Healthcare in America has taken an all-important shift toward patient autonomy. Doctors and nurses understand the value of an integrated approach for better patient outcomes.
Patient autonomy is the right of the patient to decide on the type of care they receive without the interference of providers. Patients act autonomously, with intention, and are fully involved in decisions involving their treatment and care.
Patient autonomy is a contentious subject. Some medical practitioners feel that patients need to learn more to make the right decisions regarding their care. They have yet to study medicine or nursing, so layman’s views inform any decisions or ideas they may put forward and may not have the best medical outcomes.
This may be true, but studies have shown over and over again that there are better outcomes overall when patients are involved in making treatment and care decisions. When they participate in what type of care they get and how it is delivered, even when dealing with end-of-life matters, there are often better outcomes.
Patient autonomy is sometimes confused with patient-centered care. These two concepts are similar in some respects, but there are important differences that every healthcare provider should know about.
While patient autonomy is about allowing patients to participate in their care and treatment, patient-centered care is about making sure that all actions are taken with the patient in mind. It calls for excellent communication between care teams, doctors and patients, nurses and patients, and everyone involved in delivering treatment.
Nursing educators are expected to have a good grasp of these concepts. If they understand patient autonomy and patient-centered care, they can communicate the principles clearly to their students.
Specific online nurse educator programs are designed to impart knowledge and skills to instructors so that they can prepare future generations of American nurses. Students who enroll in a Master of Science in Nursing (MSN) course from Walsh University, for example, learn about the theoretical development of nursing science, advanced pathophysiology, and practicum in nursing education.
All coursework is online, and the course can be completed in just five semesters. Enrollees don’t need a GRE or GMAT to qualify, but they need to have a Bachelor of Science in Nursing (BSN) from an accredited nursing school.
Interwoven into the course materials are patient autonomy and patient-centered care. Instructors get to understand what it is, its benefits, and how best they can teach it to their students.
Why patient autonomy?
Historically, doctors and nurses held sway in all patient decisions. It was a general assumption that because of their expertise and training, they knew what was best. A few decades ago, it would have been unthinkable for a patient to tell the practitioner what type of treatment they preferred.
All that was expected was for them to communicate their symptoms. Doctors and nurses would do the rest. It worked because there wasn’t much information in the public sphere.
Patients didn’t know much about treatments, medicines, and therapies prescribed to them. They assumed that doctors and nurses knew what was best – they were trained for it.
Technology changed this. The internet allows everyone to learn about their illness and options by simply looking online.
A cancer patient, for example, can look up all types of treatments, where to find them, their success rates, and even how uncomfortable they are. They have many options. They can decide to do chemotherapy at their local oncology center, seek herbal treatments from China, look for bee treatments in Mexico, or choose to do nothing and wait for their lives to end.
Information has made people aware of their options, and they can contribute to their treatment and care. Their families are just as informed, and they want to feel that their opinions are respected and considered by nurses and doctors.
Patients are now in the driver’s seat and play a central role in their care. They can conduct accurate research about their conditions, assess available treatment options, decide whether or not they should participate in trials, and even decide how they will die.
What role does nurse leadership play in patient autonomy?
Nurse leaders can be described as nurses who excel at inspiring, guiding, and helping other nurses. Nurse leadership requires higher levels of training than ordinary nursing, and those who qualify often hold a master’s degree.
A nurse leader is usually in charge of other nurses and acts as their representative within management. They are also trained in advanced patient care, different aspects of leadership, patient advocacy, and liaison duties.
Nurse leaders are critical in encouraging patient autonomy within the care setting. They understand how to empower patients to make decisions about how they should be treated, and they can teach those they supervise to do the same.
Nurse leaders advise other nurses on matters of patient advocacy. If a nurse encounters a situation where they aren’t sure what to do, the nurse leader steps in, and their special training and experience can help move the situation forward.
Nurse leaders also work in close collaboration with doctors, helping them to understand each patient’s wishes and create treatment plans that meet their desires.
A good nurse leader takes charge but, at the same time, gives their nurses autonomy to do right by each patient. They ensure that every nurse they supervise understands the rules and protocols that govern patient care and the principles of patient autonomy.
In some cases, patients need to be made aware that they have the right to make autonomous decisions. They assume that doctors and nurses will do their best to get them better. Even when subjected to routines or treatments they aren’t comfortable with; they may not speak up because they are afraid to offend.
A nurse leader has the special duty of letting the patient know that they are allowed to contribute ideas and communicate their feelings toward the care they receive. The nurse leader talks to them about thinking carefully about their own physical, emotional, social, and psychological needs before they make a decision.
A nurse leader can also step in if they encounter a situation where a patient is influenced to make decisions about their care. If, for example, a doctor doesn’t consult fully with a patient about different treatment options, the nurse leader should step up, have a quiet word with the doctor, and remedy the situation.
Examples of the nurse leader’s role in patient autonomy
Dave, with a gash on the head
Dave and his friends are out on Friday night, and they are involved in a minor altercation. They end up in the ER, but Dave, who has a gash on his head, doesn’t think it is anything to worry about. He is more concerned about his friends and is adamant that he doesn’t need a scan or stitches.
The ER nurse tries to talk to Dave, but he is insistent that he doesn’t like hospitals and would instead go home.
If the ER nurse feels that things may get considerably worse for Dave after he leaves the hospital, they can get advice from the nurse leader. The nurse leader talks to Dave and explains that he is in charge all the way, and nothing will be done that he doesn’t feel comfortable with.
When Dave starts to feel that he is in control, he will likely agree to a scan and have the gash treated.
Betty with terminal cancer
Betty has just been diagnosed with a very aggressive type of cancer. Her oncologist feels that if they don’t start chemotherapy and radiation straight away, she will be dead within a few months.
Betty, however, is reluctant to take this course of action. Her mother had cancer, and she saw her suffer the pain and discomfort that these treatments caused – and she died anyway. Betty knows that she doesn’t want this particular sequence to be her fate.
The nurse manager can be called in to consult in such a case. The nurse manager’s role will be to reassure Betty that whatever she chooses, her carers will back her up.
If she chooses to forgo chemotherapy, the hospital will make her as comfortable as possible and do its best to reduce her suffering.
The oncologist may feel very strongly that Betty’s best chances lie with these treatments, and they may insist that this is the only way forward. It is the job of the nurse leader to discuss the issue with the doctor and ensure that they understand that the patient’s wishes come first.
Roger’s last wish
Roger has been in the hospital for the last few months. He is old and suffers from several illnesses. When it became apparent that he was approaching the end of his life, he asked to be taken home and die there. He doesn’t like the idea of transitioning surrounded by strangers in a hospital.
However, there is only one person at home who can deliver the quality of care that the hospital can.
The nurse leader’s role is to let Roger know that they understand his desires and will try their best to make them happen.
They will discuss what options are available for home care so that Roger, with this information, can decide how he will be cared for in his last days.
What competencies are required for nurse leaders?
What prepares someone to become the kind of nurse leader who promotes patient autonomy and empowerment?
Nurse leaders need to have the right technical and soft skills. Technical skills are concerned with the everyday work of nursing, and they can be learned in any accredited nursing program. Tests and exams measure them.
Soft skills are more complicated because they cannot be taught in classrooms. They are self-taught, and those who hope to become good nurse leaders must nurture them over the years. They include the following.
One of the primary roles of a nurse leader is to communicate. They talk to their nurses, management, and patients and speak with other stakeholders. They must also be prepared to listen.
A good nurse leader knows how to communicate about complex and nuanced issues. They are role models wherever they work.
Diversity and inclusion
A nurse leader needs to serve all fairly without discrimination. Every patient needs the best care they can get. The nurse leader should listen to their wishes about how they wish to be treated.
It doesn’t matter how educated they are, where they come from, their race, or their economic background – as long as they are registered as patients, they have the right to express their opinions about how they wish to be treated.
Nurse leaders also understand the importance of diversity and inclusion when dealing with those they supervise, as well as other professionals in the healthcare setting.
It is a common assumption that all nurses are empathetic. This is only sometimes the case. Some get into the profession because it is stable and pays well, but they aren’t particularly inclined to feel the pain that others suffer.
However, they can develop empathy along the way because it is essential for anyone who wishes to care for others.
Nurse leaders work for many hours without a break. They must take care of their bodies and minds so that they can have the necessary stamina to keep going.
They should eat well, take breaks during long shifts, and rest off-duty. Having a fun hobby is an excellent way to unwind. They must be careful about burnout, and if they feel it is coming on, they should be able to recognize the symptoms and take a break.
Nurse leaders play a critical role in fostering patient autonomy and empowerment. They are patient advocates, and it is their job to ensure that all hear patients’ wishes. A good nurse leader has the technical and soft skills to get their voice heard and engender trust with patients and colleagues alike.