Understanding the meaning of nurse practitioner autonomous practice in Oklahoma; A Gadamerian approach

Despite more than 45 years of nurse practitioner (NP) history, the ability of NPs to practice autonomously as primary care providers continues to be influenced by cultural, socioeconomic, and political factors. Relatively little attention, however, has been given to the NP's own understanding of what autonomy means within the context of daily practice. The purpose of this qualitative study was to elicit an understanding of the meaning of autonomy as interpreted by NPs through the lived experiences of their everyday practice in primary health care.

This was a Gadamerian hermeneutic study that also incorporated Gilligan's feminist perspective. Purposive and network sampling were used to ensure that a broad swath of NPs from diverse primary health care practice settings was achieved. Data were collected from nine NPs during individual, face-to-face interviews of one to two hours duration. Each interview was audio-taped and transcribed by the author or a transcriptionist.

Interpretive analysis incorporated Gadamer's hermeneutic model of the hermeneutic circle and development of understanding through the fusion of horizons. Gilligan's theory that the development of one's identity is defined through relationships of responsibility and care molded the context of hermeneutic interpretation. Findings revealed that "Having Genuine NP Practice" was the major theme, reflecting the participant's own overall meaning of his or her autonomy. Practicing independently and alone (in the room) with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice, including its four sub-themes: (a) relationships, (b) self-reliance, (c) self-empowerment, and (d) defending the NP role.

The participant NPs perceived their practice as autonomous despite a restrictive practice environment. Understanding how NPs in this study shaped Having Genuine NP Practice provided insight into their daily practice, their professional self, the integral part that relationships occupy in the everyday life of being an NP, and daily struggles. This study highlighted the impact of a traditional, hierarchical culture and the social impediments to achieving full autonomy. New knowledge of what Having Genuine NP Practice means enables the NP profession to influence health care reform better.