Validity of Instruments for Measuring Autonomy and Control Over Nursing Practice

Purpose: To review the psychometric properties and evaluate the estimates of validity of commonly used instruments to measure autonomy and control over nursing practice.
Design: Literature review and evaluation of psychometric properties.
Methods: Nursing research reports published in English in peer-reviewed journals between 1990 and 2007 were examined. Psychometric properties and the actual instrument were reviewed to determine validity for measuring autonomy and control over nursing practice.
Findings and Conclusions: Instruments used to measure autonomy and control over nursing practice are frequently imprecise or inaccurate for measuring the concept of interest. Valid instruments are available to allow measurement of the concepts of clinical autonomy, work autonomy, and control over nursing practice. Clear definitions and valid measures are helpful when communicating and synthesizing nursing knowledge concerning these concepts.
Clinical Relevance: Evaluating the validity of instruments for measuring clinical autonomy, work autonomy, and control over nursing practice can be helpful when organizing and synthesizing the literature related to these concepts, so that strategies to improve professional practice environments becomes more clear.     

Resident autonomy in the operating room: Does gender matter?

Introduction

Previous data examining the effect of gender on surgical trainee autonomy is lacking. We hypothesized that female general surgery residents have less autonomy than males during laparoscopic cases.

Patients' Autonomy at the End of Life: A Critical Review

Context

The predominating definition of autonomy as a capacity to make an independent rational choice may not be suitable for patients in palliative care. Therefrom arises the actual need for more contextualized perspectives on autonomy to promote the quality of life and satisfaction with care of terminally ill patients.

Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Objective

The Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making.

Extending’ euthanasia to those ‘tired of living’ in the Netherlands could jeopardize a well-functioning practice of physicians’ assessment of a patient's request for death

The Dutch Euthanasia Act (EA) took effect in 2002 and regulates the ending of one’s life by a physician at the request of a patient who is suffering unbearably. According to the Dutch Supreme Court, unbearable suffering is a state for which the presence of a medical condition is a strict prerequisite. As a consequence, the Dutch EA has attributed the assessment of unbearable suffering to physicians who evaluate the presence of a medical classifiable disorder. Currently, a debate within the Netherlands questions whether older people, without a medical condition, who value their life as completed, should be granted euthanasia. To concede the autonomy of such a person, the Dutch government intends to create a separate legal framework that regulates this tired of living euthanasia request. This debate is crucial for policy-makers and an international audience because it discusses if a self-directed death of older people, should be implemented in (the current Dutch) euthanasia practice. However, this article argues that the current legal proposal that regulates the tired of living euthanasia request ignores crucial jurisprudence on physicians’ application of the unbearable suffering criterion in practice. Furthermore it points out that this proposal neglects physicians role in guaranteeing a euthanasia practice of due care and that its use of an ethic of absolute autonomy could jeopardize this well-established practice.     

The onset of falls reduces perceived autonomy among middle aged and older adults. Results from a longitudinal nationally representative sample

AimThe purpose of this study was to identify whether the onset of falls is associated with reduced autonomy among individuals in the second half of life.MethodsLongitudinal data (with 7626 observations) were drawn from the German Ageing Survey, which is a nationally representative sample of individuals residing in private households ≥ 40 years. An established scale developed by Schwarzer was used to assess perceived autonomy. Falls in the preceding 12 months served as the main independent variable. Age, marital status, employment status, income, self-rated health, physical functioning and the number of physical illnesses were adjusted for in the analysis.ResultsAdjusting for potential confounders, linear fixed effects regressions showed that the onset of falls was associated with lower perceived autonomy (β=-0.06, p < .01). This link was moderated by neither sex, age nor education. Moreover, a decrease in perceived autonomy was associated with worsening self-rated health (β=-.03, p < .01) and decreases in physical functioning (β = .002, p < .001). Furthermore, changes from employment to retirement were associated with an increase in perceived autonomy (β = .07, p < .05).ConclusionsThe study findings suggest that avoiding falls may assist in maintaining autonomy in the second half of life.     

Colombian adolescents’ preferences for independently accessing sexual and reproductive health services: A cross-sectional and bioethics analysis

ObjectiveOur study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences.Methods812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the variables of gender and age.ResultsA quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied.ConclusionContemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom.     

Assessing the quality of cancer screening leaflets using the International Patient Decision Aids Standards instrument: A cross-sectional content analysis

ObjectiveTo assess the quality of national cancer screening program leaflets in Japan from the informed-decision perspective.MethodsCross-sectional content analysis of invitation leaflets issued by centralized organizations and used nationwide in Japan was conducted. Three members independently evaluated the materials using International Patient Decision Aids Standards six-item minimum criteria for qualifying patient decision aids.Patient public involvementCo-author KH is a cancer patient himself. We also sought feedbacks from three other cancer survivors and two bereaved family members.ResultsInter-rater agreement was substantial (Fleiss’ kappa=0.62). The median score was 2 out of 6 (range: 2–3). All leaflets described the cancer (Q1: 7/7) and screening modality (Q2: 7/7). None stated not undergoing screening as an option. One stated another screening modality (Q3: 1/7). None stated both the positive and negative features of multiple options (Q4: 0/7. Q5: 0/7). One described the psychological and social experience of screening but only its positive side (Q6: 1/7).ConclusionsThere is room for improvement in the content of the public cancer screening invitation leaflets in Japan from informed-decision perspective.Practice implicationsCancer screening leaflets should provide evidence-based, well-balanced, easy-to-understand information to educate people on cancer screening while maintaining people’s autonomy.