Exploring Professional Autonomy Among Palestinian Nurses: A Comprehensive Scoping Review of Determinants, Barriers...

Area of Science:

• Nursing
• Healthcare Management
• Public Health

Background:

• Nurses' autonomy is vital for quality patient care, job satisfaction, and safety.
• The Palestinian healthcare system faces unique challenges due to political instability and resource limitations.
• A comprehensive understanding of nursing autonomy within this specific context is currently lacking.

Purpose of the Study:

• To systematically map the determinants, expressions, and implications of nurses' clinical autonomy in Palestinian healthcare settings.
• To synthesize existing literature on nursing autonomy in Palestine.

Main Methods:

• A comprehensive scoping review was conducted following PRISMA-ScR guidelines.
• Extensive database searches were performed for literature published between January 2019 and March 2025.
• Thematic synthesis was used to analyze nine included studies after rigorous screening of over 3900 records.

Main Results:

• Palestinian nurses define autonomy through independent decision-making, patient advocacy, and organizational participation, often under significant constraints.
• Key factors influencing autonomy include education, experience, leadership, and resource availability.
• Major barriers identified are physician-dominated hierarchies and the impact of political conflict, while enhanced autonomy correlates with improved job satisfaction and patient safety reporting.

Conclusions:

• Nursing autonomy in Palestine is complex and deeply influenced by the sociopolitical context, particularly political conflict and resource scarcity.
• Strengthening nurses' autonomy requires multi-level strategies addressing individual, organizational, and systemic barriers.
• Recommendations include adopting transformational leadership, establishing formal input structures for nurses, developing national standards, and advocating for healthcare worker protection.