Douglas College, Coquitlam, BC, Canada.
Simon Fraser University, Burnaby, BC, Canada.
Nurs Inq. 2020 Jan;27(1):e12324. doi: 10.1111/nin.12324. Epub 2019 Nov 15.
Nurses' experiences in, and the overall effectiveness of, widely used alternative-to-discipline programs to manage nurses' substance-use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative-to-discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative-to-discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and power relations co-ordinated and managed nurses' experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. 'Expert' physicians' knowledge was privileged while nurses' knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken-for-granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses' knowledge, expertise, and experiences need to be included in decision-making processes in these programs.
护士在管理护士药物使用问题方面，广泛使用替代惩戒方案的经验，以及这些方案的整体效果，尚未得到充分审查。在加拿大一个省份，我们发现了一个替代惩戒方案的官方和经验性知识之间存在冲突。我们通过制度人种学分析来阐明这种冲突。我们对参加替代惩戒治疗计划的 12 名护士和 3 名项目管理人员进行了 12 次访谈，以及对机构文本进行了分析，以探讨机构实践和权力关系如何协调和管理护士的经验。分析揭示了对非基于当前实践规范的标准化方案的盲目接受。潜在的和实际的利益冲突、权力失衡和盛行的公司利益普遍存在。护士没有像其他公民一样享有获得优质伦理医疗保健的同等权利。“专家”医生的知识被赋予特权，而护士的知识则被置于次要地位。结论是，监管机构不能依赖广泛使用的既定标准化治疗模式。必须为护士提供反映当前科学证据的个体化治疗替代方案，并且必须将护士的知识、专业知识和经验纳入这些方案的决策过程。
