The individual are able to act for themselves to the level of their capacity. It is the right of individuals, governing their actions according to their own purpose and reasons. Autonomy means the quality or state to being independent, free and self directing.
“The individual serving self with positive and negative rights, free from interference or has right to determine one’s own life”.
Autonomy is the freedom to make discretionary and binding decisions that are consistent within one’s scope of practice and the freedom to act on those decisions.
Autonomy is an important concept in ethical and political theory and arguably a central concept in bioethics. Its implications for psychiatry are clearest in cases in which competence is at issue, but its significance for the philosophy of psychiatry is much deeper. The term autonomy admits a wide range of meanings which includes qualities such as self-rule, self-determination, freedom of will, dignity, integrity, individuality, independence, and self-knowledge. In ethical thought, it is identified with the qualities of self-assertion, critical reflection, responsibility, absence of external causation, and knowledge of one’s own interest; it is also thought of in connection with actions, beliefs, principles, reasons for acting, and rules.
Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one’s professional knowledge base.
Professional autonomy means that a member makes decisions and acts independently within a professional context and is responsible and accountable for these decisions and actions.
Professional nurse autonomy
Professional nurse autonomy is defined as belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, that reflect advocacy for the client.
It often exceeds standard practice, is facilitated through evidence-based practice, includes being held accountable in a constructive, positive manner, and nurse manager support.
Critical attributes include caring, afflictive relationships with clients, responsible discretionary decision making, collegial interdependence, and proactive advocacy for clients. Antecedents include educational and personal qualities that promote professional nurse autonomy. Accountability is the primary consequence of professional nurse autonomy. Associated feelings of empowerment link work autonomy and professional autonomy and lead to job satisfaction, commitment to the profession, and the professionalization of nursing. A student-cantered, process-orientated curricular design provides an environment for learning professional nurse autonomy. To support the development of professional nurse autonomy, the curriculum must emphasize knowledge development, understanding, and clinical decision making. 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.
When Are Autonomous Decisions Needed?
Unmet patient needs and rapidly changing conditions are the stimuli for autonomous actions.
Three levels or patterns of autonomous decision making and action.
The first, do and inform later, is based on a history and mutual trust between physicians and nurses and is probably the most frequent autonomous action in the overlapping sphere of practice.
First example I had a patient go into respiratory distress. I assessed the patient—rapid respirations, anxiety, color, etc—gave him more oxygen, ordered a chest x-ray because I thought it was fluid overload. Then I called the doctor and gave him a complete report. It was fluid overload and we got him out of that fast.
The second level of autonomous action, persist until the patient gets what he or she needs, involves repeatedly contacting the same physician, contacting other physicians, going “up the chain of command,” or electing not to follow an order or a protocol that the nurse judges to be inappropriate for this patient in this situation.
Second example the patient is on a monitor and strips are OK, but she just wasn’t herself. I could see by her body language that something just wasn’t right. I bugged the residents till they came. They left without even talking to me, so I called the attending directly. He came right away and just as he was asking me: “Diane, put into words what you’re seeing that tells you something isn’t right,” the patient blew. We would have lost that baby if the doc hadn’t been right there.
True interdependent decision making characterizes the third level of autonomous practice.
Third example is the patient was in for a brain bleed, and I’d been caring for him for several days. He had much comorbidity and had to be suctioned frequently. I tried to keep these to a minimum because of the increased intracranial pressure, but I still had to do it quite often to keep him from choking on his secretions. The doctor came in while I was to lunch and ordered that the patient not be suctioned oftener than once an hour. Well, I knew that was a “no go.” I contacted Dr but he was tied up; I contacted the respiratory therapist, and the clinical pharmacist, and explained the situation, and gave them a chance to think about what they might recommend and then got back to the office nurse and we set up a conference call between Dr and the 3 of us to see how we could take care of this problem, not increase the pressure, but yet keep the patient breathing and comfortable.
Sometimes nurses are made to feel that they do not have the support of leadership and/or management in making autonomous decisions in the best interests of patients. An experienced nurse related the following:
My patient’s BP suddenly dropped, and I gave her a bolus of fluid, which, for this patient at this time, was the right thing to do, but I didn’t have a specific order. As soon as the blood pressure came back up, I put in a call, but it was a while before the doctor got back to me. The patient’s BP would have bottomed out if I had not done that, but my nurse manager made me feel like I was a criminal or at the very least, walking on eggs. The doctor was pleased; I got great thanks and support from him.