Ilomäki Sakari, Ruusuvuori Johanna
7840Tampere University, Tampere, Finland.
Nurs Ethics. 2022 May;29(3):719-732. doi: 10.1177/09697330211051004. Epub 2022 Feb 4.
Enhancing client autonomy requires close coordination of interactional practices between nurse and client, which can cause challenges when interaction takes place in video-mediated settings. While video-mediated services have become more common, it remains unclear how they shape client autonomy in telehomecare. To analyse how video mediation shapes client autonomy when nurses guide medicine taking remotely through video-mediated home care. This is a conversation analytic case study using video recordings of telehomecare encounters. The theoretical approach draws on ethnomethodology and empirical ethics. Four home-dwelling older adults and three nurses participated in the data collection; data extracts include one client and two nurses. The study was conducted in Finland. Special attention was given to protect the rights of home care clients. An ethical statement for the study was given by the Ethics Committee of the Tampere Region Video mediation complicates interacting remotely with care-relevant artefacts because of nurses' limited visual access to the medicine and client's need to simultaneously engage in vocal interaction and medicine taking. This can be overcome by dividing the guidance into manageable steps which invite the client to explicate their readiness to take the medicine and situating the video-mediation equipment and medicine close together. Different interactional practices and ways of situating video-mediation equipment and medicine have consequences for client autonomy. Understanding client autonomy in digitalised settings demands empirical examination that recognises the importance of different human and non-human aspects of care that shape client autonomy. To harness the benefits of video-mediated home care, communication technologies' reliance on home space and interactional practices should be recognised. Empirical ethics research is needed in order to make normative suggestions that fit a wide variety of care situation.
增强患者自主性需要护士与患者之间密切协调互动实践，而在视频介导的环境中进行互动时，这可能会带来挑战。虽然视频介导服务已变得更加普遍，但在远程家庭护理中，它们如何塑造患者自主性仍不明确。为了分析在护士通过视频介导的家庭护理远程指导服药时，视频介导如何塑造患者自主性。这是一项使用远程家庭护理会面视频记录的会话分析案例研究。理论方法借鉴了常人方法学和实证伦理学。四名居家老年人和三名护士参与了数据收集；数据摘录包括一名患者和两名护士。该研究在芬兰进行。特别注意保护家庭护理患者的权利。坦佩雷地区伦理委员会给出了该研究的伦理声明。由于护士对药物的视觉接触有限，以及患者需要同时进行语音互动和服药，视频介导使与护理相关物品的远程互动变得复杂。这可以通过将指导分成可管理的步骤来克服，这些步骤促使患者阐明他们服药的准备情况，并将视频介导设备和药物放置得很近。不同的互动实践以及放置视频介导设备和药物的方式会对患者自主性产生影响。在数字化环境中理解患者自主性需要进行实证研究，该研究要认识到塑造患者自主性的护理中不同人类和非人类方面的重要性。为了利用视频介导家庭护理的益处，应该认识到通信技术对家庭空间和互动实践的依赖。需要进行实证伦理学研究，以便提出适用于各种护理情况的规范性建议。
