Session 18.4 Autonomy and cooperation practices among critical ...

Session 18.4 Autonomy and cooperation practices among critical ...





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)


Autonomy is a composite multi-factorial

phenomenon spanning a wide array of

behaviours hence it is complex to define and


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


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 individualpatient

decision level and at the level of

ICU organization (Baggs et al 1999).


Nursing Autonomy has been found to be

positively related to:

– Improved patients Outcomes (Wade, 1999),

– Nurses job satisfaction (Erlen & Sereika 1997, Budge

et al. 2003)

– Recruitment and retain of nurses in the Profession

(Curley 2002, Parahoo 2000)

– The practice of Evidence Based Nursing (Parahoo


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 ICU

Better professional relationships and better patients


( 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.


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)


All Nurses working in the Adult ICUs of

Public Hospitals in Cyprus (5 Public

Hospitals) (n=184).

Neonatal and Paediatric ICUs were


Results (1)

Response rate

Sample Characteristics

The age of participants

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

Professional experience in the nursing


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).

ICU nurses felt they had

greater autonomy in their own

actions (mean 4.28) than in

decision-making (mean 4.03)

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,


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

Correlations of subscales of Autonomy

All three bases

(subscales) of Autonomy

showed positive


– 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



Collaboration/Co-operation with

doctors in decision making

Only 1:3 (32.1%) participants regarded

their collaboration with doctors as high


(% , n = 163 )




The Cypriot ICU Nurses level of Autonomy is


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


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’



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


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