Shared decision-making: nurses must respect autonomy over paternalism

Grffith, Richard; Tengnah, Cassam

doi:10.12968/bjcn.2013.18.6.303

Cited by 9 publications

(6 citation statements)

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“…Hallet et al [1] associated the passive role as a form of paternalism, wherein the patient is seen as a subject who must be limited to comply with the therapeutic indications. Kleiman, Frederickson, and Lundy [14] relate the passive role with the belief of professionals that many patients, or most of them, do not have the educational and cultural levels necessary to engage in an equal professional relationship [15].…”

Section: Role Of the Patientmentioning

confidence: 99%

“…Finally, a concept present in the literature is that of power [15,37]. Cameron [31] defined it bilaterally, in which the professional develops a "reference power" in the patient, and for the patient, the professional is considered a "frame of reference".…”

Section: Types Of Nurse-patient Relationshipsmentioning

confidence: 99%

“…Each of these patient conceptions carries with it an associated role and attitude of the nurse. It is evident in the results of records that before a patient refuses, the nurse acquires an expert role that entails persuasion and coercion to achieve the indicated healing objectives [15,61]. In the interviews, the nurse appears as an expert in the delegated activities from physicians, in association with technical skills and clinical knowledge about the pathologies.…”

Section: Nurse-patient Relationshipmentioning

confidence: 99%

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Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

Molina-Mula

Gallo-Estrada

2020

IJERPH

206

149

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Background: The patient is observed to acquire a passive role and the nurse an expert role with a maternalistic attitude. This relationship among others determines the capacity for autonomy in the decision making of patients. Objectives: The aim of this study is to analyse the nurse-patient relationship and explore their implications for clinical practice, the impact on quality of care, and the decision-making capacity of patients. Design: A phenomenological qualitative study was conducted. Settings and participants: Thirteen in-depth interviews with nurses and 61,484 nursing records from internal medicine and specialties departments in a general hospital from 2015–2016. Methods: A discourse analysis and triangulation for these sources were conducted. Results: The category elaborated from nursing records was defined according to the following codes: Good Patient, Bad patient, and Social Problem. Analysis of the interviews resulted in a category defined as Patient as a passive object. Discussion: A good nurse-patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. However, in contrast, the good relationship is conditioned by the patient’s submissive role. Conclusion: An equal distribution of power allows decisions about health and disease processes to be acquired by patients, autonomously, with the advice of professionals. The nurse-patient relationship should not pursue the change in values and customs of the patient, but position the professional as a witness of the experience of the health and illness process in the patient and family.

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Section: Role Of the Patientmentioning

confidence: 99%

Section: Types Of Nurse-patient Relationshipsmentioning

confidence: 99%

Section: Nurse-patient Relationshipmentioning

confidence: 99%

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Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

Molina-Mula

Gallo-Estrada

2020

IJERPH

206

149

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“…However, the patient may not always agree with the clinician’s decision, not even if it is based on scientific evidence. The patient, as a human being, also has ethical and/or religious concerns,5,6 which should be taken into account out of respect for their right to autonomy and in order to reinforce the surgeon–patient relationship 7,8…”

Section: Introductionmentioning

confidence: 99%

<p>Multicenter study of patients’ preferences and concerns regarding the origin of bone grafts utilized in dentistry</p>

Bucchi¹,

Fabbro²,

Arias³

et al. 2019

PPA

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PurposeBone graft materials can be obtained from the patient’s own body (autologous graft), animals (xenograft), human cadavers (allograft) and synthetic materials (alloplastic bone graft). Patients may have ethical, religious or medical concerns about the origin of bone grafts, which could lead them to reject the use of certain types of bone graft in their treatments. The aim of this multicenter study, which surveyed patients from five university clinics in Portugal, France, Italy, Spain and Chile, was to analyze patients’ opinions regarding the source of bone grafts.Patients and methodsA survey composed of ten questions was translated into local languages and validated. Patients were asked about the degree of acceptance/rejection of each graft and the reasons for rejection. A chi-squared test was used to analyze statistically significant differences.ResultsThree hundred thirty patients were surveyed. The grafts that elicited the highest percentage of refusal were allograft (40.4%), autologous bone graft from an extraoral donor site (34%) and xenograft (32.7%). The grafts with the lowest rate of refusal were alloplastic (6.3%) and autologous bone grafts from an intraoral donor site (24.5%). The main reason for autologous bone rejection was the fear of pain and discomfort, for xenograft it was the fear of disease transmission and the rejection of use of animals for human benefit, and for allograft it was ethical/moral motivations and the fear of disease transmission. Religious affiliation influenced patient’s preferences.ConclusionThe origin of bone grafts is still conflictive for a high percentage of patients.

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“…Other studies have shown that nurses make decisions without consent in their expert role to achieve health-giving effects. 36 , 37 However, although the nurse might be recognized as an expert from a professional point of view, the patient is the expert on his/her situation from a lifeworld perspective. 22 , 30 When older patients are acutely or critically ill and have cognitive impairment, it has been found that nurses perceive themselves as being competent to make decisions without patient consent, even if the older patient should always be allowed and supported to participate in decision-making.…”

Section: Discussionmentioning

confidence: 99%

Older patients’ autonomy when cared for at emergency departments

et al. 2022

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Background Older patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these preferences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted. Aim To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs). Research design This study adopted reflective lifeworld theory and a phenomenological design. Participants and research context A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden. Ethical considerations The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent. Findings Nurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’. Conclusion Stressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and promotion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’.

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Shared decision-making: nurses must respect autonomy over paternalism

Cited by 9 publications

References 0 publications

Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

<p>Multicenter study of patients’ preferences and concerns regarding the origin of bone grafts utilized in dentistry</p>

Older patients’ autonomy when cared for at emergency departments

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Shared decision-making: nurses must respect autonomy over paternalism

Cited by 9 publications

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Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making

<p>Multicenter study of patients&rsquo; preferences and concerns regarding the origin of bone grafts utilized in dentistry</p>

Older patients’ autonomy when cared for at emergency departments

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<p>Multicenter study of patients’ preferences and concerns regarding the origin of bone grafts utilized in dentistry</p>