Patient Autonomy

Agnus · Feb 22, 2008

Hi
I need to write a paper based on the thesis: "Nurses ought to respect a patient's right to autonomy".
What are your thoughts to this statement?
What are the barriers you face daily in achieving this statement?
What changes need to be made to health care to achieve this statement?
I would appreciate your help very very (very)(!) much!
Thanks!:redbeathe

Absolutely they should have autonomy in making decisions. I have seen nurses proceed with doing something to a patient when they say "no." or "stop".

This is not only unethical but illegal.

It is extreemly rare that this is a life or death situation where a nurse continues to do the act over a pt's objection. I stop and get clarification. I address their concerns. When a pt stops me from doing something there is usually a very good and real reason that I should stop.

I believe one of the big problems we face with this is truly informed consent. Often we claim a pt has given "informed consent," when in fact the pt was not given the full picture because "explaining everything takes too long." Too often a patient will say "I did not know that" or was not told xyz and they are infact telling the truth about this.

Or "if I had known this I would not ever have consented."

Teaching takes time a lot of it and that is what is needed to make truly informed consent.

The problem is our parternalistic attitude and not wanting to take the time needed with patients. "They will not understand" is a poor reason to assume that it is ok to make decisions for them.

MAISY, RN-ER, BSN, RN · Feb 22, 2008

Unfortunately, autonomy and institution do not mix.

We'd all like to think our patients have choices, but once they commit themselves to institutional care they are told we have to because.....otherwise, they are going against medical advice. That scares people.

Doctors do not explain procedures fully. Nurses do not explain everything they will do fully-no time. We insert ivs, and draw labs, catheterize patients, feed, encourage fluids, run fluids, medicate and so on.....so that our butts are covered and the institutional rules are followed.

Just think of the patient who refuses a med, or to be straight cathed or whatever.....they throw a wrench in the works! No one has time to kiss butt to get people to comply with our orders ,. So would I like to give choices, sure......but it's a pain to work with.

My feeling is especially in the ER....you came to get better.....then do it....let us help you by finding out your problem....if not, go home! That's autonomy too!

Sorry so harsh, but I am sick of hearing about "rights" sometimes things need to be done. Patients just make it sooooo painful to help them sometimes.

Maisy

madwife2002, BSN, RN · Feb 22, 2008

Autonomy-absolutly it is the patients right to be able to decide what is done to them. This should not be compromised. I have always had the time to explain tests and have in 19 years rarely been refused to be allowed to carry out a test or proceedure on a patient.

Most pt's just want to understand and be reassured, but if a pt refused then I would not carry out the proceedure.

Recently I was an inpatient and I refused to have a certain pre prep test performed-that is MY RIGHT and I had had enough poking, prodding and being made to feel worse than I had when I entered the hospital. As it turned out the prep was changed and we were all happy. There is nearly always a compromise.

lvnandmomx3 · Feb 22, 2008

You may be able to find some useful info with this link. Alot has to deal with Adults with disabilities but he is an advocate for autonomy, even for adults with disabilities. http://www.universallifestiles.com/articles.html.

RNperdiem, RN · Feb 23, 2008

In a perfect world, patients would take full responsibility for themselves.

In a perfect world, doctors and nurses would give all the information a patient needs to have autonomy, all explained and demonstrated in a way that does not talk down to a patient, nor goes over their head. Patients have varied levels of education and "health literacy", some doctors have mastered the art of explaining better than others.

We do not live in a perfect world, but we strive for the ideals.

UBC-SN · Feb 23, 2008

Thank you all so much for your contributions so far. I really appreciate it!

Now, as far as informed consent goes, how do YOU try to make this happen? I know that time and understaffing are always barriers, but how do you try to overcome these barriers?