Autonomy and Nursing
One of the more important parts of contemporary nursing revolves around the philosophical combination of ethical behavior and patient advocacy in a busy healthcare environment. We know there is a shortage of trained nurses and sometimes even physicians; we know that there are rising costs both internally and externally for healthcare organizations; and we know that a great number of Americans are under insured, or not insured at all. Still, we are in nursing because we wish to be a part of a caring profession; one that makes a real difference in a person's life and contributes to the overall welfare of society.
It seems, in fact, that due to a number of social and cultural factors within our society, the role of the modern nurse has become increasingly complex, often requiring the help of the philosophical discipline of ethics. Nursing ethics, while similar to medical ethics, seems also to take on more of a predominance of relationships, maintaining patient dignity, advocating for the patient, and collaborative care. In essence, nursing ethics uses the model of caring rather than curing, and surrounds the relationship between the client and the nurse (Galadher, 2003).
The overall trend in nursing ethics is more of one that asks that the means to the end are just as important, if not more important, than the results. This is quite apparent in the ethical maxim of autonomy. This is a moral and bioethical idea that indicates a rational individual (client) should be allowed to make un-coerced and informed decisions on their one. An individual must be responsible for their own actions, and their decisions on healthcare must reflect that they are a partner in their healing program, as well as any decisions made about their help. In the modern world, this is really exemplified by the process of patient consent; but instead of simply asking for permission to perform x, y or z, the healthcare professional must ensure that the patient has a complete understanding of the tests, the drugs, and even the procedures that the physician feels are in the best interest of the patient. This also includes a patient refusing treatment if they are cogent and informed; the physician may disagree, but the issues of quality of life or decisions about the side-effects or potential consequences of treatment must, in the long run, be decided by the patient (Rai, 2009).
Part 2 -- One superb example of a nursing theorist who epitomizes both human caring and autonomy is Jean Watson in her Theory of Human Caring. For Watson, one cannot view nursing as just a science, but a combination of art and science that uses the process of caring to increase the ability of the healthcare profession to understand and mitigate disease. Caring, though, is really the core ethic of nursing -- and not just the verbiage, but the commitment and complete viewpoint towards the patient that is continually manifested in deed and thought. This caring paradigm goes far beyond any one individual nurse and produces acts of caring that transcend any one theory and become associated with a greater good -- holism and non-judgmental care (Watson, 1989, 32).
Ethics- the power of Watson is that she does not see humans in a vacuum, but as the compilation of many different experiences that work to enrich and enliven their lives, but that cannot ever be known by the nurse unless the nurse is open to non-verbal communication. Too, transpersonal caring is the idea that the patient takes responsibility for their own health and works in conjunction with the nurse to achieve the best health outcome possible. (Watson, 1989, 70). This is a very Zen way of looking at healthcare -- the harmony between mind, body and soul -- with disease as disharmony -- but with a very real desire to change that experience into the positive. Indeed, integral to Watson's theory are ten carative factors that serve as "a framework for providing a structure and order for nursing phenomena" (Watson J., the Theory of Human Caring, 1997). This also focuses on the manner in which professional value systems integrate theory into practice by focusing on the ethical and moral relationship with the client.
Values -- Watson's theory includes 10 carative factors that, when taken both individually and in total, show us how nursing theory translates into nursing values on a day-to-day practice level:
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