2.50
Hdl Handle:
http://hdl.handle.net/10755/160863
Type:
Presentation
Title:
Study of Autonomy in Clinical Nursing Practice
Abstract:
Study of Autonomy in Clinical Nursing Practice
Conference Sponsor:Midwest Nursing Research Society
Conference Year:1991
Author:Bircher, Andrea, PhD
P.I. Institution Name:
Title:
This paper reports on a selected overview aspect of a larger line of scholarly inquiry into clinical practice phenomena in P-MHN.



Manifest Problem: The general topic of this paper is the discovery of autonomy deficits in psychiatric-mental health patients. The specific approaches taken are application of scientific process and principles in clinical practice, process definitions of concepts, secondary analysis of therapist's retrospective clinical rates of nurse-patient-relationship therapy interactions, and report of preliminary findings.



Problem Analysis: Short term issue assessment in P-MHN practice over a period of years identified themes underlying difficulties in living an problematic behaviors of patients. Clarification and process definition of a number of concepts eventually led to the identification of autonomy as an apparently ubiquitous problem in psychiatric patient care and therapy: anger, suicide, unresolved grief, feelings of helplessness and hopelessness, passive dependence, oral fixation, reality principle, primary and secondary process, selected ego functions, developmental learning tasks, and others.



Ten critical attributes were identified for the concept of autonomy, with thirty three related behavioral indicators manifest in therapy interactions. In order to better focus on the problematic issues, a clinical rating scale of 43 items was developed and used systematically by the therapist to rate therapy interactions retrospectively, after each interview.



Problem Statement: The purpose of this study is to investigate whether or not critical attributes of autonomy are manifest in nurse-patient-relationship therapy interactions. It is hypothesized that psychiatric outpatients exhibit, in nurse-patient-relationship interactions, behaviors indicative of critical attributes of autonomy. Assumptions and deduced consequences are given.



Research Design: The multiple case method is used for this secondary analysis of therapist's retrospective autonomy ratings.



Sampling: The sample source is a metropolitan Comprehensive Mental Health Center. The sample space consists of all CMHC outpatients admitted between 11/1/1982 and 12/31/1985. The sample selected is a nonprobability, opportunity sample which consists of all patients seen in nurse-patient-relationship therapy by one clinical nurse specialist in P-MHN.



The sample consists of retrospective therapist ratings for seven patients who range in age form 20 to 46 years of age, with a mean age of 31.57 years. Sex: female; SES: lower-middle class; psychiatric diagnosis: dysthmic disorder. Sample in size: N=7; 2 long-term nurse-patient-relationship therapy clients; 3 acute crisis intervention clients; 2 repeat crisis-intervention clients who had been seen for original crisis intervention three years prior to this admission. Retrospective therapist ratings of behaviors indicative of autonomy for a small ADA therapy group also were included (N=1-6 for open group meetings). Ethical review: OU HSC IRB Exemption #5.



Data: The data consist of retrospective paper and pencil ratings of the presence or absence in nurse-patient-relationship therapy interaction of patient behaviors indicative of autonomy.



Instrument development involved process definition of autonomy, listing of critical attributes, indicative behaviors, pretest, and retest rating scales and results, and problems with validity and reliability.



Data collection and qualitative analysis involved the secondary analysis of preexisting, retrospective therapist clinical ratings, score development, and tabulation and graphic presentation. Quantitative analyses are deemed premature and therefore unwarranted at this early exploratory stage of inquiry.



Results: Autonomy scores - with a possible range of -43 to +43 - ranged from -21 to +40; exhibited a trend towards lower scores at the beginning of therapy and increase of scores as therapy progressed; considerable variability from week to week; and occasional dips with the suggestion of coincidence of these dips with new problem of conflict confrontation by the client.



The hypothesis is supported, these clients, in nurse-patient-relationship therapy, did exhibit behaviors indicative of the critical attributes of autonomy, as well as absence thereof. Conclusions are drawn, new hypotheses postulated, and implications for clinical practice, education and research are delineated. Primarily, further work on the autonomy concept is indicated since there is sufficient evidence that it delineates a significant phenomenon, but needs clarification, and operationalization in order to improve validity and reliability.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleStudy of Autonomy in Clinical Nursing Practiceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/160863-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Study of Autonomy in Clinical Nursing Practice</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1991</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bircher, Andrea, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value"> </td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value"> </td></tr><tr><td colspan="2" class="item-abstract">This paper reports on a selected overview aspect of a larger line of scholarly inquiry into clinical practice phenomena in P-MHN.<br/><br/><br/><br/>Manifest Problem: The general topic of this paper is the discovery of autonomy deficits in psychiatric-mental health patients. The specific approaches taken are application of scientific process and principles in clinical practice, process definitions of concepts, secondary analysis of therapist's retrospective clinical rates of nurse-patient-relationship therapy interactions, and report of preliminary findings.<br/><br/><br/><br/>Problem Analysis: Short term issue assessment in P-MHN practice over a period of years identified themes underlying difficulties in living an problematic behaviors of patients. Clarification and process definition of a number of concepts eventually led to the identification of autonomy as an apparently ubiquitous problem in psychiatric patient care and therapy: anger, suicide, unresolved grief, feelings of helplessness and hopelessness, passive dependence, oral fixation, reality principle, primary and secondary process, selected ego functions, developmental learning tasks, and others.<br/><br/><br/><br/>Ten critical attributes were identified for the concept of autonomy, with thirty three related behavioral indicators manifest in therapy interactions. In order to better focus on the problematic issues, a clinical rating scale of 43 items was developed and used systematically by the therapist to rate therapy interactions retrospectively, after each interview.<br/><br/><br/><br/>Problem Statement: The purpose of this study is to investigate whether or not critical attributes of autonomy are manifest in nurse-patient-relationship therapy interactions. It is hypothesized that psychiatric outpatients exhibit, in nurse-patient-relationship interactions, behaviors indicative of critical attributes of autonomy. Assumptions and deduced consequences are given.<br/><br/><br/><br/>Research Design: The multiple case method is used for this secondary analysis of therapist's retrospective autonomy ratings.<br/><br/><br/><br/>Sampling: The sample source is a metropolitan Comprehensive Mental Health Center. The sample space consists of all CMHC outpatients admitted between 11/1/1982 and 12/31/1985. The sample selected is a nonprobability, opportunity sample which consists of all patients seen in nurse-patient-relationship therapy by one clinical nurse specialist in P-MHN.<br/><br/><br/><br/>The sample consists of retrospective therapist ratings for seven patients who range in age form 20 to 46 years of age, with a mean age of 31.57 years. Sex: female; SES: lower-middle class; psychiatric diagnosis: dysthmic disorder. Sample in size: N=7; 2 long-term nurse-patient-relationship therapy clients; 3 acute crisis intervention clients; 2 repeat crisis-intervention clients who had been seen for original crisis intervention three years prior to this admission. Retrospective therapist ratings of behaviors indicative of autonomy for a small ADA therapy group also were included (N=1-6 for open group meetings). Ethical review: OU HSC IRB Exemption #5.<br/><br/><br/><br/>Data: The data consist of retrospective paper and pencil ratings of the presence or absence in nurse-patient-relationship therapy interaction of patient behaviors indicative of autonomy.<br/><br/><br/><br/>Instrument development involved process definition of autonomy, listing of critical attributes, indicative behaviors, pretest, and retest rating scales and results, and problems with validity and reliability.<br/><br/><br/><br/>Data collection and qualitative analysis involved the secondary analysis of preexisting, retrospective therapist clinical ratings, score development, and tabulation and graphic presentation. Quantitative analyses are deemed premature and therefore unwarranted at this early exploratory stage of inquiry.<br/><br/><br/><br/>Results: Autonomy scores - with a possible range of -43 to +43 - ranged from -21 to +40; exhibited a trend towards lower scores at the beginning of therapy and increase of scores as therapy progressed; considerable variability from week to week; and occasional dips with the suggestion of coincidence of these dips with new problem of conflict confrontation by the client.<br/><br/><br/><br/>The hypothesis is supported, these clients, in nurse-patient-relationship therapy, did exhibit behaviors indicative of the critical attributes of autonomy, as well as absence thereof. Conclusions are drawn, new hypotheses postulated, and implications for clinical practice, education and research are delineated. Primarily, further work on the autonomy concept is indicated since there is sufficient evidence that it delineates a significant phenomenon, but needs clarification, and operationalization in order to improve validity and reliability.</td></tr></table>en_GB
dc.date.available2011-10-26T23:11:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:11:55Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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