Three points in response to this lively discussion:

(1)  Stephen's post is, obviously, spot-on. Not much more need be said about
the dangers of paternalistic thinking about patients and the power we wield
over them.

(2)  Olga reported an interesting fact about Nerissa based on her slightly
stalker-ish Google search. Whether she intended to or not, Olga seems to
excuse some of Nerissa's post based on the fact that she is "an ex-podiatrist
and new nursing grad".  It made me wonder whether podiatrists are somehow
excused from understanding the general principle that we are not our
patient's masters.  I suppose if I were a patient I would hope that anyone
providing care to any part of me (foot or soul... pun intended) would respect
(if not necessarily value) my decisions.  If I were particularly bold I might
even hope that my providers would help me to clarify my views about my health
(perhaps including a view that I don't care about my health... which should
be OK as well) and then support my voice. Podiatrist, nurse, dentist,
receptionist in a medical office, surgeon, whatever... The fact that Nerissa
has a previous degree and practiced as a professional only makes her comments
more frightening and further supports Stephen's rather strong response.

(3) Finally, I want to carefully point out that if it weren't for the
discussion about cars and philosophers, this thread would not exist. If I
recall, it emerged as a result of someone trying to 'change the subject'. So,
although I really hated the volume of emails generated by that car thread,
I'm glad it happened. 

Chad Priest

-----Original Message-----
From: A list to promote discussion of philosophical issues in nursing
[mailto:[log in to unmask]] On Behalf Of Olga Jarrin
Sent: Tuesday, November 18, 2008 8:32 PM
To: [log in to unmask]
Subject: Re: dignity -- say what?


Medical facisim, lol... and after days of dialogue on how we ought to
disagree and present our arguments! Stephen, Nerissa is an ex-podiatrist and
new nursing grad (oh the wonders of google). I'm going to take a different
tack and reference the latest issue of ANS 31(4), 283-295. Gweneth Hartrick
Doane & Colleen Varcoe's article Knowledge Translation in Everyday Nursing:
From evidence-based to inquiry-based practice addresses their "deeply felt
concern with the profound disparity that often exists between what nurses
know and what nurses do." They go on to give an example of a nurse who
provided care to one of the authors in a way inconsistent with her education.
The authors wonder briefly if workplace stress or culture might explain the
incongruence between the nurse's perception of her nursing practice and the
author's perception of her nursing care. 

Here is another side of Nerissa, something she wrote just a year ago:

I'm in nursing school with one semester to go. Student nurses are taught to
be supportive of all their patients. This includes Christians, atheists,
minorities, gays, etc. 

I agree strongly with this approach. Nurses should provide the best care they
can and not attempt to impose their opinions on the people they care for.

Nerissa Belcher
September 23, 2007  



--- On Tue, 11/18/08, Stephen Padgett <[log in to unmask]> wrote:

> From: Stephen Padgett <[log in to unmask]>
> Subject: Re: dignity -- say what?
> To: [log in to unmask]
> Date: Tuesday, November 18, 2008, 7:20 PM
> I don't know where to begin to say how much this message disturbs
> me. The astonishing arrogance and self-regard of it is
> matched only by the 
> wild self-pity. Oh, poor us! Forced to do more
> documentation, to protect 
> ourselves from vengeful patients who had the temerity - the
> cheek!-- to 
> refuse our always-excellent advice! But now they regret it,
> don't they? 
> they wish they'd listened to us, they'll try to
> "re-invent themselves" 
> (whatever that means) to blame us for their lapses, but we
> know better, 
> don't we? don't we always?!
> 
>  	and that this should arrive in my inbox under the subject heading
> "dignity"!!
> 
>  	No, Nerissa, this isn't dignity or respect or even
> nursing in my
> book. This is medical fascism. First off, it conveniently
> ignores all 
> the mistakes *we* make, all the ways our "advice"
> changes with the 
> latest research, the shifting fashions and priorities, the
> season. It 
> ignores all the nonsense we say to people...
> 
>  	Have you been a patient recently, Nerissa? Or a family member of
> one? I don't wish you any ill health, but it is an
> excellent way to shake 
> off professional arrogance. To be the recipient, as opposed
> to the 
> dispenser, of so much well-intentioned and utterly useless
> (if not 
> downright offensive) advice that nurses, doctors, and
> others dish out 
> everyday is a profoundly humbling experience. And have you
> looked 
> recently at the data on patient lawsuits & malpractice
> claims?  Most 
> clinicians wildly over-estimate their actual risk of being
> sued.
> 
>  	And that's not even the main issue. The main issue is simply that
> people do not give up their rights to make choices when
> they come into the 
> healthcare system. It's astonishing to me that we
> continue to have 
> to debate this in health care. And no, Nerissa, you're
> not the only one 
> who thinks like this -- this attitude is all too common
> among the 
> providers I meet. Not everyone, not by a long shot, but far
> too many. It's 
> the seamy side of professionalism - the "we know
> better" side.
> 
>  	Whether you agree with a patient's choices - whether
> you think
> they make the most sense from a medical standpoint, whether
> they are 
> congruent with YOUR careplan -- is not the point. The point
> is, it's 
> their call. This ethical orientation is fundamental to our
> system of 
> professional relationships -- it helps to counter that
> "we know better" 
> pull - and it is very disheartening to hear you wave that
> away because 
> people making the *wrong* choices might become
> "problems" later on - 
> problems for us, of course. (Poor us!)
> 
>  	"Warning" people is fine, documenting is always
> a good idea, but I
> think you need to do more than just "consult with the
> ethics people." I 
> think you need to have a long talk with them about what
> you're in charge 
> of and what you're not.
> 
>  	Stephen Padgett
> 
> 
> On Tue, 18 Nov 2008, Nerissa Belcher wrote:
> 
> > Hi Ms. Davis,
> >
> > IMO, if a patient deliberately chooses to increase
> their risk despite
> > nurses advising them of the danger then they are
> problems waiting to
> > happen. We all know the drill. The
> nurse/doctor/therapist, etc. didn't
> > warn them firmly enough, or document well enough, or
> consult the ethics
> > people. I support free choice but we need to be very
> aware that people
> > reinvent their pasts to claim ignorance of things
> later. Sadly, still
> > more documentation for nurses needs to be completed in
> anticipation of
> > problems.
> >
> > Nerissa
> >
> >
> > --- On Tue, 11/18/08, Davis, Betty
> <[log in to unmask]> wrote:
> >
> >> From: Davis, Betty <[log in to unmask]>
> >> Subject: RE: dignity
> >> To: "Nerissa Belcher"
> <[log in to unmask]>
> >> Date: Tuesday, November 18, 2008, 3:10 PM
> >> You stated, "Show them respect unless doing
> so harms
> >> their medical
> >> care."  Does that imply that noncompliance or
> >> disagreement with the plan
> >> of care warrants disrespect?  That statement seems
> to
> >> disallow free
> >> choice....  And, please, be gentle....
> >>
> >> Betty W. Davis, PhD, RN, CNE
> >> Assistant Dean, Nursing
> >> Program Head, Associate Degree Nursing
> >> Meridian Community College
> >> 910 Hwy. 19 North
> >> Meridian, MS 39307
> >