WHY HISTORY COLLECTION IS IMPORTANT AS A NURSE PRATIONER

Why History Collection Is Important As a Nurse Practitioner

Why History Collection Is Important As a Nurse Practitioner

Introduction

Autonomy means self-rule (Dworkin 1988). It has the ability to think, choose and act freely and independently (Gillon 1992). Each human being is part of a race of people, culture, sub culture or a community from birth. In any society we have rules, beliefs, attitudes and culturally defined norms. Each member in that given society cannot just act autonomously as they are expected to act within their societies moral and legal guidelines or risk prosecution, stigmatization or isolation. It could therefore be asked whether one is ever completely autonomous or is autonomy merely measurable by the societies legal, ethical and moral restrictions and expectations of what is acceptable behavior and what is not (Harris 1985).

Discussion

Paley (1996) argues that the concept of autonomy is vague and needs clarity, as it is open to interpretation and ambiguity. Without a universal understanding of autonomy, this could have varying implications for patients' and their care (Aveyard 2000). Kant (1964) argues that autonomy is a property of the will of rational beings. It could therefore be argued that to respect a patient's wishes and choices, staff must believe that the patient is acting with deliberation and rationality (Childress 1982). Autonomy may be restricted in healthcare settings because healthcare professionals or nurse practitioner may judge a patient's ability to make rational decisions to be limited because of their psychotic illness (Svedberg 2001) Studies by (Jansson & Norberg 1989) and (Davidson 1990) would suggest that diagnosis does influence healthcare professionals attitude towards the validity of a patient's ability to act autonomously and that some staff justified overriding patients' autonomy by acting according to the principles of beneficence, whereas others respected the patients autonomous choices irrespective of their capacity to make autonomous decisions.

If respect for patient autonomy relies on staff judging them as either rational or irrational dependent upon their diagnosis, this will have implications for practice and will impact on patients' experience of healthcare. Such judgments devalue and disempower patient autonomy, even if staff respects patients' wishes, the fact remains that staff has the decision making control. Whilst on placement, two patients', one under Section 3 of the Mental Health Act (1983) and the other informal, both refused their lunch and teatime meal, saying they felt unwell. Staff assumed the informal patient's decision was rational, based on them felling unwell, but the sectioned patient was being irrational and merely seeking attention. Whilst staff accepted both patients' decisions they judged both patients differently due to their interpretation of the meaning of autonomy and the patient's diagnosis.

Healthcare professionals' have a duty to respect the patients' autonomy and their right to agree with or refuse care, even if it results in harm to the patient, unless a court of law orders to the contrary. It should not be assumed that a patient who is mentally ill is incapable of giving or refusing consent for ...