Autonomy in the nursing profession states the importance of the client's role in making decisions that reflect advocacy for the client (Wade, 1999, p.310). Ultimately, this includes taking care of the patient physically as well as mentally and emotionally, developing a relationship with the patient that is beneficial to his care and actively advocating for the patient's rights and care. This type of autonomy, it is important to note, is not the same as individual or work autonomy, yet it must be considered that empowerment in nursing autonomy will inevitably lead to better professional and personal autonomy and should also lead to increased job satisfaction (Wade, 1999, p.310).
Typical definitions of autonomy would include the idea of complete independence for the person making the decisions. However, in the case of the nursing profession, the client's needs and desires must be heavily weighed and, in fact, become central to the idea of autonomy. No nursing professional can make such life and death decisions for someone without taking the patient's beliefs and concerns into account. It is this dependence on the patient that renders professional nursing autonomy different from almost any other kind of autonomy. Once this definition is applied to nursing, however, it is easy to see how it could impact all aspects of the profession. Becoming a full advocate for a patient empowers the nurse to make the best decisions that are in the best interest of the patient while also developing a sense of accomplishment for the nurse. Successfully advocating for a client's needs reinforces the idea of the nurse as a primary caregiver.
One example of this type of advocacy and the overall effects it may have would be the plight of a terminally ill patient who is nearing the end of his life and is currently kept alive artificially. A nurse would be in an excellent position to contact family members and discuss their wishes as well as the wishes of the patient. If a living will exists, that must be taken into consideration and someone must be available to advocate on behalf of the patient. Ideally, the family would take on this role, but a nurse can often be more persuasive when dealing with medical professionals and, often, there is no family to advocate for the patient. Aside from the family's wishes, though, the patient's medical condition must be taken into consideration. This is where the nurse can be especially effective, becoming a mediator of sorts who conveys the wishes of both the family and the medical profession. It is incumbent upon the nurse to advocate for the practice which most directly mirrors the patient's ultimate wishes.
Advocacy need not be applied only in such dire circumstances. It can be as simple an act as making a push for a patient to receive care which may not be covered by insurance. Such advocacy can take the form of dealing with insurance companies or lobbying doctors and hospital administrators to treat a patient regardless of ability to pay. It is primarily a guard against burnout and turnover, as well. Part of advocating for the best care for a patient means fighting for and receiving better coverage for patients. This would require the hiring of more nurses and ensuring that they have the proper tools to do their job to the best of their ability.
While it has, at times, been derided as a call for patients' rights advocacy, this does not entail the entire spectrum of what nursing autonomy achieves. While defending a patient's rights is certainly an important part of advocacy, it is the support of the individual's well-being that is paramount to the idea of nursing autonomy (Gaylord & Grace, 1995, p. 11).
Informed consent is the legally provided right for all patients to be informed of the extent of the procedures that are to be performed on them. This can include, but is not limited to, easy to understand details of the procedure, benefits and risks, as well as alternatives, likely outcomes, and the patient must fully understand and be able to sign an agreement to perform the indicated procedure (White, 2004, p. 64). This legal obligation, normally reserved for physicians when they are responsibility to obtain a signature, whether for a nursing or medical procedure, usually falls to the nurse to collect, leaving the nurse to determine the client's fitness for signing such a consent form (White, 2004, p.65).
The New York State Nurses Association lays out concrete recommendations for nurses when obtaining informed consent. They insist that the nurse assume the role of patient advocate, respect the patient's decision, not participate in any treatment where informed consent has not been obtained, and initiate appropriate actions if informed consent is not processed and implemented (Position statement, 2004). They further lay out the position that patients are responsible for evaluating their personal healthcare, have the right to determine what will be done to them and the right to information regarding their condition, and that the nurse should serve as more of a witness and advocate, not the person obtaining informed consent (Position statement, 2004).
Of course, informed consent is most commonly seen when a patient is about to undergo a surgical procedure. Before performing any medical procedure, the doctor will explain the entire process to the patient and make sure he understands what is to be done and the risks and benefits involved. While it may seem like overkill to go into great detail with a patient for simple treatments like a vasectomy or endoscopy, many patients are often taken aback when they learn of the inherent risks of any surgical procedure, especially one requiring anesthesia. It can also be enlightening for the patient to learn about alternative treatments he may not have known existed. A patient has the right to know the prognosis for any procedure and this can also be eye-opening. For heart surgery or cancer patients, the prognosis can be especially grim.
At any point while reviewing this information, the patient may decide that the risks outweigh the benefits and decide to try an alternative method. A patient who learns that there are significant risks to a heart surgery procedure, may opt instead to try an alternative method, such as angioplasty or even certain new drugs which may help clear blockages. Of course these alternatives carry with them their own risks which should also be conveyed to the patient.
For many patients, simply hearing about the risks is enough to deter them from undergoing risky procedures. But for others, their doctors are infallible and they will follow whatever course of action he or she recommends. This is where the nurse becomes an important advocate for the patient, relaying any wishes or concerns to the doctor and encouraging an open dialogue between doctor and patient. Many patients feel intimidated by their doctors, but they may feel more comfortable relaying their concerns to a nurse who seems more approachable and can also approach the doctor as a medical colleague.
The nurse's role in informed consent is one of mediator, ensuring that the patient's best interests are looked after, even as the doctor prescribes the most effective treatment to the best of his determination. There can be no informed consent if the patient is not informed and the nurse's role in properly explaining the procedures and risks involved cannot be overstated.
Negligence in the nursing profession is defined as a nurse's failure to act in such a way that it causes or results in harm to the patient. Negligence, if it can be established legally, must exist before a malpractice lawsuit can be filed. There are four elements of negligence: duty, breach of duty and negligence, harm, and causation (Iyer, 2001, p.208). In most cases, duty has already been established when a nurse accepts the assigned patient. Breach of duty occurs when a nurse fails to follow the well-established guidelines of the hospital policies or nursing association. Harm is, of course, the injury that has been incurred due to the negligence. Without harm, there can be no claim of malpractice. Causation is the most important element of negligence. The act of negligence must be shown to have led directly to the claimed injury. If this cannot be established, then there is no feasible claim for negligence or malpractice.
Negligence in the nursing profession can be thought of similarly to negligence in other professions. Someone who has training in their chosen field is expected to be able to perform to the standards required for the task at hand. A nurse has been trained to administer certain medical procedures and monitor patient care. Nursing is different than other professions, however, in that a negligent act by a nurse can result in the death of a patient. There is little room for error in the profession and it is the reason…
Wade, G.H. (1999). Professional nurse autonomy: Concept analysis and application to nursing education. Journal of Advanced Nursing, 30(2), 310-8.
Gaylord, N. & Grace, P. (1995). Nursing advocacy: An ethic of practice. Nursing Ethics, 2(1),
White, L. (2004). Foundations of nursing: Second edition. Clifton Park, NY: Delmar Learning.
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