Nursing theories as guidance for autonomy support in activities of daily living: a scoping review.

BACKGROUND

Supporting others with self-care activities lies at the core of nursing practices. While supporting autonomy within essential care is important, there remains a lack of knowledge on what autonomy comprises and how nurses can demonstrate autonomy-supportive behavior. In order to find guidance, we consulted nursing theories that have shaped the profession. This study aims to explore in what way autonomy is described within the nursing theories and how they describe what nurses could/should undertake to demonstrate autonomy-supportive behaviors within activities of daily living.

METHODS

A scoping review was performed, in adherence to the Johanna Briggs Institute methodology for scoping reviews, adhering to the EQUATOR guidelines, using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, PRISMA-ScR, in order to report the scoping review results. Nursing theories were identified through textbooks, PubMed and expert feedback during the period of April to July 2023. No publication year restrictions were applied. Theories (writings that informed, under pinned, or described nursing care) were included if published in English or Dutch. Data extraction was carried out, performing a content analysis using inductive coding to identify categories of autonomy-supportive behavior.

RESULTS

Of 25 nursing theories identified, nine met the inclusion criteria. While none provided explicit definitions of autonomy-supportive behavior, autonomy was described as encompassing being oneself, having freedom and control over one's life, expressing and making choices, and engagement in carrying out actions. Six categories of autonomy-supportive behavior were identified: being aware of one's own behavior, respecting individual uniqueness, fostering interpersonal connections, facilitating open communication, allowing the other person to choose the best action, and collaborative guidance and assistance.

CONCLUSION

This review explored how autonomy is defined in prominent nursing theories and how nurses can foster autonomy in activities of daily living. Despite its central role in healthcare, no consistent definition of autonomy or autonomy-supportive behavior was identified. While nursing theories provide valuable insights, these remain largely theoretical and lack practical applicability. Further research is needed to translate these concepts into actionable strategies for everyday practice.