School of Philosophy, Theology and Religion, University of Birmingham, Birmingham, UK.
Nurs Philos. 2011 Apr;12(2):83-93. doi: 10.1111/j.1466-769X.2010.00480.x.
In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally-determined time targets that are enforced by a top-down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond.
在本文中，我们反思了羞耻感和屈辱感对当代医疗保健中个人和职业操守以及道德代理的威胁。我们提供了一份由护士撰写的关于英国国民保健服务（NHS）事故和急症部特定轮班的个人叙述，作为案例研究。这篇文章与对羞耻和屈辱本质的见解进行了批判性的反思和评论。有人认为，急症科是一个容易出现羞耻和屈辱动态的地方，在一个受到外部确定的时间目标影响的文化中，这种情况可能会加剧，而这些目标是由自上而下的监控和管理系统强制执行的。其结果是，护士可能会失去他们的职业能力和责任感、道德代理和正直，这不仅对他们自己不利，也对他们与之共事的患者不利。鉴于对整体的一小部分进行检查可能会揭示出对一个非常大系统的运作和精神的洞察，这种非常特殊的案例研究叙述/反思对英国乃至更广泛的医疗保健的组织和提供具有重要的意义和教训。
