Helping Patients Make Informed Decisions and Maintain Autonomy

Health care decisions are among the most important and personal decisions anyone can face. Whether it is the patient herself grappling with a pivotal choice, or family members struggling to make the right decision for their loved one, the outcome of such choices can have significant and wide-ranging effects for the patient and the people who love her.

As a nurse, you are often eyewitness to these choices. More challenging, still, you are likely to find yourself in the position of offering guidance and support as patients and families navigate this unfamiliar terrain.

And that is a role that is at once a great privilege and a tremendous burden. As a care provider, your role, above all, is to support not only the patient’s best medical interests but also their autonomy. Unfortunately, those two imperatives are not always in agreement. Sometimes, a patient’s exercise of their independence and free will runs directly opposite to their medical needs.

So how do you balance your weighty responsibilities to your patients? How do you honor your oath to do no harm while also protecting your patients’ autonomy? Above all, how do you prevent your own personal perspectives from unduly influencing your patients, even unconsciously?

Shared Decision-Making

The relationship between a nurse, the patient, and the patient’s loved ones is, to say the least, a unique one. On the one hand, there is an intimacy in nursing that often doesn’t exist between patients and doctors. It is truly among the most caring of the caregiving professions. At the same time, nurses carry a store of medical knowledge that is inaccessible to most patients and their families.

As important as it is for patients and families to trust their nurse, both the nurse’s care and their knowledge, this can pose difficulties if patients come to rely too heavily on their nurse, or any other health care provider, in making vital healthcare decisions. This can easily reinforce the old paternalistic model, in which the patient’s fate was given over to the charge of the medical expert. Their “superior” medical knowledge, supposedly, gave them the right to ultimate control over decisions concerning the patient’s care.

Unfortunately, this paternalistic model might be rooted in medical best practices, in empirical, evidence-based care, cutting patients and their families out of the decision-making process can have profoundly harmful effects. Studies show that when patients and families share in the decision-making process, they are more engaged in and compliant with treatment and more confident in the treatment strategy and their healthcare team.

The Nurse as Teacher

Thankfully, in most cases, the paternalistic model is no longer the standard today, and the caregiver’s role in supporting patient autonomy is, rightfully, at the center of modern medical practice. But, unfortunately, it’s not always easy to transform theory into reality.

However, you can play an important role in helping patients to overcome the knowledge gap that makes medical decision making so difficult for patients and families. One of your most important duties as a nurse is patient education, equipping patients with the information they need to overcome the knowledge gap and make their own informed decisions about their health.

And it’s not only the major life and death decisions that your patients need to learn about. If you’ve been nursing for a while, the odds are pretty great that you have the inside scoop on matters of health and healing that just can’t be found in any medical textbook or internet search.

For instance, if your patient is preparing for elective surgery, you will likely be able to educate them on the best time of the week to schedule their procedure or how the seasons might affect the patient’s recovery.

Similarly, educating your patients will also often involve addressing aspects of their lifestyles beyond the specifics of diseases and their treatment plans. For example, you will likely find yourself educating patients on proper diet as well as the signs, symptoms, and risks of various nutritional deficiencies, such as lack of bone density or increase in fatigue.

Such information can be essential to patient empowerment and autonomy. For example, once patients understand the role of nutrition in overall health and fitness, they may determine that they prefer to try a simple change in diet to address troubling symptoms before turning to more aggressive medical treatments.

The Takeaway

As a nurse, you’re required to play many roles in the lives of your patients and the people who love them. You’re an empathetic caregiver, offering aid, comfort, and calm in what is often the most difficult time of your patients’ lives. You’re also the expert, one who speaks a rarefied scientific language and who possesses both the education and the experience in an arena that is a baffling, and often frightening, mystery to patients and their families. The good news is that you can build on this unique trust and intimacy to help empower your patients and provide them with the knowledge they need to make their own informed decisions.