AUTONOMY AND

COLLABORATION PRACTICES

AMONG CRITICAL CARE NURSES

IN CYPRUS

Ε. Georgiou BSc Hons, MSc, PhD Cand. (Cyprus University of Technology)

Α. Pavlakis PhD (Open University of Cyprus)

Ε. Papathanasoglou MSc, PhD (Cyprus University of Technology)

OPERATIONAL DEFINITIONS

Autonomy is a composite multi-factorial phenomenon spanning a wide array of behaviours hence it is complex to define and measure.

The comprehensive definition provided by Varjus et al (2003) is adopted: Autonomy is defined as independence, right and responsibility in decision-making, in actions and in values

OPERATIONAL DEFINITIONS

Collaboration/Co-operation is defined as

nurses and physicians working together,

sharing responsibility for solving problems,

and making decisions to formulate and

carry out plans for patient care. It may be

conceptualized both at the individual-

patient decision level and at the level of

ICU organization (Baggs et al 1999).

LITERATURE REVIEW

Nursing Autonomy has been found to be positively related to:– Improved patients Outcomes (Wade, 1999),

– Nurses job satisfaction (Erlen & Sereika 1997, Budgeet al. 2003)

– Recruitment and retain of nurses in the Profession (Curley 2002, Parahoo 2000)

– The practice of Evidence Based Nursing (Parahoo 2000).

Autonomy in ICU

ICU Nurses role in clinical decision making is crucial :

Care for critically ill patients that are vulnerable to crisis situations in a high technology unit that most of the times complicates decision making

The rapid changes of the health status of the patient that happen in ICU demand high level decisions from the Nurse in a climate of high time stress

– Bucknall (2000), reported that ICU nurses were likely to make a patient care decision every 30 seconds, including a wide range of decisions from grand to trivial ones.,

– Watson (1994) reported that nurses made approximately nine important patient-care decisions per hour.

Collaboration between Nurses and

Doctors in ICUBetter professional relationships and better patients outcomes

( Baggs et al 1999, Dechairo-Marino,et al 2001 )

Minimization of medical errors (Dougherty & Larson 2005).

Recruitment and retain of staff in ‘Magnet’ Hospitals

Collaboration may be regarded both as a precondition and an outcome of autonomy

Purpose of the study

To explore the level of critical and

intensive care nurses’ autonomy in Cyprus

and to assess potential associations with

nurse-physician collaboration.

Specific Aims:

To describe the level of perceived autonomy, as quantified by the Varjus et al (2003) scale in Cypriot intensive care nurses.

To describe the level of nurse-physician collaboration as perceived by Cypriot intensive care nurses through the Collaboration & Satisfaction about Care Decisions instrument (Baggs 1993).

To explore potential associations between the perceived level of Autonomy and collaboration with– Nurses characteristics: educational background, nursing experience,

type of post, continuing education, gender and age

– Organizational characteristics: type of ICU, place of work

To pursue potential associations between perceived level of autonomy and nurse-physician collaboration measures.

METHODOLOGY – INSTRUMENTS

Questionnaire consisted of three parts

1. Demographics

2. The Autonomy Scale (Varjus et al. 2003)

3. The CSACD Scale (Collaboration and

Satisfaction about Care Decisions Scale)

(Baggs, 1999)

Sample

All Nurses working in the Adult ICUs of

Public Hospitals in Cyprus (5 Public

Hospitals) (n=184).

Neonatal and Paediatric ICUs were

excluded

Results (1)

Response rate

Sample Characteristics

The age of participants

22 -57 years (Mean =33.8, SD =8.85).

Professional experience in the nursing profession

Mean = 11.56 years (SD 9.03)

Professional experience in ICU

Mean = 7.01 years (1 month - 30 years,

SD= 6.44).

Sample Characteristics

Results (2)

Most of the nurses considered independence and

Autonomy in their job as important (Mean 8.33, Likert

Scale 1-10 10=very important, SD=1.48).

Almost all nurses (> 85%) felt responsible for their own

work and actions and the progress of their patients

However Autonomy level of Cypriot ICU Nurses is

moderate (Mean=4.23, Likert Scale 1-6, 6= Completely

agree SD=0.92).

Subscales of Autonomy Based on the comparisons between the three subscales of Autonomy, the ICU nurses enjoy the strongest autonomy in the area of value base(Mean=4.36 Likert Scale 1-6 6=Completely agree, SD=1.18)

However the respondents(21.1%) felt that they could not always act according to their own values in matters of patient care and unit operation

ICU nurses felt they had greater autonomy in their own actions (mean 4.28) than indecision-making (mean 4.03)

Correlations of subscales of Autonomy

All three bases

(subscales) of Autonomy

showed positive

Intercorrelations

– When decisional

Autonomy increases

– nurses are more able to

act independently

– ability to act according

to their own nursing

values within their own

sphere of practise

AUTONOMY- EXPERIENCE -

EDUCATION

Collaboration/Co-operation with

doctors in decision making

Only 1:3 (32.1%) participants regarded

their collaboration with doctors as high

SATISFACTION WITH COLLABORATION

(% , n = 163 )

INTERCORRELATIONS

Autonomy-Collabotation-Satisfaction

Conclusions

The Cypriot ICU Nurses level of Autonomy is moderate

ICU nurses felt they had greater autonomy in their own actions than in decision-making.

Nurse-physician collaboration in the decision making process was low

Most of the nurses were dissatisfied with their collaboration with doctors regarding the decision making of patient care

Conclusions

The strong association observed between teamwork and autonomy suggests that synergy rather than conflict may empower nurses and enhance their autonomy.

Autonomous nursing practice and collegial/collaborative nurse-physician relationships are essential for ICU nurses’ satisfaction

Therefore……..

The ICU nurse managers in Cyprus need to implement strategies to promote, support and enhance:

1. nurses decisional autonomy, since clinical decision-making is a complex, constant and intensive aspect of ICU nursing.

2. collegial/collaborative nurse-physician relationships since they are strong determinants of healthy work environments.

This is how Cyprus looks this time

of the year

CYPRUS IN SPRING