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The aspects that governed patient autonomy are varied and studies have investigated them. Freedom which has been specified as positive and negative, paternalism, patient’s dignity, integrity of actions by nurses and partial paternalism are subjects that have been investigated by researchers. The influence of issues on the ethical practices of the nursing profession and the difficulties experienced has been evaluated. The problem of getting informed consent from the patients has been one issue of significance and faced everyday by the nurse. The problem of medical paternalism was another issue which disturbed the atmosphere of caring. This paper explores the qualitative content of four studies and compares them critically so as to highlight the issues involved in the ethical administration of caring for all types of patients ranging from home care through nursing home care, hospital care and care for post-operative patients, medical patients and elderly patients. The first article has been focused upon and the others are taken for comparison for highlighting the concept of autonomy and how it influenced nursing care in a patient –centered framework. Moser et al (2007) reviewed 1236 studies involving patient autonomy and how nurses supported it and selected 6 of them: 2 on homecare, 1 on nursing-home care and 3 on hospital care. The researchers had found that patient autonomy consisted of two types of freedom: negative and positive (Moser et al, 2007). Negative freedom had allowed the patient freedom of action without an outsider’s interference. Positive freedom had indicated that freedom was attained through one’s convictions and individuality. Theories that had supported negative freedom focused on self- care and self-governance. Those that had supported positive freedom focused on caring, identification, communication and achievement of goals. The patient autonomy had been studied in home care, nursing home care and in hospital settings. A mixed approach with both negative and positive freedom was appreciated by patients (Moser et al, 2007). Nurses could not follow a single model for all actions in patient autonomy because actions varied according to the situation. They had to derive knowledge for interaction through previous experience. Nurses had been described as professional care-givers for chronically ill people. The shared care model was one which required patients to participate in the management of their condition. Patient autonomy had an ethical perspective. Nurses guided the patient to practice autonomy by helping them to make their own decisions (Moser et al, 2007). For autonomy with positive freedom, the nurses collaborated actively with the patients. Positive freedom required social relationships for practicing autonomy. A patient with less autonomy tended to be bullied by interfering persons. For a patient to be autonomous, he had to be at liberty to make choices. Nurses were able to provide interventions only if consent was secured. Orem’s self-care theory indicated that nurses needed to help the patient to resume his autonomy by self-care principles. Four phases of caring had been identified: caring about, taking care of, care giving and care receiving (Moser et al, 2007). The moral qualities of attentiveness, responsibility, competence and responsiveness had been associated with them. The relationship between the patient and nurse flourished using these moral qualities so that appropriate choices were made as ...Show more


PATIENT-CENTERED FRAMEWORK Abstract Patient autonomy is the focus of patient-centered care. Research has investigated the various aspects of patient autonomy and how the nursing process facilitates it. The issue is especially significant in the obtaining of consent from the patient for interventions and therapy…
Author : nernser
Patient- Centered Framework
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