University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
Department of Care Science, Faculty of Health and Society, Malmo University, Malmo, Sweden.
Int J Nurs Stud. 2019 Mar;91:148-152. doi: 10.1016/j.ijnurstu.2018.12.018. Epub 2018 Dec 31.
In this article we ask our profession to consider whether something is rotten at the core of modern nursing. We will use our own experiences as patients, together with published literature, to ask questions of our profession in perpetrating what one of our colleagues recently, and with great embarrassment, referred to as 'shitty nursing'. Our intention is most certainly not to offend any readers, for this term has been used in literature for more than one hundred years to describe bad situations, including those where events or people's behaviour are of a low standard. Our intention instead, is to challenge ourselves, the profession and you the reader by raising a measured debate which seems at present to be missing within the profession. We examine the potential idea that poor nursing care may not be the exception, but horrifyingly, may be the new normal. We are particularly concerned that patients' fundamental care needs may be falling into an ever widening gap between assistant and registered nurses. Whilst we acknowledge the potential causes of poor nursing care, causes that are often cited by nurses themselves, we come to the conclusion that a mature profession including clinicians, educators, administrators, researchers and regulators cannot continually blame contextual factors for its failings. A mature profession with an intact contract between itself and society must shoulder some of the responsibility for its own problems. We do suggest a way forward, including a mix of reconciliation, refocus and research, underpinned by what we argue is a much needed dose of professional humility. Readers may take us to task for potentially overstating the problem, ignoring non-nursing drivers, and downplaying other significant factors. You may think that there is much in nursing to glory in. However, we make no apology for presenting our views. Our lived experiences tell us something different. As professional nurses our main aim is to ensure that our adverse experiences as patients are statistical anomalies, and our future encounters with nursing care represent all that we know to be excellent in our profession. We leave you to judge and comment.
在本文中,我们要求我们的专业思考现代护理是否存在核心问题。我们将结合自己作为患者的亲身经历和已发表的文献,对我们的专业提出质疑,正如我们的一位同事最近尴尬地提到的那样,我们的专业存在“糟糕的护理”。我们的目的绝不是冒犯任何读者,因为这个术语在文献中已经使用了一百多年,用来描述糟糕的情况,包括事件或人们的行为标准低下。相反,我们的目的是通过提出一个有针对性的辩论来挑战自己、专业人士和读者,目前这个辩论在专业领域似乎缺失。我们探讨了这样一种可能性,即糟糕的护理可能不是例外,而是令人震惊的新常态。我们特别关注的是,患者的基本护理需求可能在助理护士和注册护士之间的差距越来越大。虽然我们承认护理质量差的潜在原因,这些原因通常是护士自己提到的,但我们得出的结论是,一个成熟的专业,包括临床医生、教育者、管理者、研究人员和监管机构,不能将其失败的责任归咎于环境因素。一个与社会保持完整契约的成熟专业必须为自身问题承担部分责任。我们确实提出了一个前进的方向,包括和解、重新聚焦和研究的结合,以我们认为急需的专业谦逊为支撑。读者可能会因为我们可能夸大了问题,忽视了非护理驱动因素,以及淡化了其他重要因素而对我们进行指责。您可能认为护理工作中有很多值得称赞的地方。然而,我们毫不掩饰地提出自己的观点。我们的亲身经历告诉我们一些不同的情况。作为专业护士,我们的主要目标是确保我们作为患者的负面经历是统计学上的异常,而我们未来与护理的接触代表了我们所知道的护理专业的所有优秀之处。我们将把判断和评论留给您。