Thank you Savina, I look forward to reading the article. Olga
  
Gadow, S. (1983). Basis for nursing ethics: paternalism, consumerism, or advocacy. Hospital Progess, 64(10), 62-67,78.

--- On Wed, 11/19/08, Savina Schoenhofer <[log in to unmask]> wrote:

> From: Savina Schoenhofer <[log in to unmask]>
> Subject: Re: dignity -- say what?
> To: [log in to unmask]
> Date: Wednesday, November 19, 2008, 9:57 AM
> Olga,  what you have said calls to mind the classic paper by
> Sally Gadow on 
> three models of relationship common (at that time...and
> maybe still?) to 
> nursing: paternalism, consumerism, and advocacy.  Sorry I
> can't call up the 
> specific citation...but perhaps now is the time for this
> work to be brought 
> forward in prominence for consideration by our novice
> nursing scholars.
> 
> Savina Schoenhofer
> 
> ----- Original Message ----- 
> From: "Olga Jarrin" <[log in to unmask]>
> To: <>
> Sent: Wednesday, November 19, 2008 8:21 AM
> Subject: Re: dignity -- say what?
> 
> 
> Doane & Varcoe's (2008) article I mentioned
> "how the discipline has 
> inadvertently adopted epistemologies that are contrary to
> nursing values and 
> goals" and goes on to note "there has been little
> exploration into 
> embodiment/disembodiment and the living relation of
> epistemology and 
> ontology (p. 289)."
> 
> I so glad Barb mentioned she works in an institution that
> uses Watson's 
> Caring Science to guide nursing practice. The integration
> of caring 
> standards might help to clarify the focus of nursing care
> in the larger 
> context of overall care which is shared with biomedical
> oriented providers 
> with biomedical outcome goals.
> 
> Nerissa's alma mater has in their philosophy statement
> that: "Nursing is the 
> art and science of caring. The focus of nursing is to
> provide a caring 
> presence and to create an environment that facilitates
> healing of persons, 
> families, groups, and communities. Caring, as the essence
> and central focus 
> of nursing, is what makes persons, their environments and
> interpersonal 
> concerns meaningful. Caring in action consists of
> philosophical, 
> interpersonal, and technical components that interface to
> facilitate caring 
> interactions and caring environments. Professional nurse
> caring combines 
> cognitively and culturally learned behaviors, actions, and
> techniques that 
> enable the creation of healthy, healing environments for
> nurses, clients, 
> and colleagues. The ethics of care and responsibility
> involves moral agency, 
> interdependence, and professional integrity."
> 
> My work is centered on the idea that nursing is situated
> caring shaped by 
> interior and exterior environments. Interior environments
> referring to 
> concepts like mental attitude; personal philosophical of
> nursing, 
> ethical/moral & cultural orientation... while exterior
> environments include 
> educational training, work setting, systems issues,
> human/material 
> resources, etc. How we define caring and what it means to
> be a caring nurse 
> is shaped by all these dimensions and can change over time.
> Grounding in 
> paternalistic, biomedical education seems like it would be
> extremely 
> influential in one's conceptualization of caring as a
> second career nurse.
> 
> I notice my inbox filling with other's response and
> will stop here for now 
> and add this to the mix.
> 
> Olga Jarrin, RN, MS, PhD Candidate
> University of Connecticut
> School of Nursing
> 
> --- On Wed, 11/19/08, Barb Gingher
> <[log in to unmask]> wrote:
> 
> > From: Barb Gingher <[log in to unmask]>
> > Subject: Re: Fw: Re: dignity -- say what?
> > To: [log in to unmask]
> > Date: Wednesday, November 19, 2008, 4:42 AM
> > The electronic medical record has gotten the nursing
> staff
> > in our organization back to tthe bedside and patient
> care.
> > As Jean Watson is our theorist of choice, we now have
> caring
> > standards incorporated into the EMR. Many of our
> patients
> > have researched their disease process and are making
> > intelligent decisions in regard to their own
> healthcare.
> > Those who are not as savy can be educated in a
> supportive
> > way and if we cannot change the direction, so be it,
> > however we are no longer "tied" to the
> chart. A
> > simple statement of understanding and feedback from
> patients
> > satisfies documentation needs.
> >
> > Barb, RN, MA, MS
> >
> >
> >
> >
> > "The past is our definition. We may strive, with
> good
> > reason, to escape it, or to escape what is bad in it,
> but we
> > will escape it only by adding something better to
> it.”
> >
> > Barb Gingher
> >
> > --- On Wed, 11/19/08, Nerissa Belcher
> > <[log in to unmask]> wrote:
> >
> > From: Nerissa Belcher <[log in to unmask]>
> > Subject: Fw: Re: dignity -- say what?
> > To: [log in to unmask]
> > Date: Wednesday, November 19, 2008, 4:31 AM
> >
> > Once again I assumed the default setting for this
> group was
> > "reply to
> > all" so I accidentally sent my reply to an
> individual.
> > That message is
> > being forwarded to the group.
> >
> >
> > Nerissa
> >
> >
> > --- On Wed, 11/19/08, Nerissa Belcher
> > <[log in to unmask]> wrote:
> >
> > > From: Nerissa Belcher
> <[log in to unmask]>
> > > Subject: Re: dignity -- say what?
> > > To: "Chris Hanks"
> > <[log in to unmask]>
> > > Date: Wednesday, November 19, 2008, 4:10 AM
> > > Hi everyone,
> > >
> > > It appears my position has been mis-interpreted.
> What
> > > I'm trying to say is we need to provide
> quality
> > medical
> > > care while respecting our patients. As for
> protecting
> > > ourselves with documentation if only it were not
> > necessary.
> > > In the USA, however, nursing is much more about
> > > documentation than patient care. I'm a new
> nurse
> > but was
> > > a podiatrist for twenty years. The same rules
> applied
> > to me
> > > as a foot doctor. Documentation requirements in
> the
> > USA (UK
> > > too?) are out of control. But, like it or not if
> we
> > wish to
> > > retain our employment we do what we're paid
> to do.
> > Which
> > > is to document. A major reason I got out of
> podiatry
> > is I
> > > wasn't paid to document. Each and every
> ridiculous
> > new
> > > documentation requirement to come down the pike
> did
> > not come
> > > with any funding for it. As advantage of nursing
> is as
> > > ridiculous as the requirements are if someone
> wants to
> > pay
> > > me good money to write for the 10,000th time my
> > nursing
> > > focus about pain control and preventing falls
> (hint to
> > the
> > >  administrators - I got the ideas well before
> writing
> > them
> > > down for the 100th time) then so be it. I can
> cash my
> > checks
> > > in good faith.
> > >
> > > Getting back to patient care the ethical issue is
> when
> > > quality care conflicts with patient desires. I
> > disagree with
> > > Stephen Padgett who seems to think that since
> medical
> > > standards change over time we should assume
> patients
> > are as
> > > likely to be accurate in their medical
> assessments as
> > nurses
> > > and other trained medical professionals. Fact is
> the
> > > patients are likely to know less about what works
> than
> > we
> > > do. If they decide not to follow our advice then
> we
> > should
> > > support them in doing so but not put our jobs at
> risk
> > by
> > > failing to document the discussion.
> > >
> > > Additionally I wish to point out that patients
> will
> > more
> > > likely follow our advice if we show confidence in
> > ourselves.
> > > I.E. if we really believe we don't have a
> clue,
> > since
> > > things are always changing, patients will be
> prone to
> > not
> > > following our advice. IMO part of being a
> professional
> > is in
> > > keeping up with our studies so our advice is as
> > current as
> > > research allows.
> > >
> > > Nerissa
> > >
> > > --- On Wed, 11/19/08, Chris Hanks
> > > <[log in to unmask]> wrote:
> > >
> > > > From: Chris Hanks
> > <[log in to unmask]>
> > > > Subject: Re: dignity -- say what?
> > > > To: [log in to unmask]
> > > > Date: Wednesday, November 19, 2008, 3:26 AM
> > > > Dear all
> > > > Thank you Olga for the reference, I will
> read
> > this.
> > > > I have to say that I fully agree with
> > Stephen's
> > > > eloquent outburst.  And there is no reason
> not to
> > be
> > > > passionate in decrying a situation which is
> > commonly
> > > > encountered (though there are delightful
> > exceptions).
> > > > As I read Stephen's contribution I did
> feel
> > for
> > > > Nerissa, as I think that I recognise the
> anxiety
> > of
> > > the new
> > > > nurse placed in a stressful environment,
> however,
> > I
> > > feel it
> > > > crucial that the points Stephen makes are
> carried
> > into
> > > > practice.  I have been having discussions
> with
> > senior
> > > > undergraduate student nurses regarding these
> > ethical
> > > issues
> > > > for many years; the students express
> positive
> > patient
> > > > centred ideals.  When I visit practice areas
> or
> > teach
> > > some
> > > > post qualifying classes, it saddens me that
> often
> > the
> > > ideals
> > > > appear lost.  In particular it worries me
> how
> > often
> > > nurses
> > > > think that they know best, sometimes blessed
> with
> > only
> > > > scanty second hand knowledge, and no
> inclination
> > to
> > > > question.
> > > >
> > > > Thanks Stephen
> > > >
> > > > From Chris Hanks
> > > > Senior Lecturer
> > > > University of Plymouth
> > > > England
> > > >
> > > > ________________________________________
> > > > From: A list to promote discussion of
> > philosophical
> > > issues
> > > > in nursing [[log in to unmask]]
> On
> > Behalf
> > > Of
> > > > Olga Jarrin [[log in to unmask]]
> > > > Sent: 19 November 2008 01:31
> > > > 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
> > > > > >
> 
> 
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> 
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> 8:58 AM