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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 > > > > > > > > > -------------------------------------------------------------------------------- > > > > No virus found in this incoming message. > Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.9.7/1799 - Release > Date: 11/19/2008 > 8:58 AM