Autonomy
Introduction
Autonomy, and the concept of respecting the patient’s autonomy, continues to garner prominence in nursing and healthcare provision. Acknowledging and respecting the patient’s autonomy is the foundation of medical ethics and the corner-stone of patient-centered care (Fagan, 2017). Nurses, among other healthcare providers, have a responsibility to respect the patient’s autonomy while effectively caring. The word autonomy describes deliberate decision-making and sticking to the decision. Respecting patients’ autonomy encompasses recognizing that patients’ who are capable of making decisions are entitled to make their own choices regarding the care they receive. There are two main prerequisites associated with respecting a patient’s autonomy, giving sufficient information about the condition and the treatment options, and engaging the patient in decision making (Greaney & Mathanu, 2017). Indeed, nurses have a responsibility to support the patients even when their decisions contradict the physician’s recommendations.
In the hospital setting and nursing care, several situations might invade the provision of this basic need in patient-centered care. For instance, when a nurse has a heavy workload and is pressed for time, respecting the patient’s autonomy might seem like a distraction to the provision of care. It is essential to acknowledge that respecting patients’ autonomy involves building a rapport with the patient, often time-consuming (Molina-Mula & Estrada, 2020). When pressed for time, a nurse can facilitate patient autonomy while delivering effective care through time management practices.
Specifically, nurses must prioritize, acknowledge the importance of flexibility and patience, and be organized. Organization encompasses planning out all the tasks that need to be done, including how long the activity might take. Organization also involves gathering all supplies, equipment, and knowledge before starting a particular task (Molina-Mula & Estrada, 2020). Similarly, it is vital to learn how to break down tasks into smaller ones and clustering care. Practical organization skills help a nurse manage his or her time well, implying the aspect of being pressed for time will not be at the forefront of the mind when communicating with the patient.
Learning to prioritize between several competing tasks can be a challenge, but mastering such a skill will vital in respecting the patient’s autonomy. It is essential to acknowledge that the complexity of medical conditions varies and is often accompanied by other parameters making prioritizing difficult. A nurse needs to ask these questions before choosing one task over the other, which job do I need to do first, and why? Which action is more important, and why? Are there any consequences for not acting immediately? What is more important to the patient? Answering these questions allows a nurse to pick the most pressing task and handle it first (Molina-Mula & Estrada, 2020). Learning to prioritize fosters patient autonomy since it will enable a nurse to dedicate his or her attention to a specific task and patient at a time allowing for open and insightful discussions that encompass engaging the patient in decision making. Prioritizing is also allows a nurse to avoid distractions and interruptions. When one has a clear list of what he or she needs to accomplish first, it is easier to focus on the task (Greaney & Mathanu, 2017). As mentioned, respecting patient autonomy encompasses building a relationship with the patient, which is best done without interruptions and distractions.
Nurses can also facilitate patient autonomy even when pressed for time by knowing the importance of flexibility and patience. Nurses work in an environment that necessitates being calm and collected even with a heavy workload. Being patient allows a nurse to listen to a patient attentively while addressing their concerns even when pressed for time (Molina-Mula & Estrada, 2020). Flexibility is also crucial since it allows a nurse to deviate from his or her schedule accordingly without any difficulty. Patience and flexibility are vital in allowing for open communication channels between the nurse and the patient and, hence, better patient engagement in decision making.
While patient autonomy is primarily recognized as the acceptable tenet in professional practice, supporting independence when one is pressed for time can create a lot of tensions and ethical concerns. Respecting patient autonomy encompasses providing sufficient information about their condition and the available treatment options while engaging them to make a decision. While the aspect of providing information to the patient can be effectively done through better time management practices when a nurse is pressed for time, time management cannot help the patient with decision making (Molina-Mula & Estrada, 2020). Ethical issues arise when the patient’s decision differs from physician recommendations, available clinical evidence, and treatment of a minor. Such issues bring to the forefront the aspect of professional accountability and responsibility for patient welfare. These issues are particularly pressing when there is a sense of urgency when a nurse is pressed for time.
In many cases, a patient will almost always agree with the recommendations of the physician and, as such, allow for a smooth process that assists a nurse in his or her endeavor to manage time effectively. However, in some cases, a patient might refuse an initial medical treatment even with the knowledge that refusing case or settling for an alternative might result in devastating health consequences and, in some instances, death (Fagan, 2017). For example, Jehovah’s Witness Church followers are against blood transfusions, which often raise ethical concerns. In such a case, a nurse has the responsibility to provide more information about the condition and the available treatment options in addition to warning the patient about the consequences of their choices. In the event, the patient still maintains his or her decision; the aspect of professional accountability and responsibility of the patient’s welfare comes into play (Fagan, 2017). Flexibility is particularly important in such circumstances since a nurse will have to reorganize his or her schedule and discuss it with the physician and the hospital administration if obtaining a court order is necessary for an effort to save the patient life.
When a nurse is pressed for time, addressing patient autonomy in a hospital setting is especially challenging when the medical consequences of the patient’s choices are particularly severe. How to proceed when a patient refuses medical attention depends on the situation. For instance, if the decision is not based on specific religious or cultural beliefs, the patient’s mental competence analysis is made. If the individual has the mental capacity to make the decisions, the nurse has a responsibility to discuss the patient’s decisions with the physicians and the healthcare administration and subsequently acquire a court order that allows the individual to receive care. A court order is particularly relevant in that the patient is a minor, and an adult is deciding on their behalf with devastating consequences to their health (Fagan, 2017). In many cases, a judge will rule in favor of the physician in the event the person in question is a minor.
In some instances, a nurse has to respect a patient’s autonomy even if it undervalues other nursing values such as beneficence. A nurse is usually forced to respect a patient’s autonomy when their choices are grounded on specific cultural and religious beliefs. For example, if a patient from Jehovah’s Witness is admitted to the hospital and urgently needs a blood transfusion but refuses to get one since it goes against his or her religious beliefs, the nurse in such a circumstance is forced to uphold patient autonomy. However, the nurse is allowed to consult with the physicians and the hospital administration to determine if seeking a court order is necessary (Molina-Mula & Estrada, 2020). A court order works to overrule the decision of the patient. In recent years, many courts judge in favor of the patient urging that any consenting adult has the right to his or her own beliefs and how those beliefs impact the medical care he or she receives.
Respecting patient autonomy when they are grounded on specific cultural and religious beliefs even if they undermine other values is important because the exercise of autonomy includes the acknowledgment of both the deepest and the most trivial beliefs and commitments that an individual holds. Religious and secular ethical obligations often require specific fundamental and explicit adherence to a pre-determined set of rules and guidelines which different individuals that commit to that community from others (Greaney & Mathanu, 2017). When a patient showcases any dedication to his or her beliefs, a nurse needs to recognize them and embrace them.
It is essential to recognize that the concept of autonomy is grounded on choice. As a nurse and a healthcare provider with a responsibility to respecting patient’s autonomy, it is ill-informed to dismiss one’s beliefs since the whole point of acting autonomously is to engage patients in the delivery of their care. Indeed, the fact that an individual identifies with a specific religious or ethical group in itself is evidence of the person’s autonomous decision (Greaney & Mathanu, 2017). Indeed, being part of a particular community illustrates that the person is not only aware of the rules and guidelines associated with them but also recognizes the consequences of those rules upon joining. Indeed, it will be ill-informed to ignore an individual’s beliefs even if his or her compliance with them might result in a medically preventable death for the patient.
Conclusion
Respecting patient’s autonomy encompasses recognizing that patients have a right to make their own decisions regarding their health. The right for patients to make their own choices is supported by several national and international rules. However, respect for patient autonomy is far more complicated than merely engaging the patient in decision making. The complexities are more evident when a nurse is pressed for time in a hospital setting. Therefore, time management I particularly important in ensuring a nurse respects the patient’s autonomy. Effective time management allows the nurse to discuss the patient’s condition extensively and will enable the patient to make an informed decision. It is essential for nurses and all healthcare providers to recognize and respect patients’ autonomy even in the event the patients’ choices differ from the best clinical evidence. Indeed, the whole idea of patient autonomy is allowing for patients’ options in the medical decision, and it will be unfair for those decisions to be easily undercut.
References
Fagan, A. (2017). How Autonomous Is Medical Decision Making? AMA Journal of Ethics.
Greaney, A. M., & Mathanu, D. P. (2017). Patient autonomy in nursing and healthcare contexts. Key Concepts and Issues in NursingEthics, 83-99.
Molina-Mula, J., & Estrada, G. J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 185-198.