Operationalizing autonomy: solutions for mental health nursing practice

Harnett, Patrick John; Greaney, Anna‐Marie

doi:10.1111/j.1365-2850.2007.01183.x

Cited by 22 publications

(24 citation statements)

References 35 publications

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“…Harnett & Greaney (2008) used the term ‘protective responsibility’ to describe the particular responsibilities that an individual acquires when working within a healthcare setting, when working with vulnerable patients. They contended that nurses occupy a unique position to facilitate ethical practice as a consequence of their continuous 24‐h contact with patients.…”

Section: Resultsmentioning

confidence: 99%

The meaning of mental health nurses experience of providing one‐to‐one observations: a phenomenological study

Rooney

2009

Psychiatric Ment Health Nurs

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There has been much recent literature about the need for appropriate policies and approaches to ensure that patient's rights and standards of care are safeguarded. The focus from national policy is on suicide reduction and prevention, and the nursing literature has concentrated on the importance of engaging the patient and ensuring that there is the least amount of restriction possible. A research study was carried out to explore the perspective of mental health nurses working in these intensive situations, using a purposive sample of nursing staff from the local National Health Service Trust's acute units. A phenomenological approach to the study was chosen to allow an in-depth exploration of the issues -'seeing things up close' -using the philosophy of Husserl as a base. The key areas of enquiry were: to explore and amplify the experiences of nurses undertaking constant observations, including any effects that may have on nurses; to gain further understanding of the dynamics and processes involved; to discover information that can inform and support development needs. Individual taped interviews were carried out with six nurses working in an acute admission ward, and these were then transcribed and analysed using Giorgi's method of analysis. The results of this analysis showed that nurses are keenly aware of some of the professional and ethical tensions involved in the process of keeping patients safe while trying to promote recovery. Results have implications for policies, preparation and support of staff, and provide some further insights into the nature of this experience for nursing staff who are caring for patients who are presenting with risks to themselves.

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Section: Resultsmentioning

confidence: 99%

The meaning of mental health nurses experience of providing one‐to‐one observations: a phenomenological study

Rooney

2009

Psychiatric Ment Health Nurs

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“…Within (mental) health care, autonomy has gained increasing attention (Harnett & Greaney 2008; Tauber 2001). Although an increasing body of literature describes the different forms autonomy can take, both as a theoretical concept (Tauber 2001) and in the way it plays out in different practices (Pols 2006; Schermer 2001), the dilemmas occurring within a particular conceptualization of autonomy remain relatively unexplored.…”

Section: Introductionmentioning

confidence: 99%

“…Second, because some symptoms of mental illness do not tally with rational thinking and decision making, some choices that they make might not be deemed justified or beneficial, and effort might then be put in creating ‘choices’ that correspond to caregivers' ideas (Velpry 2008). Third, involuntary treatment is sometimes deemed necessary in mental health‐care settings (Harnett & Greaney 2008; Sjöstrand & Helgesson 2008).…”

Section: Introductionmentioning

confidence: 99%

Quest for client autonomy in improving long‐term mental health care

Broer

Nieboer

Bal

2010

Int J Mental Health Nurs

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The objective of the present study was to explore how mental health-care professionals initiate, improve, and maintain client autonomy while improving other aspects of quality of care. We studied the different ways in which they approach autonomy and the dilemmas associated with them. As a methodology, we used the insights of actor-network theory, where concepts cannot be predefined, but are formed within specific situations, and therefore, should be studied by addressing the actors involved. Data were gathered by conducting ethnographic observations of national conferences of a quality-improvement collaborative and by interviewing actors involved in the improvement practices. In a bottom-up analysis, four approaches to autonomy emerged: (i) professionals removed constraints to autonomy and passed initiative to clients; (ii) professionals made an active effort to learn and support client preferences; (iii) clients were given opportunities towards independent lifestyles; and (iv) professionals tried to 'normalize' their relationship with clients to encourage roles other than those of client. The study showed that autonomy is an important issue throughout the process of quality improvement. Articulating the different approaches to autonomy and the dilemmas in these approaches contributed to reflection on the concept and highlighted the limits of the concept within a mental health-care setting.

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“…There are numerous other accounts in the literature which suggest that an overzealous adherence to patient autonomy may allow individuals to be disadvantaged by their own choices, create unnecessary confusion and provide a means whereby healthcare professionals abdicate, either intentionally or otherwise, their own professional and caring responsibilities (Holm, 1997;Scott et al, 2003a;Kapp, 2007;Whitney andMcCullough, 2007, Harnett andGreaney, 2008).…”

Section: Professional Care and Patient Autonomymentioning

confidence: 99%

Patient autonomy and choice in healthcare: self-testing devices as a case in point

Greaney

O’Mathúna

Pearce

2011

Med Health Care and Philos

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IntroductionThe growing number of self-testing diagnostic devices available for home use raises a number of ethical, psychological and social questions. Such devices allow individuals to test for a range of medical conditions in the absence of medical supervision. These devices are on sale in pharmacies, super-markets and a growing online industry where over a thousand tests are listed (Parliamentary Office of Science and Technology, 2003). It is now possible to test for HIV (albeit only one system approved) (Federal Drug Administration, (FDA) US, 2009), genetic markers (Levitt, 2001), response to coagulation therapy (Heneghan et al., 2006) and glaucoma (Ianchulev et al., 2005) without leaving one's home. The premise underpinning the nature and availability of these devices, which is noted in their marketing strategies, is that they assist individuals to be more autonomous in the assessment and management of their health by assuming a more independent role. Increased patient autonomy is assumed to be a good thing. In this paper we critique this assumption. We do not oppose patient involvement in care, but rather seek to critique a particular understanding of patient autonomy and its practical implications.We propose that diagnostic self-testing is a specific instance of the application of a developing model of patient autonomy in healthcare policy and practice. Recent legislative change and health policy in are claimed to support these views. We suggest that policy-makers have adopted these 'assumptions' to underpin current healthcare policy with little substantive debate.The aim of this paper is to reflect on these 'assumptions' and the extent to which autonomy, in so far as it is often construed as patient choice and freedom in decision-making, represents a progressive principle for healthcare delivery. The central thesis here is that current perceptions of autonomy do not represent a progressive philosophy for healthcare, as they fail to capture the multi-dimensional nature of the concept and undermine other significant issues such as relationality, care and responsibility.The paper draws on the philosophical literature and examples from the self-testing process to support this claim. The self-testing process represents a specific microcosm of greater patient involvement and autonomy in healthcare and therefore provides an ideal practical context for discussion. We conclude by offering an alternative account of autonomy which may better serve patients. We accept that autonomy is constituted, perceived and valued differently in various cultures. This paper draws primarily on the Irish, UK and US perspectives; therefore, we acknowledge that the discussion has relevance primarily in a Western context. 1 The argumentThe argument we propose may be outlined as follows. Current healthcare ethics and recent social policy documents uphold patient autonomy as a paramount ethical principle. This model of autonomy goes beyond merely encouraging participation as autonomy is increasingly portrayed as individual freedom to ...

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Operationalizing autonomy: solutions for mental health nursing practice

Cited by 22 publications

References 35 publications

The meaning of mental health nurses experience of providing one‐to‐one observations: a phenomenological study

The meaning of mental health nurses experience of providing one‐to‐one observations: a phenomenological study

Quest for client autonomy in improving long‐term mental health care

Patient autonomy and choice in healthcare: self-testing devices as a case in point

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