Patient autonomy is more than a buzzword. Healthcare facilities across the United States now strive to make it a core pillar of healthcare delivery. Nurses are at the forefront of patient care, and they need to understand patient autonomy and its value in treatment and care.
Simply put, patient autonomy means that patients are allowed to make decisions about their care, even when their desires and suggestions don’t match those of doctors, nurses, and other healthcare professionals. For patient autonomy to exist, clinicians must refrain from coercion, persuasion, and manipulation.
The role of the clinician is to ensure that the patient understands the various interventions that are available to treat their illness as well as the benefits and drawbacks of each. Once this is done, the clinician must step back and allow the patient to decide how they would like to proceed.
Patient autonomy is a contentious topic in medical circles. Not all doctors and nurses are convinced that patients know what’s good for them.
They may be allowed to take part in choosing a course of treatment or care, but because they lack medical training they don’t always make the best choices.
While this is certainly true, it doesn’t affect the benefits of allowing patients to make decisions about their care. Doctors and nurses must, whenever possible, allow each patient to make autonomous decisions.
Patient autonomy in nursing
Nurses have always been pillars of the healthcare profession. Of all practitioners, they are the ones who spend the most time with patients. Doctors are present to diagnose and recommend treatment, but the nurse is left to handle everything else.
The issue of patient autonomy is even more critical for them. They must understand its benefits for the patient. It is their job to ensure that those in their care participate in choosing treatment and care options.
Nurses are also advocates and as such should strive to ensure that the patient’s wishes are respected. If the patient isn’t in a position to make decisions, the nurse should find a suitable representative, like a family member, to make the decisions on their behalf.
Nursing education is evolving to reflect the need for patient autonomy. Whether you are training to become an RN or have enrolled in a master’s in nursing, you will encounter the topic of patient autonomy along the way.
It becomes more central to the curriculum as you pursue higher education where you learn how to handle complex patient needs. A CCNE accredited nurse is expected to understand the meaning of patient autonomy and how it affects outcomes. They must be able to practice it in a real-world environment, not just define it in theoretical terms. The CCNE accreditation by Walsh University is designed to ensure that nurses can deliver healthcare to the highest standards, and that involves ensuring that patients are included in making decisions about their care.
As you research nursing schools, you should check to see whether they are CCNE accredited. This means that their curriculums are deemed fit and meet the outlined quality standards.
Why patient autonomy?
Patients haven’t always been free to participate in decisions about their care. A few decades ago healthcare practitioners exercised complete control over every aspect of a patient’s illness. A doctor made a diagnosis and recommended treatment.
Nurses helped dispense the treatments. Little attention was paid to how the patient felt about how they were treated. If the doctor recommended it, the patient had to endure it.
It is important to understand this dynamic in context. Patients didn’t have the same amount of knowledge they have today. Medical journals and textbooks were the purviews of practitioners.
Technology changed that. Today, the average patient can find out anything they want about their illness and proposed treatments. There is plenty of medical information on the internet.
As people became more aware, they wanted to participate more in their treatment. Today’s patient wants a consultative process, where they discuss the available treatment options with their practitioners. If they are unhappy or uncomfortable with a proposal, they have the right to opt-out.
Patient autonomy has become widely accepted because it has obvious benefits. When patients speak openly about their concerns, fears, and preferences, they tend to have better outcomes from their treatments. They are also more likely to collaborate with suggested treatments.
The concept of wellness is well-understood. Health is no longer the absence of illness. Just because someone isn’t in pain doesn’t mean that they are healthy. Wellness is about physiological, psychological, emotional, spiritual, and social health.
It is the nurse’s job to talk to patients and find out as much as they can about them so that they can help doctors create tailored treatments that deliver wellness.
A good example of this is in patients who suffer from heart disease. There are many treatments that doctors can dispense to manage it, but this isn’t usually enough. Practitioners understand that it may be more than a physical illness. It could be a manifestation of a patient’s emotional state. Heart disease can also be a result of a stressful lifestyle, poor diet, or genetics.
While the patient will be issued with medications to manage their symptoms, caregivers will also strive to understand the underlying causes of the disease.
Ideally, a nurse will work closely with the patient to learn as much as possible about his or her life. They will ask about family history, home life, the sort of work they do, and even how they socialize.
Together with the doctor, the nurse and patient will discuss how best to treat the illness given the factors that have led to the condition.
If the patient prefers one form of treatment over another, the practitioners must take the patient’s wishes into account.
How can nurses encourage patient autonomy?
By the time nurses qualifies to become a practitioner, they should understand the value of patient autonomy in healthcare. Even as junior nurses, they must always take the patient’s desires into account.
Certain skills can help them excel as patient advocates:
They must be good listeners
Patient autonomy is all about listening. To understand what a patient wants, the nurse must listen to them. This is one of the soft skills that are widely understood as a requirement for the nursing profession.
Listening is more than hearing what the other person is saying. Nurses must learn how to read body language and even understand uncommunicated concerns. This is especially important when nurses are dealing with sensitive issues that patients may not be willing to discuss.
A woman who is battered by her partner, for example, may not want to talk about it with her healthcare providers, but by making careful observations the nurse can see that all isn’t well at home.
Her good communication skills allow her to broach the topic carefully so that the patient can feel comfortable about opening up.
It may not be the patient’s desire that the nurse contacts the police. She is exercising patient autonomy and the nurse must respect her wishes.
Cultural competence
Cultural competence is critical for nurses who exercise patient autonomy. A patient can be uncomfortable with a certain treatment because it goes against their culture or beliefs.
A Muslim woman, for example, may be uncomfortable about taking hydrotherapy treatments because they do not want to wear a swimming costume or bikini. A good nurse would understand this right away and discuss other ways that the patient can be outfitted so that they can get into the hydrotherapy tank.
Teamwork
Patient autonomy requires good teamwork. The nurse acts as the patient’s advocate, and they must communicate their desires and wishes to the rest of the team.
If, for example, the doctor recommends certain tests that the patient isn’t comfortable with, the nurse should be able to discuss the issue with the doctor and other members of the treatment team. Together, they can come up with alternatives that the patient is more amenable to.
Professionalism
It isn’t easy for a nurse to hear that the treatment or care they are offering a patient isn’t appreciated. The human instinct is to push back, coerce, and insist. It takes a high level of professionalism to maintain a level head, listen to the patient, and carry out their wishes.
Problem solving
A good nurse must be willing to explore options so that they can provide the best care possible to his or her patients. If, for example, a patient is uncomfortable with a certain procedure, the nurse should explore available alternatives that deliver the same benefits.
They should then discuss them with the patient to see if any of the alternatives are acceptable.
A good example is patients who are unwilling to undergo chemotherapy treatments because of resultant nausea. Rather than throw the whole idea out the window, the nurse looks for acceptable remedies for nausea.
Critical observation
Attention to detail can be highly beneficial in the practice of patient autonomy. A patient may not be explicit about why they want to avoid certain treatments, but by observing them a nurse can deduce why they are reluctant.
Imagine a young woman walks into an ER and is diagnosed, and the doctor recommends an overnight stay for observation. The patient, however, is adamant that they cannot stay overnight. Could it be that they have a small child at home that they must care for? Or an elderly parent who needs their attention?
Sometimes observation helps tease out problems that may not be obvious. A patient complains of frequent headaches that don’t seem to respond to ordinary painkillers. The nurse may observe that they squint when they read. Their headaches can likely be attributed to eye strain, and prescription eyeglasses should help.
Observations may not always discover the problem, but they open up avenues of discussion, and the nurse can learn more about the patient. An observant nurse can provide comprehensive treatments.
Are there limits to patient autonomy?
Healthcare professionals have to battle this issue every day. What happens when a patient asks for a treatment that the doctor knows will not help, while adamantly refusing a course of treatment that is immediately beneficial?
Patients are often in an impaired state. They may be confused, incoherent, or unable to communicate. What should the nurse or doctor do? They must be guided by the ethics of the profession. If a course of treatment will cause harm or cause deterioration, they must not administer it. Patient autonomy is defined by knowledge and objectivity. The healthcare provider, through discussions, will establish whether the patient is well-informed and objective.
Doctors and nurses must explain proposed treatments so that the patients can understand their benefits and also what happens if they decline. If a patient proposes a treatment that causes harm, the doctor can override the principle of autonomy in favor of their professional knowledge. Doctors and nurses must know when to override patient autonomy. They must weigh the patient’s wishes against the benefits of the proposed treatment to make a decision.
Healthcare professionals need to acknowledge that autonomy is not necessarily a principle that can be granted or refused. It is more helpful to think about it in terms of the degrees to which it can be offered. To provide the best treatments, there must be a consensus. If a patient understands that the doctor is willing to listen to their desires but stops short of causing harm, then there is room for discussion, and both parties can come to an agreement that provides the best outcomes.
Conclusion
Patient autonomy is a central pillar of healthcare, and nurses must strive to listen to their patient’s desires. At the same time, they must endeavor to balance autonomy against sound medical doctrine. They must not do anything that will harm a patient or cause their condition to deteriorate.
