(P39 WM:25y). Knowledge use in nursing practice: the importance of practical understanding and personal involvement. I do think that we need …have an understanding in terms of patients’ treatment” (P42 SN:6 m). This study was conducted in two NHS hospitals in the South East of England. But you might find in another department the manager is not so controlling so you become less controlling isn’t it? Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care. Some participants equated autonomous practice to routine tasks such as washing patients and dressing wounds: “I think autonomous is just like you do it routine.... it’s like you come to work, you wash the patient… you give them medication, you take your observation and make things comfortable” (P24 SR:22y). Similarly, a ward manager described boundaries in terms of nurses having had nursing training that provided them with the capability to look after patients within that remit: That the nurse is being seen to be their own individual professional and have had training as such and therefore they should be able to look after patients within that remit… the training would help you to be an autonomous professional. 2007;1:99–100. Some participants also described autonomous nursing practice as being linked to nurses having the confidence to use their knowledge and experience to make decisions. Kramer M, Maguire P, Schmalenberg CE. We would like to thank Claudia Schmalenberg (one of the authors of the EOMII scale) for her suggestions regarding the interview questions generated to explore the understanding of the concept of autonomy amongst the participants in our study. Differentiating between descriptive and interpretive phenomenological research approaches. Cancer Nurs. They maintained that the decision is based on knowledge and assessment, but the nurse is acting on instruction to ‘advance diet as tolerated’; therefore, it is not considered autonomy. Received 8 April, 2015; Accepted 19 May, 2015 This study discusses an ethical dilemma on “Euthanasia”. doi: https://doi.org/10.1111/ijn.12711. One participant stated: “I would probably take more of an autonomous role of a weekend in a way, of that leadership… the sisters of a week kind of run the shift don’t they, or the nurse in charge” (P21 SN:2y9m). A concept analysis of autonomy. Skar R. The meaning of autonomy in nursing practice. PubMed Google Scholar. Sandelowski M. Whatever happened to qualitative description? Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Further to describing hierarchy and organisational structure and policies as boundaries of autonomous practice, the NMC Code of Conduct was highlighted as a factor that could determine or inhibit autonomy practice: “...if we fear getting into trouble it’s because it depends on the policy inside the structure of the NHS” (P1 SN:14y). In addition to the discussion of the skills and knowledge required for autonomy, participants considered the importance of decision making either on a day-to-day basis or in emergency situations. The concept of autonomy has been an important topic of study in the nursing profession for many decades and has given rise to a range of definitions. However, the research highlighted hierarchy and organisational structure in the NHS as determinants or hindrances to autonomy. Lewis FM, Batey MV. Clinical autonomy: The authority, freedom, and discretion of nurses to make judgments about patient care 2. Nursing Standard. Offredy M, Vickers P. Developing a healthcare research proposal. All interviews were transcribed verbatim and analysed using the five-step descriptive phenomenological analytical method described by Giorgi, Giorgi, and Morley . Patient autonomy and decision making This article is timely when technocratic models of health care, decision making, feminism (in the context of child birth), evidence and patient’s human rights are being discussed in the context of healthcare in more innovative ways than … The descriptive phenomenological psychological method. Selecting samples with diverse characteristics would highlight the similarities or diversity in their views. Titilayo Olufunke Oshodi. Nursing is a profession rooted in professional ethics and ethical values, and nursing performance is based on such values. The authors declare that they have no competing interests. 2009 Sep;65(9):1882-90. doi: 10.1111/j.1365-2648.2009.05047.x. A phenomenological approach was employed to understand the perceptions and experiences of autonomy of nurses in England. I must admit sometimes I am not very assertive, and I do rely on my colleagues” (P31 SN:8y). Another two participants corroborated the above comment stating: “I know there are people who are higher than me, like the site managers or things like that. These comments highlighted participants’ emphasis on the importance of collaboration as enabling team members to work more closely together to make decisions. Nurs Res. Patient autonomy has increasingly become an issue in a health care system that often promotes dependence in decision making. Issues for nurses regarding elder autonomy. This comment suggests that autonomy can be turned on and off as necessary rather than being ingrained in practice. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Jones, H. 1996 Autonomy and Paternalism: partners or rivals British Journal of Nursing 5(6) 378 – 381 Google Scholar Kennedy, I. This was done by reviewing all of the transformations written in the second column to determine the essential structure or themes. It's not, it's basic nursing care, it's what we do, and I actually feel that we have dumbed down nursing to some extent... (P18 WM:18y). Gagnon L, Bakker D, Montgomery P, Palkovits JA. Please enable it to take advantage of the complete set of features! Maximum variation sampling is a purposive sampling procedure based on achieving representativeness or comparability . Background: Care is the essence of the nursing role and is closely related to the concept of professional autonomy. Registered nurses’ perceptions and experiences of autonomy: a descriptive phenomenological study. A ward manager argued that due to the oversimplification of aspects of the nursing education or role, the intellectual standards of the nursing profession or education are undermined. Participants described autonomy as the ability to make evidence-based decisions such as being dependent on the availability of the best, up-to-date knowledge and research, without which practice would be unsafe: “…but without having that knowledge, sometimes these decisions are perhaps not safe decisions, if your knowledge isn’t up-to-date” P29(SN:9y). AACN: The Practice of Clinical Autonomy in Hospitals: 20 000 Nurses Tell Their Story. Participants highlighted the development of confidence in the junior nurses, enabling them to make autonomous decisions when they receive affirmation or confirmation before or after making their decisions. For example, one ward manager reflected that: ...autonomous practice is working independently and being accountable for your own actions... They’re doing it on their own back if they’re not being told what they need to do first. Studies have indicated that control over nursing practice is associated with increased job satisfaction and improved patient outcomes 1,34,36 and with decreased job-related stress, burnout, and staff turnover. Quality in Health Care. Keegan  equated accountability to responsibility and answerability to authority for one’s actions. Registered nurses' perceptions and experiences of autonomy: a descriptive phenomenological study. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. One of the extracted factors, Restriction of Decision-making, suggested that Chinese nurses experience prohibitions on autonomous decision-making. There appears to be no set definition of autonomy and interpretations of autonomy were found to be diverse. ABSTRACT While delivering quality care, nursing home personnel may unintentionally adversely affect residents' sense of personal autonomy. Confidentiality was assured, and participants were also informed that they could stop or discontinue with the interview at any time without prejudice. Interpretation is the adoption of a non-given factor to help account for what is given in experience such as a theoretical stance, a hypothesis, or an assumption. Kramer M, Schmalenberg C. Learning from success: autonomy and empowerment. Professional Autonomy of Nurses: A Qualitative Meta-Synthesis Study. Oshodi, T.O., Bruneau, B., Crockett, R. et al. The subtheme ‘Working within boundaries’, explored the determinants or hindrances to autonomy, such as the hierarchy and organisational structure in the NHS. Furthermore, two ward managers emphasised the importance of utilising information in making safe and informed decisions, and reiterated the corollaries of autonomy which are accountability and responsibility: “to make informed decisions and take responsibility for them...” (P7 WM:33y), and “you are accountable for your responsibility of the information that you use for practice” (P38 WM:16y). J Clin Nurs. Handbook of Health Research methods: investigation, measurement and analysis. And both rely on competent nurses who can initiate therapeutic actions and patient care programs and who can be held accountable for these initiatives. Labrague, McEnroe-Petitte, and Tsaras  found that consistent with international studies, nurses in the Philippines demonstrated moderate levels of professional autonomy. J Clin Nurs. 2015;22:22–7. Understanding that additional training regarding autonomy would support nurses, and in turn result in better patient care, other participants highlighted inadequate training as a factor hindering autonomous nursing practice. Between June and July 2013, the first author contacted the ward managers of the participating wards by telephone and booked appointments to discuss the plan to conduct qualitative interviews with the registered nurses. Examples of the codes and their interpretations are presented in Table 4. https://www.nursingtimes.net/keen-calls-for-end-to-nhs-blame-culture/5001010.article. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Lomas C. Keen calls for end to NHS ‘blame culture’. Participants identified confidence as being connected with autonomous practice. Wiley: Chichester; 2016. To be knowledgeable and confident was found to be the coherent meaning of autonomy in nursing practice. Maximum variation sampling was used in recruiting the participants for the purpose of achieving comparability , as participants varied in professional and socio-demographic characteristics. (P17 SN:3y). 2009;34:312–22. J Adv Nurs. Fielding N, Thomas H. Qualitative interviewing. An interview schedule containing four questions was developed in response to the aims of the study and was used to guide the interviews (Table 1). London: SAGE Publications Ltd; 2017. p.176–92. Health organisations are responsible for providing necessary means for nurses to act autonomously by formulating clear roles, responsibilities and behaviours, and enhancing competence in practice and decision-making . Several respondents mentioned working within their own boundaries and limitations which involve a degree of self-knowledge. 2001; Supplement 2: ii32–7. An understanding of autonomy is needed to clarify and develop the nursing profession in rapidly changing health care environments and internationally there is a concern about how the core elements of nursing are taken care of when focusing on expansion and extension of specialist nursing roles. One of the participants gave an example of how decisions are made in practice based on nursing knowledge. COVID-19 is an emerging, rapidly evolving situation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Health Care Manag Rev. Rao AD, Kumar A, McHugh M. Better nurse autonomy decreases the odds of 30-day mortality and failure to rescue. Another participant linked nursing knowledge and skills with competence, highlighting that nurses feel supported in being autonomous when they are equipped with the right competence and skills: by ensuring that nurses are equipped with the right competence and the right skills gives them that support and the backing for them to be autonomous… (P19 WM:8y). 2019 Nov 1;18:51. doi: 10.1186/s12912-019-0378-3. I think autonomous practice is very important for nurses. Participants in  discussed their ability to organise their work day, set priorities among the tasks, assessments, and personal care, as examples of inherent autonomy in their practice. They also highlighted the importance of the absence of a blame culture in order for autonomy to thrive. J Mixed Methods Res. However, participants in an American study  argued that it is not autonomy when, for example, a nurse decides to advance a patient’s diet from soft to full, or to discontinue IV fluids when a patient is eating and drinking. Now I have got a little bit more experience but even so it could happen that way because you think well you have to follow the organisation’s way of working. doi: 10.5812/ircmj.20596. TOO was responsible for the drafting of the manuscript. This theme is specifically about participants’ experiences of autonomy. Registered nurses providing direct adult patient care on 29 wards were invited to participate in the study; however, one ward manager in Hospital A declined participation on behalf of her nurses. In addition to hierarchy determining whether or not nurses practice autonomously, the NHS structure was described as influencing the work pressure experienced by nurses on the wards. Participants in this study identified several examples where they had breached boundaries for the benefit of the patients. The dataset from this study is available from the corresponding author upon reasonable request. Online Journal of Issues in Nursing: great resource for ethics. BMC Nursing The researcher concentrates on the “given” as a phenomenon, and everything that is said about the phenomenon is based upon what is given . 1997 Jun 26-Jul 9;6(12):703-7. doi: 10.12968/bjon.1922.214.171.1243. The emphasis placed on team involvement as a key ingredient in autonomy, can be gathered from comments such as: “...but it has to be into a team as well... at times we have to wait for their decision too” (P3 SR:33y); and “…you always involve the team” (P1 SN:14y). In: Willig and Rogers, eds. J Nurs Adm. 2006;36:479–91. Methods: Similarly,  revealed that nurses, by default, felt acutely responsible for everything overnight due to the relative absence of other team members, which challenges their scope of practice. https://doi.org/10.1186/s12912-019-0378-3, DOI: https://doi.org/10.1186/s12912-019-0378-3. Kramer and colleagues  delineated three dimensions of autonomy in clinical practice settings. De Brouwer and colleagues  also assessed the psychometric properties of the EOMII amongst nurses in The Netherlands.