Parker Judith M
School of Nursing, University of Melbourne, Level 1, 723 Swanston Street, Carlton, Victoria 3053, Australia.
Nurs Inq. 2004 Dec;11(4):210-7. doi: 10.1111/j.1440-1800.2004.00230.x.
This paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses. I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse-patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses' relationships with patients and the complex dimensions of their medical nursing role.
本文探讨了当代医学护理面临的一些问题，并借鉴精神分析理论来研究医学护理工作中一些看似简单且被视为理所当然的领域。我认为，医学护士在照顾患者的日常工作中，涉及到为本质上不稳定和动荡的情况带来秩序并划定界限。我还认为，护士在这方面管理和组织工作的方式源于那些往往被视为理所当然且未被明确思考过的传统做法。因此，护士很难考虑改变这些往往会给护士带来负面后果的做法。我想研究三种被视为理所当然的护理做法所产生的后果对护士的影响：（i）护士倾向于将自己的反应局限于正在发生的事情，以展现出关怀的自我形象；（ii）护士在与患者的日常交谈中倾向于限制、限定和最小化意义；（iii）护士在履行将患者限制在床上或病房的监管职能时所出现的紧张和模糊性。这些做法对护士的潜在负面后果可能包括对他们照顾患者能力的压力和困惑；对护理技能的低估；以及护患关系的恶化。建议对医学护士进行临床督导，作为促进对护士与患者关系的本质以及他们医学护理角色的复杂维度有更深入理解的一种手段。
