Autonomy and Accountability presentation by mr. tanoj patidar, 1st year M.sc nursing, D.Y. PATIL SCHOOL OF NURSING.

1. AUTONOMY AND
ACCOUNTABILITY
BY-TANOJ PATIDAR

2. AUTONOMY

3. INTRODUCTION
 Autonomy is derived from a Greek word ‘’autos’’ means
‘’self’’ and ‘’nomo’’s means ‘’laws’’. The right of self
government acting independently or having the freedom
to do so. It’s the right of personal freedom of action,
which is regarded a one of the hall marks of the
profession.

4. DEFINITION
 Autonomy means that individuals are able to act for
themselves to the level of their capacity. It is the right of
the individuals, governing their actions according to their
own purpose and reason.
NURSE AUTONOMY
 It is define as belief in the centrality of the client when
making responsible discretionary decision, both
independently and interdependently, the reflect advocacy
for the client.

5. BENEFITS OF AUTONOMY
 Professional autonomy leads to work autonomy and job
satisfaction.
 Freedom to act on the binding decision the nurse make.
 For example the nurse does not need to obtain permission from the
others to carry out actions she has decided on. Instead , the nurse’s
education has prepared her to an act the decisions. For example ,
a nurse can decide to initiate an educational teaching plan with a
new mother who is trying to initiate breast feeding her new born
but who is not being consistently successful. No one needs to give
the nurse permission to do this education with the mother.
 Autonomy in nurse’s practice contributes to the well-being of
patients and add to the quality of services and care that patient
receive.

6. STRATEGIES FOR ENHANCING AUTONOMY IN
NURSING
 Strategies for enhancing autonomy are based on setting clear
expectations for autonomous decision making and providing
support for increasing the knowledge and expertise of nurse.
 Clarifying expectations about clinical autonomy.
 Enhance competence in practice.
 Collaboration with physicians works very well with autonomy in
nursing.

7. CHALLENGES TO AUTONOMY IN INDIA
 Lack of recognition and valuing of nursing knowledge and
contribution to patient care goals by physicians and other
member of health care team.
 Inability to raise and resolve concerns about treatment plan.
 Interruptions to the nurse’s ability to access coordinate
resources for the patient care.
 Relationship with nursing colleagues, physicians and managers
that undermine shared collaboration, confidence and decision
making.

8. ACCOUNTABILITY

9. INTRODUCTION
 Accountability means an individual are answerable for
their actions and have an obligation to act.
 Manifesting accountability in nursing practice provides the
opportunity to evaluate nursing contribution within health
care and is a means of clarifying the significance of
nursing to society.

10. DEFINITION
 Accountability is being responsible for one’s actions and
accepting the consequences for one’s behaviour,
Accountability is not a vague feeling or an obscure
concept. It is clear obligations which must be manifested
as a structured component of nursing practice, based on
responsibility, authority and autonomy.
 Accountability is a sense of overriding concern for nursing
care, while responsibility is the sense of duty in
performing special tasks.

11. LINES OF ACCOUNTABILITY
 UPWARD: looking up the line and doing what managers
and administers require.
 LATERAL: as a self regulation in which practitioners are
accountable to and judged by, criteria set by the their
peers.
 DOWNWARD AND PUBLIC: accountability where staff
are accountable for/to patients.

12. TYPES OF NURSING ACCOUNTABILITY
 FISCAL ACCOUNTABILITY: the accountability is concerned with
financial probity and the ability to trace and adequately explain
expenditure.
 PROCESS ACCOUNTABILITY: concerned with the use of proper
procedures.
 PROGRAMME ACCOUNTABILITY: concerned with the activities
undertaken and their quality.
 PRIORITIES ACCOUNTABILITY: this deals with the relevance or
appropriateness of chosen activities.

13. ELEMENTS OF ACCOUNTABILITY
 CLARITY: expectations and goals are clear and specific.
If staff members know about reason Behind the
expectations, they are more likely to commit themselves
to meeting it.
 COMMITMENT: the accountable person must listen,
understand, agree, and commit to achieving the
objectives.
 CONSEQUENCE: consequence are the after of the
negligence to commitments. A person should bear the
consequences of being accountable.

14. ACCOUNTABILITY OF NURSING
PERSONNEL
ACCOUNTABLE FOR WHAT:
 You can only be accountable for which you are responsible, and you
can only be responsible for those things which are clearly designated
as accepted as your responsibility.
 For providing safe and therapeutic environment.
 Maintaining adequate supplies material for smooth function of working
unit.
 Protecting client’s legal rights.
 Maintaining accurate records and reports.
 Working within ethical boundaries.
 Delegating responsibility appropriately.

15. CONT…
ACCOUNTABLE TO WHOM:
 Nurses are accountable to nursing council.
 This relates to practicing within scope of practice,
according to register or roll in which your name entered,
and being accountable for your professional conduct.
 The nursing councils code of conduct for nurse and
midwives further outlines professional accountability in
terms of ethics, standards of practice, rights of patient
and justifying public trust and confidence.

16. REASONS FOR LACK OF ACCOUNTABILITY
 Job description not available.
 Lack of guidelines, standards and control.
 Authority not specified.
 Overburdened staff due to shortage of staff.
 Lack of adequate training and efficient experience.
 Lack of up to date knowledge, skills, and competence.
 Unwilling.
 Inadequate supervision by managers.
 Out-dated policies, protocols and procedures.
 Lack of decision making.

17. WAYS FOR ENHANCING ACCOUNTABILITY IN
NURSING
 Well defined duties and job description.
 Written policies, protocols and procedure.
 Nursing audit and standards of practice.
 Proper delegation of responsibilities.
 Proper training and education of self.
 Periodical evaluation of nursing practice.
 Refine and modify outdated policies and procedures.
 Conducive working environment.
 Availability of adequate number of personnel and resources for care.