Quandaries of Autonomy and Empowerment in Evidence-Based Nursing Care

Marita Nordhaug

doi:10.7577/pp.3711

Abstract

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively. In this article, patient empowerment is taken to imply a transfer of control and power from the nurse to the patient through communication and care and acknowledging the patient’s perspectives and values. Empowerment-based nursing may thus be central to enhancing a patient’s autonomy. Evidence-based nursing combines up-to-date research findings, the nurse’s clinical expertise and the patient’s preferences. This article concerns some of the potential conflicts these principles may give rise to in everyday deliberations in nursing care. It is argued that patient empowerment and autonomy potentially both have paternalistic connotations. It is also questioned whether an increased emphasis on patient empowerment and autonomy may lead to a risk of diminished professional autonomy.

Highlights

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively
Nursing care is conducted within health care organisations, through health care political guidelines, and very often in cooperation with other health care professions, which may affect the power balance between staff and thereby the ability to carry out professional autonomy in Miller’s sense of the concept
As we shall see in the chapter, a central value in nursing care when it is based on the principles of empowerment, is that the patient is an expert on his or her situation

Summary

Introduction

Empowerment and evidence-based practice represent two influential principles in nursing care: that decision-making should be based upon the patient’s autonomous choice, and the most up-to-date research findings, respectively. Evidence-based nursing combines up-to-date research findings, the nurse’s clinical expertise and the patient’s preferences. Bound by a professional duty to respect the patient’s autonomy and prevent harm, as well as practise in accordance with principles of empowerment and evidence-based practice, what should the nurse do?. In order to be evidence-based, nursing care combines up-to-date research findings, clinical expertise and experience, and the patient’s preferences and desires in the situation at hand. This implies that the patient’s articulated needs, preferences and desires form a knowledge base that should be taken into account, which is a core element of empowerment thinking. In the final part I provide an analysis of 12 cases of epistemological and ethical conflicts involved in evidence-based nursing, some of them rather trivial, some more complex ones

Objectives

Conclusion