Rushton Carole, Edvardsson David
College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
College of Science, Health and Engineering, Austin Clinical School of Nursing, La Trobe University, Heidelberg, Vic., Australia.
Nurs Philos. 2018 Apr;19(2). doi: 10.1111/nup.12190. Epub 2017 Sep 26.
Key commentators on person-centred care have described it as a "new ethic of care" which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person-centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person-centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person-centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses' ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person-centred care. We argue that nurses' responses to the ethical demand by way of parrhêsia can be an important feature of intra-organizational reflexivity and its transformation towards the delivery care that is more person-centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research.
以患者为中心的护理的关键评论者将其描述为一种“新的护理伦理”，他们将其与个人自主、行动、改变和改善的概念紧密相连。本文探讨了两个关键点。第一，很少有关于伦理与以患者为中心的护理的讨论以任何特定的伦理理论为依据。第二点是，尽管以患者为中心的护理有诸多宣称的益处，但在急性护理环境中的实施在很大程度上仍只是一种理想状态。护士在实践中做出的选择往往更符合普遍规范，而非以患者为中心的护理所倡导的规范。我们借鉴道德哲学家洛斯特鲁普和福柯的著作元素，以深入了解护士的道德行为，并追问为何当护士的所思所为被视为正常时，他们会想要采取其他行动，或者当在组织中这样做被视为违规时，他们会选择不同的思考和行动方式？为了解决这些更具体的问题，我们将其与以下概念相关联进行讨论：伦理要求、生命的主权表达和直言不讳。我们的结论是，一个伦理理论框架能够使护士增强对伦理要求的感知和理解，尤其是那些源于组织规范与以患者为中心的护理所援引的规范之间不可通约性的伦理要求。我们认为，护士通过直言不讳对伦理要求做出的回应可以成为组织内部反思性及其向更以患者为中心的护理交付转变的一个重要特征，特别是对于认知障碍的老年人而言。我们在文章结尾强调了这对护理教育和研究的启示。
