses may inform their patients about the potential consequences of various decisions. It is reasonable to support their claims by the corresponding statistical information and analysis. However, patients should be free to make their decisions based on their needs and preferences. Consequently, nurses should respect the diversity of individuals’ needs and worldviews.
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At the same time, nurses should concentrate on ensuring that patients’ decisions are responsible and rational. In other words, patients should understand the risks, as well as potential benefits and costs of adopting a specific mode of behavior. If such requirements are met, nurses should accept patients’ choices and make everything that is possible for the realization of his/her plans. However, if patients do not demonstrate the necessary level of understanding of the plausible consequences of their actions and choices, nurses should orient on the existing legal requirements rather than patients’ decisions. For such reason, the area of investigation mentioned in the study of Wulff et al. (2013) is very complicated. The patients with dementia cannot always comprehend all complexities of decisions they have to make. Therefore, nurses should differentiate between their rational choices and the ones when their level of understanding is insufficient. The former should be respected and fulfilled, while the latter should be corrected according to the existing legal requirements and nurses’ professional knowledge.
Heesen et al. (2013) stress such difficulties applying their analysis to the sphere of patient autonomy with multiple sclerosis. On the one hand, some mental functions of such patients can be affected negatively by the diseases. On the other hand, the study shows that the patients are highly competent regarding their physical and mental state and often can make rational and effective decisions. The authors suggest that nurses should develop their knowledge on risk tolerance and knowledge (Heesen et al, 2013). The application of uncertainty management can also lead to the desired results. In general, nurses should use a flexible approach and adopt their knowledge and skills to the conditions of each specific case.
Cole, Wellard, and Mummery (2014) show that autonomy has substantial broader implications and is closely related to advocacy. Therefore, all patients’ advocates should understand the principles of autonomy perfectly and be able to apply it correctly. Autonomy allows organizing one’s time correctly and accepting the necessary responsibility of all actions and decisions made. Nurses should understand the internal world of their patients, as well as their physical and spiritual needs. In such way, they have to integrate the major short- and long-term goals into the complex system. Therefore, nurses should increase their qualification constantly to make more rational and efficient decisions. At the same time, they should also ensure the maximum level of freedom and moral courage. It may be especially important during the interactions with other professionals who may try to influence the nurses’ decisions.
Cameron (2014) evaluates the concept of autonomy in relation to the effectiveness of entire organizations and workers in general. Both empirical findings and theoretical analysis demonstrate that the maximum results are possible only when both professionals and patients are free to make independent and responsible decisions regarding their lives. Each individual has deep and unique understanding of his/her needs. If he/she also possesses the necessary knowledge about the proper means, he/she may select the optimal strategy. Therefore, nurses should work constantly on maximizing their qualification. The knowledge of nursing, psychology, and management may be highly helpful in various contexts. Moreover, it is also necessary to consider the needs of a given patient. All models and theoretical frameworks should be flexible in order to adjust them to the requirements of a given situation. In relation to patient autonomy, nurses should preserve it and create the necessary conditions for providing patients with a whole variety of helpful information that may allow them to make responsible and rational decisions. If the principles of autonomy are addressed and enforced, the effectiveness of healthcare organizations also increases because each professional can maximize his/her potential (Cameron, 2014). As a result, the synergic effect emerges, and the general productivity exceeds the sum of individual contributions. In general, one of the major strengths of autonomy is the ability of balancing the needs of all individuals involved.
Key Characteristics and Attributes of the Model
The concept of autonomy is very complex, and it is reasonable to examine the key aspects of the model. From one perspective, it includes both the autonomy of nurses and patients. Thus, autonomy is crucial for any activity that includes making decisions and acting in a responsible way. From another perspective, the major attributes of autonomy include legal, professional, and moral aspects. Legal aspects refer to following the existing legal requirements and regulations. Professional aspects include the ability of increasing one’s qualification constantly. Moreover, nurses should concentrate not only on their knowledge and skills in a narrow sense but on all issues that have either a direct or indirect impact on the patients’ health. If nurses can maintain the process of constant self-development, their results will tend to improve radically. Ethical aspects include the ability of acting according to the basic moral principles even if some substantial opposition is present. The moral courage plays a central role in providing assistance to patients at all stages of the nursing care.
Skar (2010) suggests that the following basic attributes of autonomy in work situations can be determined. The first one is having the holistic view of all processes and events (Skar, 2010). It means that nurses should evaluate all processes and events from a broader perspective in comparison with other social members. They should comprehend the interrelationships between symptoms and potential outcomes. The second one is knowing the patient (Skar, 2010). It means that all nursing practices should not be abstract but always directed at the needs and requirements of a given patient. The third one is comprehending one’s knowledge (Skar, 2010). Nurses should understand the basic relevant issues not only intuitively but rationally in order to explain their justifications to others. The fourth one is a desire to implement such principles (Skar, 2010). It refers to moral devotion to ethical behavior. It plays a central role in reaching the desired outcomes.
The following model case may allow realizing one of the possible implications of the autonomy principles. The patient has serious illness, and the care is provided by nurses and other professionals. One of healthcare decisions requires informed consent as it is crucial for the patient’s treatment. The nurse follows all legal and ethical principles. However, other healthcare professionals do not behave properly. In particular, they impose their views on a given patient and do not respect his/her autonomy. Although the nurse understands that his/her colleagues are motivated by good intentions, their behavior is incorrect for several reasons.
First, they evaluate the entire situation from their perspective rather that of the perspective of a patient. Second, they violate one of the basic patients’ rights. Therefore, such strategy cannot lead to sustainable positive results. The antecedent of the situation is the positive intentions of healthcare professionals and their neglect to the basic patient’s rights. The major consequence is violating the patient’s rights and exposing him/her to additional risks. It seems that the proper strategy for the nurse under such conditions is addressing the problem at the organizational level. Top-managers should understand the seriousness of the problem and explain the significance of autonomy for all professionals. It is the only way of respecting patients’ rights and maximizing the overall treatment efficiency. The healthcare professionals should be punished for their misbehavior even if there are not any direct negative consequences to the patient’s health. The reason is that all people should respect the rights of others, including autonomy. It is especially important in the healthcare sphere as health-related decisions are crucial for all individuals.
Contrary, Related, and Borderline Cases
It is reasonable to provide contrary, related, and borderline cases to stress the implications of respecting autonomy. The contrary case is the one where all healthcare providers respect the patient’s rights. Thus, they only provide the patient with the reliable and objective information about the plausible outcomes of a wide variety of alternatives. They do not impose their views on the patient but respect his/her preferences and assist with implementing the selected strategy. The related case may refer to the situation when healthcare professionals respect patient autonomy but try to impose their views on their colleagues. In such case, the healthcare professionals may try to use such influence to promote their ideas at any expense. However, nurses should respect the rights of autonomy and resist to any of such attempts.
The borderline case may refer to a metaphorical use of the autonomy concept in relation to all people in the world. As all people have their goals and objectives, they make decisions regularly. Therefore, everyone should have the right to select the means that correspond to his/her objectives in the optimal way as far as he/she does not violate the rights of others. Thus, it seems that respect to autonomy and its application to all spheres of life lead to such philosophical principles.
Antecedents and Consequences of Autonomy
The concept of autonomy is not isolated from other nursing concepts. The major antecedent that leads to autonomy issues is the need for making urgent and responsible decisions. Such fact leads to the situation when a nurse has to make the choice from available alternatives. Therefore, even the existence of controversial situations when complex decisions should be made lead to the need for considering autonomy. The correct application of the autonomy concept refers to the situation when an individual both demands respecting autonomy from others and follows such principles while interacting with other social members. The universality of autonomy is one of the first direct implications and consequences of following it.
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Another consequence is the ability of becoming a patient advocate (Cole, Wellard, & Mummery, 2014). Nurses should respect patient autonomy and determine the scope of their functions correctly. In particular, they should demonstrate their qualification to the patient and explain the major existing alternatives to him/her. The nurse should ensure the patient’s understanding of all key issues and his/her ability to make rational decisions. Thus, the positive dynamics of health indicators and the patient’s well-being is also one of the consequences of the correct application of autonomy. The nurse should adjust his/her strategy in a way that will allow maximizing positive consequences and minimizing corresponding risks. Moreover, the positive effects should be considered from the patient’s rather than nurse’s perspective.
The concept of autonomy has a very wide scope of applications. The first one is maintaining one’s autonomy when making nursing decisions. Every nurse should be able to minimize the external negative impact that creates difficulties in making independent and responsible decisions. The second one is respecting the autonomy of other professionals. Nurses should not try to affect the decisions of other professionals even if they are motivated by positive intentions. The third one is respecting patient’s autonomy. Nurses should recognize the variety of people’s needs, preferences, and desires. Therefore, any meaningful and rational decision should be supported by nurses even if it does not coincide with their personal preferences.
The concept of autonomy is crucial for a modern society, and its application can be even extended beyond the sphere of nursing (Cameron, 2014). It seems that all people should respect the rights of each other and do not intervene with the process of independent decision-making as it is a foundation of social development and mutual respect. Therefore, the correct application of such principles by nurses may have a substantial positive impact on the development of society in general. The atmosphere of tolerance and mutual respect will allow minimizing the scope of inter-personal conflicts, and it will have a positive effect on the overall health standards of the population.
The analysis provided demonstrates that the concept of autonomy is one of the most important in nursing. Its significance is caused by several factors, including the need for independent decision-making while addressing urgent patients’ needs. One of the aspects of autonomy refers to nurses’ operations and strategies. It is demonstrated that the maximum efficiency and responsibility can be achieved only if advocacy principles are followed precisely. Another aspect of autonomy refers to respecting patient autonomy. Nurses should not intervene with the process of patients’ decision-making. However, they should provide patients with reliable and objective information about the plausible consequences of various patients’ decisions. Nurses should also ensure that the patient comprehends the risks and potential outcomes of his/her decisions. It is especially relevant for the patients with dementia or sclerosis.
Autonomy includes legal, professional, and ethical requirements. Legal requirements refer to following the major current norms in the nursing sphere. The professional ones include the need for the constant professional development and improvement. Ethical aspects refer to following one’s moral obligations and not compromising on the interests of patients even if a substantial psychological or other pressure from other parties is present. The respect of autonomy in all its forms has a number of long-term effects on the organization’s efficiency. Thus, it seems that autonomy is crucial both for individual nurses and entire organizations. Nurses cannot fulfill the functions of patients’ advocates properly, if autonomy issues are not addressed.
The concept of advocacy has both antecedents and consequences. The former refer to all situations when there is a need for making independent decisions that affect the quality of care provided to patients. The latter refer to the ability of being a patient’s advocate, as well as the possibility of balancing the interests and needs of all parties involved. The concept has a wide sphere of application. On the one hand, it is applicable to almost all decisions in nursing. On the other hand, it may be extended to all other spheres of social life as tolerance and mutual respect are the foundation of any social development under current conditions.