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Professional Nurse Autonomy Coursework Example

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Professional Nurse Autonomy: A Concept Analysis
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Professional nurse autonomy: a concept Analysis
Concepts are not only elementary units of theoretical frameworks or scientific knowledge in nursing, but they play a crucial rule in all disciplines. The strength that theories depend on to guide a discipline is influenced or is dependent on the substantiality of concept analysis. Because of this, exploitation of shallowly understood concepts in theory development and research will lead to questionable validity and reliability. Also, concepts can be established and expanded as units of larger theories. Concept development calls for dedication to modern realism which also applies to the development of concepts. Concept analysis is divided into two: colloquial and theoretical. Each one of these categories has its purpose as well as evidence that is used to prove it. This paper elucidates more about autonomy as a concept used in nursing and as supported by Self-Determination theory which is used as a basis for understanding the reason behind the choices made by individuals as well as things that maintains the choices (Nielsen & Bark, 2014). The paper has different sections namely, the definition, followed by the literature review, then the attributes. After that is a section on the antecedent and the consequence, which is followed by the empirical referents part, then the construct cases. The final part of the paper has the theoretical applications of the concept and the conclusion.

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Autonomy definition
Autonomy is delineated as the freedom associated with the making of discriminatory and binding decisions, which are consistent with an individual’s space of practice and the freedom associated with acting on the choices made (Skår 2013). For people to have the ability of proficiency in making decisions centered on their autonomy, they must possess principles based on a critical reflection on the regulations as well as influences that are within. Autonomy, in concept analysis, comprises the aptitude to self-govern through making informed and flexible choices based on one’s scope (Lindberg, Fagerström, Sivberg & Willman, 2014). This concept is unclear in nursing since most definitions are based on the writers as well as the context of the material, and it ends up being defined differently by various nurses. The term has many definitions in nursing, and most nursing administrators delineate or define it as the ability to self-govern, the liberty to perform and self-determination when it comes to decision making and nursing. Concerning linguistics, Oxford English Dictionary described the concept as independence. As per Merriam-Webster dictionary, autonomy is a state to self-govern, i.e., responsiveness and self-directing. The synonyms of the concept include liberty, freedom, self-governance, and independence.
Literature review
The term autonomy, from the literature, is seen to be dependent on culture (Lindberg et al., 2014). Similarly, it is rare to find the term as a separate concept as it is mostly linked to others like work or structural autonomy, professional nurse autonomy, attitudinal autonomy, and woman’s autonomy. A lot of theories and researchers of this concept pointed out that the term lacked a unified delineation. The concept originates from Greek words auto (self) and nomos meaning law. Therefore it is a self-law. Many sources, as well as sciences, have studied the concept and many delineations have been suggested. Cole, Wellard, & Mummery (2014) pointed out as a crucial tool in comprehending advocacy. They argued that the concept is vital despite tradition claims which point out the concept as outdated. Sena (2017) defined autonomy as the actions of a person or a practitioner according to performance standards as well as ethical codes.
In sociology, individual autonomy is viewed as a kind of a person’s freedom to act, where one decides their line of action as per themselves. Moreover, woman’s autonomy has been delimited as a woman’s capability or lack of it to make choices in the house (Skår, 2013). It is also delineated as a social influence concept suggested by self-determination theory reflecting social influences that do not pressurize. On the other hand, Riley and Maree (2016) elucidated that autonomous nurses are required to make decisions independently. They also pointed out that intrinsic motivation is dependent on autonomy. Hence, intrinsic motivation cannot flourish without a sense of autonomy. Skår (2013) went ahead and suggested an operational delineation of the concept as the exercise of independent judgment undertaken to come up with the desired result. To summarize in my perspective, autonomy is a crucial feature that arises from power, trust, authority, and liability with the aim of improving the quality of nursing care.
Defining attributes
The main reason for identifying or recognizing the attributes of the concept is to set apart the idea from others that are related to it. Many attributes of autonomy are pinpointed by going through the available literature that is linked to the concept (Mororó, Enders, Lira, Silva & Menezes, 2017).
Self-governance is the essence of this concept and is established on a set of laws and philosophies some scholars refer to it as the right, accountability and ability to create or establish the environment. This involves making choices that are in line with one’s professional practice to be in control over working conditions, self as well as practice.
The other attribute of this concept is independence, which is essential in reflecting the freedom of practitioners.
Decision making is one of the crucial attributes of this concept. This is because a person’s capability to be autonomous is influenced by his/her capacity or capability to choose wisely among numerous alternatives. Riley and Maree (2016) asserts that an autonomous individual is the one who can make independent and informed decisions
Competence, capacity, knowledge, and ability are other defining attributes of this concept. The importance of knowledge is validated in Skår (2013 simple delineation of autonomy as an individual’s freedom to perform things the way they knew. Furthermore, Riley and Maree (2016) stressed competence as the basis of autonomy.
Lastly, judgment is another attribute of this concept, centered on experience and knowledge and encourage people to make right decisions to become autonomous.
Autonomy has some concepts which relate to it. Some of them include control, authority, freedom, responsibility, power, professionalism, and independence.
Antecedent
Antecedents are events or conditions that take place before the process of autonomy begins. The following are antecedents of autonomy.
Individuals should possess the capabilities to prioritize aspect or part of the knowledge of personal values as beliefs that are related to situations.
Persons should have the experience to carry out their duties autonomously.
They should be educated enough to perform their duties as individual’s autonomous.
They must also have self-discipline for them to make judgments and act autonomously.
Morals play a role here. It helps individuals to reason and critically think for them to act autonomously.
Individuals should be able to discriminate or distinguish their knowledge to help patients deal with their ailments.
Consequence
Walker and Avant delineated consequences as incidents or those events that come about after the concept has occurred. The following are outcomes of autonomy.
The most apparent consequence of this concept is accountability. It is delineated as the responsibility or answerability to authority or power for an individual’s actions. This means that an individual should be ready to be accountable for anything in whatever they are doing.
Because of the process of autonomy, individual autonomous will have authority, power, commitment as well as the freedom to deliver nursing care depending on the scope of their personal satisfaction and their responsibilities.
Lastly, individuals or groups will achieve empowerment through the autonomy process, and this will result in self-efficiency, trust as well as self-awareness amongst individuals. This will result in an improvement in working environment by persons.
Empirical referents autonomy
These are observations or measures that offer evidence that autonomy has occurred or is occurring. For this case, it includes observing incidents which have occurred due to nurse decisions and factors that might have contributed. For instance, examination of a case might tell that a particular decision was made due to pressure or against the demand by a nurse who knew what was ethical and right. Doing a random questioning of patients about the decisions and actions made by nurses can provide evidence regarding the occurrence of this concept.
Construct cases
Model Case
In a concept analysis, a model case must encompass all attributes of the concept itself and must be a typical example. Similarly, the attributes of the concept, as illustrated by Walker and Avant should be put into consideration. The following is an illustration of a model case for the concept of autonomy.
Liz is a registered nurse who graduated from Villanova University in 2012. She has worked at Pennsylvania Hospital for six years where is attached to the pediatric intensive care unit. Liz is an expert and is full of knowledge on matters (policies, hospital rules and regulations) that affect her practice. Her nursing experience is based on encouragement, critical problem solving, support and collaboration with other healthcare practitioners and patients to deliver high quality of nursing care. One day, Liz was on a night shift duty and was responsible for a 17-year-old male patient who was suffering from a spinal injury. Earlier, a surgeon had operated the patient and inserted a tube which was intended to drain cerebral spinal fluid for pressure reduction in cranial area. As Liz examined her patient, she was astonished to see fresh blood being drained instead of the spinal fluid. This was contrary to what she knew from her experience as she knew that fresh blood drains for about 15 minutes after an operation has been carried out and a tube inserted.
Liz documented her patient’s status since she knew his situation was worsening as per her experience. After that, she informed the same to a resident physician who was supposed to inform a specialist, but to her astonishment, the resident physician said that the condition was normal and require no specialist. Since fresh blood was still draining, Liz went to the resident physician again and informed him to contact the specialist, but he once again refused. Since Liz knew she was responsible for her patient as per the nursing ethics, she went against her senior and called him. She knew that liability in practice is obligatory according to nursing ethics and that it was necessary for her to make dependent and knowledgeable decision for the good of the patient. The specialized arrived, and after reassessing the patient’s condition, he realized that Liz was right after which a second operation was performed on the patient.
Borderline case
One day in the PICU, Mary, a 13 years old patient was brought and diagnosed with Juvenile Rheumatoid Arthritis. On a given day, Liz was on duty. As she goes around checking on the patients, she realized that Mary was prescribed with chloroquine and she was already using the medicine. According to Liz’s experience, chloroquine was used to treat malaria and Mary was supposed to be prescribed with ibuprofen or naproxen as she was suffering from Juvenile Rheumatoid Arthritis. On further inquiry, Liz realized the confusion which had occurred. Liz informed the patient that the medication she was given was wrong, but Mary insisted it was the right medicine. Liz left the patient with the wrong prescription.
Contrary case
One day at the Psychiatric Intensive Care Unit during medicine administration, Liz realized that the femoral cannula used in her patient had abnormal clotting and it should be changed as per experience. She informed the physician about the same and on checking the cannula, the physician told her to leave it the way it was. In this case, the physician’s decision is not based on knowledge and experience. Therefore it is a contrary case, and we can name it autocracy rather than autonomy as the physician uses power to order Liz to leave the cannula as it was yet Liz was aware that it was not safe for the patient.
Theoretical Applications autonomy
As pointed out earlier, exploitation of shallowly understood concepts in theory development and research will lead to questionable validity and reliability. Similarly, the strength that theories depend on to guide a discipline is influenced or is dependent on the substantiality of concept analysis (Nielsen & Bark, 2014). Therefore, a lot has to be done when it comes to concept analysis for the developed concepts to be up to date and quality. Concept development calls for dedication to modern realism which also applies to the development of concepts.
Conclusion
Autonomy in nursing is increasingly becoming an issue in the system of healthcare that usually encourages dependency on matters of decisions. Nurses are among the key participants in the decision-making practice. Models that are in existence for the development of the theoretical approach of this concept have limited literature. Autonomy support, besides, is delineated as a social influence concept suggested by self-determination theory reflecting non-pressuring types of social influence. Furthermore, the model for nursing autonomy is crucial for nurses who work at different functional levels. As per Meyer’s model, Patient-Autonomy in Care was established to include functional needs as well as the special vulnerability of patients during their stay in health care system (Castro, Van Regenmortel, Vanhaecht, Sermeus & Van Hecke, 2016). Research carried out in 2014 supports the same and suggest an in-depth understanding of this concept as necessary to elucidate and cultivate the nursing profession in the fast-changing healthcare environments. As a concept in the field of nursing, autonomy is and will remain ambiguous since there is no unified definition. However, it is an important term that nurse practitioners should integrate into their day to day practice for them to make sound and independent decisions that are good for the well-being of the patients. The research on concept analysis has challenged me to think more about the concepts used in nursing. From the look of things, numerous concepts having no unified meaning are used in nursing. While that is a matter of concern, some perceive the use of such concepts as harmless so long as the concept enhances group and individual empowerment, improves trust, improves job satisfaction and speeds the healing process as the is outcome nurse awaits.

References
Cole, Wellard, & Mummery. (2014). Problematizing autonomy and advocacy in nursing. – PubMed – NCBI. Ncbi.nlm.nih.gov. Retrieved 21 March 2018, from https://www.ncbi.nlm.nih.gov/pubmed/24399831Nielsen, C., & Bark, L. (2014). A closer look at self-determination theory & autonomy in nurse coaching.. EBSCOhost. Retrieved 21 March 2018, from http://connection.ebscohost.com/c/articles/94340564/closer-look-self-determination-theory-autonomy-nurse-coachingCole, C., Wellard, S., & Mummery, J. (2014). Problematizing autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576-582.
Riley, G., & Maree, R. (2016). The role of self-determination theory and cognitive evaluation theory in home education. Taylor & Francis Online. Retrieved 21 March 2018, from https://www.tandfonline.com/doi/full/10.1080/2331186X.2016.1163651Lindberg, C., Fagerström, C., Sivberg, B., & Willman, A. (2014). Concept analysis: patient autonomy in a caring context. Retrieved 12 March 2018, from http://onlinelibrary.wiley.com/doi/10.1111/jan.12412/abstractMororó, D., Enders, B., Lira, A., Silva, C., & Menezes, R. (2017). Análise conceptual da gestão do Cuidado em enfermagem no âmbito hospital. Retrieved 21 March 2018, from http://www.scielo.br/scielo.php?pid=S0103-21002017000300323&script=sci_arttext&tlng=enSena, B. (2017). Professionalization without Autonomy: The Italian Case of Building the Nursing Profession. Journals.hioa.no. Retrieved 21 March 2018, from https://journals.hioa.no/index.php/pp/article/view/1900/2385Autonomy | Definition of autonomy in English by Oxford Dictionaries. Oxford Dictionaries | English. Retrieved 21 March 2018, from https://en.oxforddictionaries.com/definition/autonomy

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