| Research Abstract |
The results of the interviews with the visiting nurses indicated that, in situations where the nurses' discretionary authority was exercised during visit, the patients' basic needs were not met, their illnesses were worse, their pain increased and the discretionary authority was directed by the doctors' comprehensive directives.
A questionnaire survey was then conducted on the nurses' discretionary authority during their visit. The questionnaire was administered to the managers, nurses and doctors at 300 visiting nursing centers randomly selected thoughout the country. The result showed that the responses where the visiting nurses exercised their discretionary authority in medical acts were found most frequently in the order of the following. : "treatment when discovering illnesses," ,"execution of pulmonary therapy," "execution of functional rehabilitation," and "increase/decrease in administering internal medicine". More specifically, their contents included the following : "addition/
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deletion of injury treatment", "changes in contents and frequency of functional rehabilitation", and "bladder cleaning". Almost all managers of the visiting nursing centers responded that visiting nurses' discretionary authority was necessary, while the most frequently given response in relation to the doctors' directives was that "comprehensive directives allow the discretion because of urgency and patients' need." On the other hand 70% of the managers of the visiting nursing centers responded that "we would be in trouble" if medical acts were executed through nurses' discretion. Their most frequently given reasons were : "there would be problems with the current legal system" and "we can't be responsible for it." The most frequently mentioned medical acts, where visiting nurses "should receive another directive from their doctor" in case of changes occurring in patient" conditions, were in the following order, "management and guidance in medicine-taking," "management and guidance in oxygen therapy at home, " "management and guidance in tracheal cannula," and execution of tube feeding." The most frequently given reason for these responses was "we cannot be responsible for visiting nurses' action." Next to these medical acts, there were other acts mentioned (15 items) with the following as the most frequent visiting nurses "could change or stop the acts" and "it could be done depending of the patient's condition"-combined, these two responses comprised about 70%. Less
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