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

aimTo systematically map the determinants, expressions and implications of nurses' clinical autonomy in Palestinian healthcare settings. BACKGROUND/

introductionNurses' autonomy is crucial for quality care, job satisfaction and patient safety. In Palestine, the healthcare system operates under unique political instability and resource constraints, yet a comprehensive synthesis of nursing autonomy in this context is lacking.

methodsA scoping review was conducted following PRISMA-ScR guidelines. PubMed, Scopus, CINAHL, PsycINFO, Google Scholar, ProQuest, Al-Manhal and Arab World Research Source were searched for literature published between January 2019 and March 2025. A total of 3916 records were identified across all databases, of which 1203 duplicates were removed, leaving 2713 unique records for screening. After title/abstract screening, 178 records proceeded to full-text review, and nine studies meeting the inclusion criteria were synthesized thematically. RESULTS/

findingsPalestinian nurses conceptualize autonomy as independent clinical decision-making, patient advocacy and participation in organizational processes, often exercised within significant constraints. Key determinants include education level, clinical experience, leadership styles and resource availability. Major barriers were physician-dominated hierarchies and the impacts of political conflict. Enhanced autonomy was associated with improved job satisfaction and patient safety reporting. DISCUSSION: The findings align with international research on determinants like education and leadership but highlight the profound, context-specific influence of political conflict and resource scarcity in Palestine. These factors create a practice environment where autonomy is often reactive and improvisational. Although formal quality appraisal was not conducted, consistent with scoping review methodology, Oxford Levels of Evidence were assigned to each study to aid interpretation of evidence strength. Readers should note that most included studies are cross-sectional or qualitative, which limits causal inference.

conclusionNurses' autonomy in Palestine is multifaceted and contextually embedded. Strengthening it requires multilevel strategies that address individual, organizational and systemic barriers, particularly those arising from the unique sociopolitical context. IMPLICATIONS FOR NURSING: Nurse leaders should adopt transformational leadership styles and create formal structures for nursing input in decision-making to empower staff and foster professional growth. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policymakers must develop clear national standards for autonomous nursing practice and invest in sustainable resources and staffing. International partners should support professional development and advocate for the protection of healthcare workers in conflict zones. REPORTING

methodThis review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.