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Introduction

The issue of autonomy is gaining interest in the healthcare sector, especially due to the fact that care decisions have to focus on the patient. With patient-centered care becoming an important aspect of care, patients are considered to play a decisive role in the care services they receive. Their needs and preferences are also important when providing care. Along with healthcare, the concept of autonomy has been studied in diverse disciplines such as nursing, sociology, psychology, education and political science, among others. The use of the word autonomy is evident in diverse settings (Welford, Murphy, & Casey, 2010). For instance, some of the common usages of autonomy include patient autonomy, professional autonomy of nurses, groups’ autonomy, family autonomy, individual autonomy, and teacher autonomy, among others. In the domain of nursing, autonomy lacks a clear definition. The concept of autonomy is often erroneously taken to have similar meanings to such concepts as authority, empowerment, control, power and independence (Welford et al., 2010). The precise definition of the concept of autonomy in the field of nursing is still unclear owing to the fact that a universal definition of autonomy is inexistent. Various authors have defined autonomy based on their beliefs and contexts. The focus of this paper is to conduct a concept analysis of autonomy.

The Walker and Avant (2005) process of concept analysis was used in analyzing the concept of autonomy. According to Walker and Avant, a concept will often seem to have a comprehensive description and seem well-developed mainly because of the vast attention that the concept has gained in literature. This results in various authors covering the topic creating a perception that the concept receives due to the empirical and theoretical coverage. However, a deeper look at the concept is likely to reveal inconsistent definitions coupled with several implicit theories trying to explain the concept, which is the case with autonomy. Walker and Avant (2005) recommended the concept classification method, which involves performing a review of literature and content analysis regarding the concept of interest. In addition, this process of concept analysis involves analyzing the uses and attributes associated with the concept, and the consequences and antecedents of the concept. In this respect, a search of the word “autonomy” was performed in abstracts and/or titles of publications written in the English language in a number of electronic databases such as Google Scholar, PubMed, CINAHL, PsycINFO, Ebsco, and Cochrane Review. The uses, attributes, antecedents, and consequences associated with autonomy are present in this paper. Model cases and empirical methods used for measuring the concept of autonomy are also presented in this paper.

Purpose of Analysis

This concept analysis has the primary aim of clarifying the meaning of the concept of autonomy. While autonomy is a commonly used concept in healthcare, the lack of its clear definition hampers its understanding among health practitioners, which in turn hinders its integration in clinical practice. To this end, there is the need to undertake an analysis of concept of autonomy in order to help clarify the concept in terms of its characteristics, antecedents and consequences. Clarifying the meaning of autonomy will help in enhancing nursing practice as well as knowledge base.

Uses of the Concept

Possible Definitions

The concept of autonomy differs significantly with respect to meaning and interpretation. Several definitions of autonomy exist in literature. The word autonomy comes from the Greek word “auto” meaning self and “nomos” meaning law. Therefore, it means self-law. Many definitions of autonomy have been suggested by authors from various disciplines. In the Oxford English dictionary, autonomy is defined as independence. The Merriam-Webster Dictionary defined autonomy as a state of self-governance and self-direction, especially in terms of moral independence (Merriam-Webster, n.d). In the Mosby’s Medical, Nursing and Allied Health Dictionary, autonomy refers to the capability to function independently (Mosby, Inc, 2012). In the variety of dictionaries, the synonyms for the word autonomy include sovereignty, independence, self-sufficiency, self-government, freedom and liberty. Another definition of autonomy is provided by Hannum (2011) who linked autonomy to the state of being self-governing or independent. Autonomy has also been associated with being able to make one’s own decisions using sound judgment. In this respect, a person is said to autonomous when he/she uses all the pertinent information to make a decision considered the most logical based on the available information. Another definition of autonomy is provided by Reis, Sheldon, Gable, Roscoe, and Ryan (2000) who pointed out that autonomy denotes the freedom of choice. Based on this definition, autonomy emphasizes on the importance of making unforced and informed decisions in accordance to the freewill of an individual. Personal choice has also been reported as an important aspect when defining autonomy. In this sense, autonomy is perceived as the right to be able to determine one’s values, goals, and interests, without any outside interference. The cultural differences in the definition of autonomy have also been acknowledged in literature (Reis et al., 2000). This means that different cultures have different definitions of autonomy. For instance, in the American culture, autonomy is linked to power and being empowered to make one’s own decisions regardless of gender or any factor. In other cultures, the definition of autonomy is still conservative in the sense that there are some limitations on autonomy for other groups such as women who are perceived to lack the power to make choices.

Possible Disciplines

The concept of autonomy has been used in various disciplines. In sociology, the uses of autonomy include individual autonomy and women’s autonomy. Individual autonomy denotes the freedom that a person has with respect to making decisions in regard to his or life in accordance to his or her plan (Rice, 2001). Women’s autonomy denotes women’s ability or lack thereof in making decisions relating to the household. In sociology, it is evident that autonomy focuses on one’s ability to decide, choose, believe and think independently and freely. Similar to sociology, autonomy in psychology focuses on decision-making abilities although gender differences are acknowledged. For instance, male autonomy places emphasis on separation and control whereas female autonomy is more concerned with the ethics of caring and relationships (Rice, 2001).

In nursing, the concept of autonomy is used at two levels, which include nurse autonomy and patient autonomy. Nurse autonomy refers to the power that the nurse has in determining what is needed to offer quality care, undertake assessments, and be accountable for his or her decisions. In this respect, nurse autonomy lays emphasis on the ability of the nurse to make independent judgment that results in the most desirable outcome (Reis et al., 2000). Nurse autonomy also involves having the liberty to make binding and discretionary decisions that correspond to the nurse’s scope of practice, as well as having the liberty to act and be responsible for these decisions. Patient autonomy denotes the ability of the patient to use the information provided by physicians and nurses in making the safest and the most logical care decision. Patient autonomy also entails the ability of patients to advocate for their needs and make decisions regarding their care, without nurses and physicians interfering (Rice, 2001).

Attributes of the Concept

Walker and Avant (2005) emphasize that attributes help in distinguishing and differentiating a concept from other similar concepts. From the review of literature, a number of defining attributes for the concept of autonomy have been identified. The first attribute of autonomy is self-governance, which refers to being capable of making decisions in accordance to one’s interests as well as ensuring control over the self. The second attribute is independence, which is manifested through having freedom. Self control is another attribute of autonomy. In this respect, autonomous people are supposed to act freely, without any restrictions being imposed on them provided they are liable for their actions. Freedom is another attribute of autonomy, which is concerned with being free from outside influences (Taylor, 2014). Through freedom, autonomy ensures that one is capable of self-directing his or her actions in accordance with their personal goals and interests (Hannum, 2011). Another important attribute of autonomy is decision-making, which is concerned with the ability of a person to make a choice in a variety of options. The autonomous individual is able to male unrestricted and logical choices and act on these choices. Other attributes of autonomy include critical self-reflection, self-determination and judgment. Reflection entails taking thoughts into account and letting thoughts guide one’s actions. In this respect, autonomy is characterized by having the ability to act on a purpose that has been given a critical thought (Welford et al., 2010).

Other concepts related to autonomy outlined in literature include independence, power, responsibility, authority, freedom and control.

Model Case

Case studies can also be used in further clarification of the concept of autonomy. The model case study highlights all the defining attributes of the concept. The case studies can be either derived from literature or conceived by the author. In this paper, case studies are developed by the author. In this model case, a young man visits the emergency department complaining of painful urination. The doctor explains to the young man that the urine specimen is needed. The patient is provided with the option of offering clean catch urine specimen or through the insertion of a catheter. The doctor explains both these procedures and the differences between them, and provides the patient with an opportunity to choose the procedure that will be used in collecting the urine sample. In this case, the patient exercised self-governance, acted independently, without being influenced by the physician and implemented decision-making after critically evaluating the options.

Similar Case

A similar case presents a situation whereby not all defining attributes are present. In the situation presented in the Model Case above, assume the physician presents the patient all the alternatives and information; however, the doctor tries to persuade the patient to choose a particular procedure to collect the urine sample. In this case, the choice made by the patient is under the influence of the doctor.

Otherwise

This case contradicts the Model Case and has none of the defining attributes of the concept. Assuming the same case presented above, the physicians opt for the insertion of the catheter, without giving the patient an opportunity to select the procedure for collecting the urine sample. In addition, the patient is not presented with available alternatives to the procedure; instead, the doctor directly orders a procedure, without taking into consideration the preferences of the patient. In this case, the patient is not provided with an opportunity to make a free decision.

Antecedents and Consequences

Antecedents refer to events that precede the occurrence of a concept. The antecedents of autonomy that have been identified in literature include the individual having self-discipline needed to autonomous judgment and action; being sufficiently knowledgeable to make autonomous, rational choices; having morals as well as the ability to think and reason critically, and accepting the scope of responsibilities with respect to autonomous action. Other antecedents include being willing to make decisions, availability of sufficient information needed for decision-making, the extent, to which the external environment allows autonomous decision-making, and lack of restrictions such as legal on individual decision-making (Taylor, 2014).

Consequences denote the outcomes that follow the concept. The outcomes of autonomy that have been identified in literature include accountability, professionalism, personal satisfaction, and individual self-efficiency and self-awareness. Some negative outcomes of autonomy, such as non-compliance, have also been reported in literature (Welford et al., 2010).

Empirical Methods for Measuring the Concept

The concept of autonomy is related to several other concepts such as professionalism, responsibility, independence, authority, power and control, among others. For this reason, there is no universal empirical measurement tool for autonomy. Most of the tools used in measuring autonomy are tailored in accordance with the discipline such as patient autonomy, whereby autonomy is measured using the Ideal Patient Autonomy Scale (Taylor, 2014). In psychology, the Personal Values Clarification Worksheet is used in measuring autonomy empirically (Hannum, 2011).

Conclusion

It is evident that the concept of autonomy lacks a clear meaning because of its multifaceted and complex nature. Autonomy also comprises of various sub-concepts such as decision-making, freedom, self-control, self-governance and self-determination. In addition, there are other numerous concepts related to autonomy such as professionalism, responsibility, independence, power, authority and control. For this reason, developing a universal instrument for measuring autonomy is not possible. This implies that various disciplines must explore the concept of autonomy in accordance with the confines of the discipline.

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