Preserve Chronic Patient Autonomy Process in Hospital: Grounded Theory Study.

Abstract

Abstract: Introduction: Patient autonomy is essential element in patient-centers care, an accepted ethical principle and the opposite of paternalism. Since the autonomy is interactive, developmental and social process and autonomy is culturally relative and how preserve autonomy is not clear in chronic patient in Iranian hospitalized patients then the aim of this study was to explore chronic patient autonomy process in Iranian hospitalized patients. Method: this study was conducted through a qualitative approach and the Corbin and Strauss grounded theory (2008) method between 2013-2015. The participants in this study were chronic inpatients, nurses and physician working in medical wards of Tabriz and Hamadan hospital. Selection of participants was initiated using purposeful sampling and continued by theoretical saturation was achieved. The main data collecting tool were unstructured interviews and observation. A total of 40 interviews were performed with 34 participants (23patients, 9 nurses and 2 physicians).data were analyzed on Corbin and Strauss (2008) method and with the MAXQDA- 10software. Results: interpersonal factored, disease status and hospitalization, supportive family and friends, paternalism authority, organizational constraints constraints were five main categories of contextual factors that influences on chronic inpatients autonomy process. Ignored was the participant’s main concern. Exposure and accept paternalism, attempt to self- expression, attempt to self-proof, attempt to shared decision-making, and attempt to self-determination were the perspective five stages of process that participants use for overcoming of paternalism authority that accompanied with physical and mental comfort, trust-compliance cycle and hospital capital escaping. “authority scrambling: response to paternalism authority” was the core category that connected categories” to each other. Conclusion: generally, though changes in patients’ health and live can create serious threats for their autonomy, they want to maintain their independence. Treatment team with consideration this ethical concept in communication, help to patients for preserve autonomy. Key words: personal autonomy, chronic disease, inpatients, Hospitals, grounded theory, qualitative research.