A Practical Examination on Awakening of Proficient Nurses' Autonomy Utilizing Reflection

Abstract

This study is an action research that aims to clarify the changes to the awareness and actions of proficient nurses and nursing supervisors and the processes thereof. To enhance proficient nurses' autonomy, we held “discussion workshops” and discussed autonomous nursing case by using a reflection program, together with consenting nurses who belong to one ward unit of the mid-scale hospital in the Kanto region: one head nurse, two charge nurses and 24 nurses. The data collection period is about three months. We repeatedly interpreted and analyzed transcriptions at the discussion workshops and participant observation field notes at the hospital ward to correct the progress and content of the actions, and we sorted all the data in chronological order and analyzed them qualitatively. As a result, the study participants deepened reflection through three steps, “sharing of knowledge about reflection,” “information sharing about the current status and reflection,” and “awareness of changes and maintenance” at seven discussion workshops, and they agreed that day-to-day conferences are important and that they can provide good nursing care by respecting each other through a heart-to-heart talk and information sharing during discussions. The proficient nurses have changed their actions in such ways as: proactively proposing to hold conferences for discussion; being able to give their opinions candidly regardless of their years of experience; and consulting a doctor regarding the patients under their charge at their discretion. The nursing supervisors reviewed their current relationships with other staff. The results suggested that it is significant for proficient nurses to practice reflection together with nursing supervisors, and that a reflection program is useful for the awakening of proficient nurses' autonomy.