Aspects and Contexts of Clinical Autonomy of Nursing Practice at Acute-Care Hospitals

Abstract

The purpose of this study is to clarify aspects and contexts of clinical autonomy of nursing practice at acute-care hospitals. Semi-structured interviews were conducted with four nurses working at an acute-care general hospital regarding situations where these nurses demonstrated clinical autonomy. The data obtained from the interviews were qualitatively analyzed. The results revealed that the nurses participating in this study displayed clinical autonomy in settings where they felt a conventional approach would be difficult. The demonstrating clinical autonomy began from the moment the nurses perceived the true needs of a patient, and the nurses were driven to demonstrate clinical autonomy after gaining empathetic understanding of the patient’s experience. Furthermore, the nurses did not only act or make decisions individually, they also adjusted their environment by influencing those around them and overcame difficult situations with support of others, which ultimately led to meeting the patient’s needs. This process also included behaviors such as recommending treatment plans to physicians and anticipating instructions. This analysis of characteristics to demonstrating clinical autonomy suggested that the demonstration of autonomy is influenced by the context which nursing teams acknowledge and endeavor to actively engage in nursing approaches and practices identified through tackling difficult situations.