Personal Autonomy: Development of a NOC Label

Abstract

PURPOSE To develop a NOC label for the concept of personal autonomy. METHODS Using a focus group approach, a NOC label, definition, and indicators were developed for personal autonomy. Using a concept analysis method, the NOC Psychological/Cognitive Focus Group constructed a conceptual definition of personal autonomy and created a list of indicators. An extensive review of nursing, psychology, ethics, and philosophy literature from 1988 to 2001 was conducted using approximately 30 empirically based and theoretical sources. The focus group identified pertinent data from the literature and clustered the data into the predetermined categories of conceptual definition and indicators, giving careful attention to the rules of development for outcome definitions and indicators. FINDINGS The label, definitions, and list of indicators were conceptualized at several levels. The definition and indicators were refined into a conceptually and clinically coherent outcome. Personal autonomy is defined as “the ability of a competent individual to govern one's own life and make choices based on the information available.” The indicators are ▪ Demonstrates cognitive ability to make an informed decision. ▪ Is able to receive a thorough disclosure of pertinent information about alternative treatments for condition. ▪ Comprehends the information received in thorough disclosure of pertinent information about alternative treatments for condition. ▪ Comprehends the risks versus benefits of alternative treatments ▪ Makes choice from alternatives available. ▪ Expresses satisfaction in choice made. ▪ Expresses noninterference with decision-making process by family. ▪ Expresses noninterference with decision-making process by friends. ▪ Expresses noninterference with decision-making process by healthcare providers. ▪ Expresses noninterference with decision-making process by (other). ▪ Makes decisions free from undue pressure. DISCUSSION Nurses are educated to value and protect clients' rights to make their own decisions in healthcare matters. Informed consent is an essential value of the profession, but the concept of clients' competence to receive the information, weigh all options, and make a choice free from undue pressure is often minimized or overlooked. Not only must nurses advocate for clients' right to make decisions, they must be vigilant in ensuring that patients are cognitively able to make those decisions. One school of thought argues that true autonomy is not possible, given that individuals exist within relationships: People cannot make decisions without pressure from the people in those relationships. The NOC Psychological/Cognitive Focus Group suggests that while individuals may consider the wishes of friends, family, and healthcare providers, the person retains the right to make the decision that best suits him/herself. Nurses are in a unique position to offer support to individuals as they attempt to balance the information about treatment options and the suggestions/demands of others. CONCLUSIONS Autonomy is not a simple concept. It challenges nurses to view individuals within the context of relationships and with consideration of their cognitive abilities. Use of NOC outcome indicators can facilitate an improved awareness of the facets of autonomy. Testing the indicators in clinical practice will be necessary to confirm this conclusion.