School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Heidelberg, Vic, Australia.
Austin Health/Northern Health Clinical Schools of Nursing, Schools of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Heidelberg, Vic., Australia.
Nurs Philos. 2020 Jul;21(3):e12298. doi: 10.1111/nup.12298. Epub 2020 Feb 27.
Person-centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person-centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person-centred. In this article, we explore key concepts of neo-liberal thought which forms an important back-story to the articles. Economic concepts, "efficiency" and "freedom" are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo-liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power.
以患者为中心的护理是一种相对较新的正统观念，正在发达国家的现代医院中得到实施。证明这种护理方式在改善患者预后、提高员工士气和组织效率方面的优点的研究才刚刚开始出现。相比之下，大量文献表明，在急性护理领域，特别是在认知障碍的老年人中，实现以患者为中心的护理仍然主要是一种愿望。在之前的文章中，我们认为护士不断努力协调时间、空间、人际关系、身体和道德的现有观念，以满足他们提供的护理是以患者为中心的期望。在本文中，我们探讨了新自由主义思想的关键概念，这些概念构成了这些文章的重要背景。我们考察了经济概念“效率”和“自由”，以说明护士如何协调经济权力的压制性和生产性影响。最后，我们提出了一个新的研究议程，旨在更细致地了解新自由主义影响下护理实践的混乱实际情况，揭示护士为应对经济权力而不得不做出的妥协和调整。
