Autonomy is a Greek word which autos- mean (self) and nomos means (rule of law) (Merriam-webster, 2019). The Piagetian view defines autonomy in moral is a right or wrong decision making (Raya, 2007). In general, it is means self-determination or self-rule. However, professional is related to the profession which means work with potential (Walter, and Lopez, 2008). Broadly, professional autonomy means autonomy principles application whereby professional people serve independently to make a decision by using their knowledge and experience (Csp.org.uk, 2011).
Word professional autonomy appeared in Madrid in October 1987 by World Medical Association WMA when professional autonomy and self-regulation pick out some basic principles during 39th World Medication Association held in Madrid, Spain (Med.or.jp, 2019).
In fact, clinically use professional autonomy while practicing with patients and they define it as when a physician’s employ his ethical and moral standers to provide all the best to the patients (Stoddard, 2001).
Many of professions in whole word hospitals use term professional autonomy such as physicians, nurses, physiotherapists and more.
Professional autonomy is an issue has impacts on physiotherapists, patients, and the profession. Furthermore, this report includes the professional autonomy evidence in issue impact and analyses it.
In clinical situations significantly decision making depended on the trust between patients and their medical staff. In multiple hospitals, patients have the confidence to the doctors, other professions and their families to make a decision in their health state. In Korea, 42.4% of patients give medical staff and their families a responsibility in decision-making. However, 21.7% of Korean patient make a decision on their own (Mo, 2012). Maybe those patients who did not give the green light to others to make a decision have no trust of others or have enough knowledge to decide on their health care. Another view, in some hospitals patients decision almost depended on doctors due to lack of patients’ right on information and knowledge, neglect of taking permission to do daily exercises, staffs not listen to patient complain clearly or some staff do not respect patients’ privacy and make a noise in the round while patients sleep. All of that affects inpatient decisions and choose their treatment and patient feels valueless (Ebrahimi et al. 2016).
Professional autonomy issue has an impact on physiotherapists, patients, and professions. First of all, professional autonomy has a clear picture effect with patients. Kleffens et al. said that medical information about the patient’s health state and treatment choices are the basics of patient’s autonomy. There are internal and external factors effects on patients in the decision making process. Often patients’ knowledge and awareness such as self-understanding, perception of care, desire in decision making, and patients’ belief in decision making as internal factors to patients. On the other hand, the external factors that affect patients’ autonomy are medical staff like doctors, nurses, physiotherapists, and others. Moreover, patient’s families, social environment consider as external factors. Whereas in a qualitative study done by Rahmani et al. found significant statistics of patients autonomy connected with an understanding of their health state and medical staff needs. Also, Proot et al. study showed that the patient’s family and health care provider has a big role in the decision making process with patients. Those two studies prove the importance of factors which affect in patient’s autonomy. In the opposite side, Cullati et al.'s study in Switzerland in 2010 show up that increasing in autonomy rate with people who live alone. This study proves the opposite of two previous studies mentioned which those patients who living alone did not have information and life experiences. Negative society and the patient’s body and mind always affect negatively in patient decisions.
The second thing which as how professional autonomy affect the profession? The duration between 2001-2004 Gellatly et al. found there is affirmative effects appear with professional autonomy in the workplace which an increase in job performance and outcomes. In general, some organizations give the employees a chance to choose their schedule. Also, other organizations allow employees to select their job. Those employees have the ability to overlap any job stress by organizing their work and arrive at job satisfaction. In addition, when the employees apply a good professional autonomy and order his or her job correctly, they easily can manage their responsibility and that will affect inappropriate way their effectiveness and behavior reaction. Cohrs et al. (2006) were checked the relationship between using professional autonomy and job satisfaction, the result found the positive association (Saragih, 2015). Furthermore, the trust in the organization increases the productivity of work and the responsibility of work will improve with the organization’ employees, but an observation must be present there to control and monitor the work and increase the professional autonomy Gur and Bjornskov in 2016; Van Hoorn in 2017 said that (Hoorn, 2018). The professional autonomy with increases of job performs, satisfaction and the trust on the profession is effect and studies were mentioned above proved that.
The third and the final point are the professional autonomy issue impacts on physiotherapists. The nature of physiotherapists work is direct with patients. They assess, diagnose and provide appropriate treatment and rehabilitation sessions by teaching the patient suitable exercises related to their diagnosis. In Sweden, the patient can meet the physio staff without referral even in public sectors. In fact, Swedish physiotherapists have high independent that is mean they have an ability to deal with patients without physicians referrals (Dannapfel et al., 2013). The professional autonomy has a good influence on physio which increases confidence and motivation. In addition, when physiotherapists apply autonomy, they may learn and gain new skills which that improve his or her knowledge and experiences. The World Confederation for Physical Therapy (WCPT) supported that professional autonomy gives physiotherapy staff freedom to practice and decision making to patients, which that will lead to develop and promote the knowledge and practice (Wcpt.org, 2019).
Finally, experimental results showed that professional autonomy has a great work effect on the patient, physiotherapist, and general professions. Preliminary experiments with patients lead them to get a good result while they make a decision with others such as health care providers, families, and friends opposite to who decide alone. However, should the health care provider notify the patient the risk and the benefits of their health state which to allow them to decide correctly and avoid any risks. That is means; in some cases, the patient state may harm others. Also, maybe patient state needs to other resources of the money to treat them. For that, some physicians in the world advise patient to discuss their condition with others and ask for help from them (Zolkefli, 2017). As a result of that, Lord Diplock announced that “it is my right to decide whether any particular thing is done to my body, and I want to be fully informed of any risks there may be” (Coggon, and Miola, 2011).
In the other hand, clearly indicated the profession impacts positive points. Which as should give the employees a chance to organize their work and schedule to practice their work with confidence and trust. In addition, managers and employees must build a good relationship. Furthermore, in the clinical situation should the health care provider like a doctor, physio and nurses make a good relationship with patients. Further research is recommended to determine the maximum achievable enhancement from the ministry of health to use professional autonomy in all hospitals because it has good impacts.
This report summarizes the professional autonomy impacts on patients first, then on the profession and at the end the impacts on physiotherapists.
One study done in Iranian hospitals proved that younger patients, patients who freelance and in-depended lifestyle, patients who had previous in hospitalizations, and patients with high education had a good autonomy and decision making.
In these cases, patients’ decisions and health state depended on patients’ environments support like families and friends. Whereas, Dooley and Swords study showed and proved that family has a significant influence on patients (Ebrahimi et al. 2016).
On the other hand, professional autonomy has great work and influence on the profession itself which improve the outcome of the job and job productivity.
However, physiotherapists who use professional autonomy have an ability to improve their skills, knowledge, and experiences.
In the end, the application of professional autonomy on patients, physiotherapists, and any other profession lead to increase the communication skills and promote the confidence between the staff and their patients. In addition, increase in other values between the manager and their employees (Murray et al., 2018).