Autonomy is regarded as an important feature in nursing, however it is frequently confused with professional and personal characteristics of the caregiver. The word refers to nurses' belief in aiming for client-centeredness when doing their duties, both interdependently and autonomously. Collegial interdependence, caring and responsible decision-making, actively advocating for patients, and building affiliative connections are the most important aspects of professional autonomy (Rahmani, Ghahramanian & Alahbakhshian, 2010). Personal and educational quality that fosters professional autonomy are some of the most important antecedents. According to current research, autonomy in nursing is connected with job satisfaction, professionalism, and client dedication. At the same time, policy and clinical development in health care have created demand for the professional response of roles for nurses which call for nursing autonomy.
Literature indicates that nursing autonomy has a huge impact on the patient recovery process. Recent research studies show that greater autonomy results in improved care, client satisfaction, and elevated status of professionalism for nurses. Further, autonomy allows the nurse to acquire respect in the community from their customers. Similarly, the practice is also perceived as a way of reducing stress that may arise from patient acuity, poor doctor-nurse interactions and use of new technology. Also, it can increase self-esteem and mental balances of healthcare providers (Rahmani, Ghahramanian & Alahbakhshian, 2010). Therefore, increasing nurse autonomy can lead to the improved health care system by decreasing cost and enhancing nurse retention.
The findings show that the healthcare facilities need to recognize that autonomy is an important component that increases nurse's ability to make decisions and experiences high job satisfaction. A common theme in literature is that it is imperative to devise methods that can enhance autonomy in nursing. In other words, there is a need for research to identify the most viable method of promoting nurse professional autonomy.
As such, the purpose of the paper is to define autonomy as used in healthcare, determination of positive impact associated with it and strategies that can be used to foster it in healthcare. In particular, the goal will be achieved by reviewing two articles: Strategies for enhancing Autonomy and Control over Nursing Practice and Autonomy in Nursing and articulating the implications of nurse autonomy for the nursing profession and identified at least two lessons learned from the assignment as to the potential effects on nursing practice.
Literature Review
Article #1: Autonomy in Nursing
The article aims at achieving three major objectives: analyzing concept to autonomy, identifying structural and attitude attributes and unique challenges in Japan that prevent advancement of autonomy in nursing. The author defines the concept of autonomy as the freedom to make discretionary decisions which means that nurses have control over the needed knowledge in the process of choosing an act (Lewis & Sterling, 2006). It also includes freedom to act on a binding decision which implies that nurses do not need to get permission from another party to act.
According to the source, autonomy has both structural and attitudinal dimensions. The writers contend that autonomy forms part of the attitude of nurses which must values autonomy for successful patient satisfaction. Similarly, the concept involves a structure that encompasses professional practice standards, license laws, advanced certification, and knowledge development. In particular, the approach has to do with the reflection of the healthcare agency (Lewis & Sterling, 2006). For example, some require nurses to acquire permission from the relevant individuals before carrying out an act. On the other hand, some agencies promote value the ability of the nurse to make discretionary and binding decisions for the clients which means that they support structure that encourages autonomy. The authors further argue that collaboration with other physicians is important for autonomy in nursing, but research is needed from nurse scientific to examine the impact of the practice and action that can foster it (Lewis & Sterling, 2006).
The final segment of the source focuses on the challenges that Japan is facing in terms of nurse autonomy. The country is one of those that value harmony, modesty, deference and respectfulness (Lewis & Sterling, 2006). However, autonomy needs nurses to do discretionally acts based on the license and knowledge that can add well-being of patients and quality of services offers to them. In other words, the author contends that it is imperative for Japan to integrate these values into nursing practices to oversee increased autonomy which can, in turn, enhance client outcome. More importantly, the healthcare in Japan is characterized by a tension between these values and those related to autonomy (Lewis & Sterling, 2006). The authors hold the country need to focus more on the well-being of the patients to ease the challenges.
Article#2: Strategies for enhancing Autonomy and Control over Nursing Practice
Weston (2010) indicates that nurse autonomy is associated with increased patient outcomes and nurse job satisfaction. The author outlines strategies for enhancing autonomy and control over nurse practice, the role of nurse leaders, work upstream.
Strategies for Enhancing Autonomy. The first strategy the articles proposes is the need to clarify expectations about clinical autonomy which can be achieved through communication and organization of work ensuring that nurse has the freedom to act using their clinical judgment (Weston, 2010). At the same time, the process should involve setting action of independent nursing action that supports their decision-making. Also, the author notes that is fundamental to identify acceptable response based on the underlying situation because nursing practice entails making interdependent and independent actions (Weston, 2010). Similarly, the article argues that it is important to determine if one's behavior falls within the range of expected actions which create a climate that promotes nursing and autonomous practice.
The second strategy that author propose are enhancing competence through the establishment of sound clinical judgment and creating environments that foster learning and confidence among nurses (Weston, 2010). The goal can be attained using methods such as formal continuing education and teaching sounds. Additionally, nurses can discuss complicated scenarios involving their patient in staff meetings which promotes the autonomic practice. More importantly, the techniques allow integration of culture from the diverse clinician working in the facility. Therefore, the author asserts that autonomy can be increased using methods that incorporate unique experience and knowledge among clinicians (Weston, 2010).The objective can be realized through professional education and build extensive clinical competence and knowledge base.
Strategies for promoting control over nursing practice (CONP). The first method that Weston (2010) puts forward is the establishment of decision-making processes that are participative. In other words, the scholar shows that there is need to have strategies that increase nurse participation in major decisions within the organizations and professional structure which provide a framework for enhancing CONP. The other techniques are enhancing the competence of clinician in decision making which can be accomplished through coaching and teaching nurse about processes of making decisions (Weston, 2010). The approach enables individuals to acquire necessary skills to manage meetings, analyze underlying evidence and alternative to make sound choices.
Roles of Nurse Leaders. Weston (2010) illustrates the role of nurse leaders as facilitators of autonomy and CONP as they can create an environment that promotes autonomy. At the same time, the can assist in disseminating skills such as effective communication techniques to resolve problems (Weston, 2010). Nurse Manager can also foster new ideas and innovation that promote autonomy among the clinicians.
Implications for nursing
The primary implication of the above information is that autonomous nursing practice should be a major focus of research by nurse scientists to help define and create healthy work environment. In particular, attention should be given to articulating strategies that can be used to empower nurse decision-making to increase professionalism and support the patient outcome. More importantly, it is fundamental to identify areas of conflict in healthcare that present significant problems to attaining nurse autonomy (Delmar et al., 2011). In particular, healthcare facilities should oversee that their organizational structure promote autonomy among the nurse allowing them to make discretionary and binding decisions without necessarily having to acquire permission from other parties. Similarly, there is need to research to create tools that can consistently and accurately measure attributes and theories of nursing autonomy that help to define the relationship between the nurses and hospital management. The approach is crucial for ensuring nurse job satisfaction and retention which in turn enhances patient satisfaction with the services provided (Delmar et al., 2011). Finally, it is critical to devising methods that can enrich expertise and knowledge among nurses which boost autonomy and impact the quality of patient care offered. Therefore, the two articles have clearly identified the concepts of nursing autonomy, challenges, and methods that can be used foster it in healthcare.
References
Delmar, Ph.D., C., Alenius-Karlsson, Rn, N., & Højer Mikkelsen, Msc, A. (2011). The implications of autonomy: Viewed in the light of efforts to uphold patients dignity and integrity. International journal of qualitative studies on health and well-being, 6(2), 6045.
Lewis, F. M., & Sterling, E. (2006). Autonomy in nursing. Ishikawa Journal of Nursing, 3(2), 1-6.
Rahmani, A., Ghahramanian, A., & Alahbakhshian, A. (2010). Respecting to patients' autonomy in viewpoint of nurses and patients in medical-surgical wards. Iranian journal of nursing and midwifery research, 15(1), 14.
Weston, M. J. (2010). Strategies for enhancing autonomy and control over nursing practice. Online J Issues Nurs, 15(1).
