Moser Albine, Houtepen Rob, Spreeuwenberg Cor, Widdershoven Guy
Department of General Practice, Faculty of Health, Medicine and Life Science, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Med Health Care Philos. 2010 Aug;13(3):215-23. doi: 10.1007/s11019-010-9241-8.
The goal of this article is to augment the ethical discussion among nurses with the findings from empirical research on autonomy of older adults with type 2 diabetes mellitus. There are many factors influencing autonomy. These include: health conditions, treatment, knowledge, experience and skills, personal approach as well as familial patterns, type of relationship, life history and social context. Fifteen older adults with type 2 diabetes mellitus were interviewed in a nurse-led diabetes clinic. These participants perceive three processes which support autonomy in responsive relationships: preserving patterns of concern and interaction, nurturing collaborative responsibilities and being closely engaged in trustful and helpful family relations. People with diabetes realize autonomy in various responsive relationships in their unique life context. Next, we performed a literature review of care ethics and caring in nursing with regard to relational autonomy. We classified the literature in five strands of care: attitude-oriented, dialogue-oriented, activity-oriented, relationship-oriented and life-oriented. According to our respondents, autonomy in responsive relationships is fostered when patient, nurses, professionals of the health team and family members carry out care activities supported by a relational attitude of care. They can best realize autonomy in relationships with others when several essential aspects of care and caring are present in their lives. Therefore, we advocate a comprehensive approach to care and caring.
本文的目的是通过对2型糖尿病老年人自主性的实证研究结果，加强护士之间的伦理讨论。影响自主性的因素有很多。这些因素包括：健康状况、治疗、知识、经验和技能、个人方式以及家庭模式、关系类型、生活史和社会背景。在一家由护士主导的糖尿病诊所，对15名2型糖尿病老年人进行了访谈。这些参与者认识到在回应性关系中支持自主性的三个过程：保持关心和互动模式、培养协作责任以及密切参与信任且有益的家庭关系。糖尿病患者在其独特的生活背景下，在各种回应性关系中实现自主性。接下来，我们对护理中关于关系自主性的护理伦理和关怀进行了文献综述。我们将文献分为关怀的五个类别：态度导向型、对话导向型、活动导向型、关系导向型和生活导向型。根据我们的受访者，当患者、护士、健康团队专业人员和家庭成员开展由关怀的关系态度支持的护理活动时，回应性关系中的自主性会得到促进。当护理和关怀的几个重要方面存在于他们的生活中时，他们能在与他人的关系中最好地实现自主性。因此，我们倡导一种全面的护理和关怀方法。
