Search results for Nursing

Summary

Introduction

It is not enough to understand what we ought to be unless we know what we are; And we do not understand what we are, unless we know what we ought to be.

(T. S. Eliot, 1935 )

T. S. Eliot reminds us of the relationship between our beliefs and values, and our interactions, interpretations and responses. He also describes the inextricable interrelationship of past, present, and future events and meanings. Exploring past and present meanings of ‘culture’ in the context of New Zealand nursing is an essential part of future development. This chapter begins by tracing the evolving meaning of culture within the context of New Zealand nursing. It then describes the meaning of cultural difference from a nursing perspective and explores the notions of prejudice, paradox and possibility in relation to nursing practice.

Nurses in New Zealand have experienced considerable public criticism for their efforts towards a fairer and more equitable health service. The introduction of cultural safety in nursing and midwifery education has been, and continues to be, the subject of much debate. Nursing people from cultures other than one’s own is a complex and contradictory undertaking and ‘striving towards right’, in this context, lives in the tensions and prejudices of nursing practice. Success is achieved when possibilities are recognised and the nurse and the person from another culture understand each other.

Summary

Introduction

The common catch-phrase ‘Culture! We don’t have a culture!’ is often the reply to the question: ‘What is your culture?’ when it is posed to New Zealanders today. Since the implementation of cultural safety in the schools of nursing andmidwifery, students have been introduced to concepts that were not as evident in most programmes prior to the early 1990s. Topics such as culture and the dynamics of power are now commonplace within these programmes. Similarly, with the movement towards ‘doing with’ as opposed to ‘doing for’ the client, students are required to possess an awareness of their values, beliefs, biases and prejudices. The first step towards cultural safety, therefore, is for a person to have sufficient awareness of their own culture.

So, for many students who ascribe to the dominant culture and values in Aoteroa New Zealand, they may well ask the question: ‘Why do I need to learn about my culture?’ This is particularly difi cult for students to reflect on if they believe that they are just ‘normal’ and culture is something Maˉ ori or immigrants possess. The short answer is that once there is clarity about people’s own values and beliefs (which are key components of culture) and how they affect their living, then they are in a better position to appreciate that other people do things differently. Nurses and midwives work with people from a range of cultures and circumstances. To be effective, therefore, they must become aware of their own culture and the impact this has on their practice. Nurses and midwives can unknowingly place other people’s cultural perspectives at risk. This is exhibited when people avoid going to a health service because they perceive the health professional to be disrespectful of their cultural practices and traditions.

Summary

Introduction

Cultural safety is borne from a specii c challenge from indigenous nurses to Western healthcare systems. It is increasingly being developed by scholars and practitioners as a methodological imperative towards universal health care in a culturally diverse world. The extension of cultural safety, outside an indigenous context, reflects two issues: a theoretical concern with the culture of healthcare systems and the pragmatic challenges of competently caring for ethnically and religiously diverse communities.

As discussed throughout this book, the term ‘culture’ covers an enormous domain and a precise dei nition is not straightforward. For the Nursing Council of New Zealand (‘the Nursing Council’) ( 2009 , p. 7), for example, ‘culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability’. In an attempt at a precise two-page definition, Gayatri Chakravorty Spivak ( 2006 , p. 359), captures the reflexive orientation required to grasp how the term ‘culture’ works:

Every definition or description of culture comes from the cultural assumptions of the investigator. Euro-US academic culture . . . is so widespread and powerful that it is thought of as transparent and capable of reporting on all cultures. […] Cultural information should be received proactively, as always open-ended, always susceptible to a changed understanding. [. . .] Culture is a package of largely unacknowledged assumptions, loosely held by a loosely outlined group of people, mapping negotiations between the sacred and the profane, and the relationship between the sexes.

Summary

Introduction

Frail older residents living in one long-term care facility and the nurses, caregivers and healthcare assistants caring for them, took part in a field study (Kiata & Kerse, 2004). In the facility, which was located in a large New Zealand city, most of the health professionals were of Pacific Island descent and the majority of residents were European (Pākehā). The purpose of the study was to explore how Pacific Island caregivers and Pākehā care recipients in the facility negotiated their way through the giving and receiving of care. Intercultural issues that arose are examined and used in this chapter as illustrative examples.

Caregivers were sanctioned by management to participate in the research and encouraged by reassurances of coni dentiality. Caregivers were interviewed by two researchers - one young man of Pacific origin, the other a middle-aged Pākehā woman. The frailty of the residents meant that they tired quickly, so shorter interviews were conducted. Residents were quick to become teary during interviews. This may have been part of certain illnesses, such as stroke, or these emotional outbursts may also have been due to the interest shown when asked to share their stories. Certainly, the majority stated that the ‘nurses’ were ‘always so busy’ (Miss E, 90s), and how they were reluctant to bother them. Participant observation was added to interview data, and information and understanding through thematic analysis. Conducting this research gave insight into the everyday lives of those who live and work in residential care.

Summary

The concepts of personhood and human dignity are widely used in contemporary healthcare ethics. This chapter provides a brief overview of how the concept of human dignity came to be so important in healthcare ethics, and examines how the concept’s widespread use and relationship to the concept of personhood have led to problems regarding its meaning and relevance. A practical solution is then presented.

The rise of the concept of human dignity in healthcare ethics

The word dignity is derived from the Latin dignus, which means worthy. Since dignity refers to worth, human dignity refers to the worth of the human. What makes the concept of human dignity important for ethics is that, unlike the dignity of a queen or the dignitaries at an awards ceremony, which expresses the worth or status of particular human individuals in relation to others, human dignity is meant to express a worth that is equally shared by all human individuals. It is not meant to be dependent upon their social status, economic wealth, race, gender or anything else. Moreover, it is meant to affirm a worth beyond price. Human individuals are said to be moral goods or ends in themselves, not merely good or useful as means to achieving other ends.

Summary

If all the world hated you and believed you wicked,

while your own conscience approved of you and absolved

you from guilt, you would not be without friends.

– Charlotte Brontë, Jane Eyre

Conscience is widely recognised as a universal, yet highly personal, human phenomenon. In recent times, however, the role of conscience in public and professional life has increasingly been challenged. This chapter explores whether conscience is indeed the ‘friend’ or ‘foe’ of healthcare professionals and all those who seek their services. It proposes a definition of conscience that is grounded in traditional ethics, and introduces the reader to the concept and practice of conscientious objection. This is followed by an analysis of challenges to the legitimacy of conscientious objection in a contemporary healthcare system, and a discussion of how the case for or against conscientious objection ultimately depends on competing models of healthcare and professionalism. The chapter concludes with proposals for how conscientious objection might best be accommodated in a contemporary healthcare setting.

What is conscience?

Most people – including most scholars – presume that conscience exists, and that its function is to alert us to a potential conflict between values and to indicate which values should guide our choices (Morton & Kirkwood, 2009).

Summary

Studying any discipline is worthwhile simply for the knowledge it brings and the skills in reasoning that can be learned and honed. For healthcare professionals, study – formal and informal – is part of the vocation: competence and excellence are not benchmarks to be achieved once in a lifetime and then relegated to the shelves, as one might a sporting trophy. Rather, the health professions demand a commitment to lifelong learning. Part of that professional commitment is an awareness of and engagement with the ethics of health and healthcare. The skills of this philosophical discipline are just as vital as clinical skills and the various dimensions of physiological and psychological knowledge that are essential for the work of a healthcare professional.

Why ethics?

Ethics has been an important sub-set of philosophy since the time of the ancient Greeks. For those early philosophers, there were three big questions to be answered by every human being and every society:

Summary

In her book Feminist Politics and Human Nature, Alison Jaggar (1983) argues that, in some form or another, feminism has always existed. For as long as women have experienced social, political or cultural subordination, there have been either individual or communal women who have resisted this reduction in status. Over the last two centuries, a visible and organised feminist movement has emerged. This chapter will present a historical timeline of feminist theory that will include an identification of several proto-feminists, and explore the social, cultural and ethical foundations of contemporary feminist theory. The three main ‘waves’ of feminism will be analysed, key writers and activists in these areas identified, and some workable definitions of relevant broad terms presented. Emancipation, suffragettes, radical feminism, liberation movement, care ethics and global feminism are fundamental terms that will be explored in this chapter. It will be argued that contemporary feminist theory is predominately a Western construct and that for application in non-Western, indigenous and culturally and linguistically diverse cultures, theoretical adaptation should be considered.

In the final section of the chapter, an application of one element of contemporary feminist theory will be presented in connection with healthcare ethics: relational autonomy. A case study involving the care of a woman with an unplanned pregnancy will be highlighted to assist with the application of relational autonomy and the connection with healthcare ethical reasoning.

Summary

‘My Hippocratic oath tells me to cut a gangrenous appendix out of the human body. The Jews are the gangrenous appendix of mankind. That’s why I cut them out.’ So explained one of the doctors working in a Nazi death camp during World War II. He thought the procedures he carried out at Auschwitz were justifiable on medical grounds. Killing Jews, Gypsies, Catholics, the mentally and physically disabled, homosexuals and other vulnerable people by various methods - including starvation, lethal injection or poisoning with carbon monoxide - furthered Hitler’s aim of cleansing the gene pool and ensuring the Aryan race’s dominion over all other races (Cook, 2014, citing Lifton, 2000: 232).

Unfortunately, the Allied Powers do not escape culpability for the misuse of science and medicine. In recent years, reports have emerged of unethical medical experiments conducted by the Americans in Guatemala after World War II. Dr John Cutler, who eventually rose to be US Assistant Surgeon-General, led this project and was associated with a parallel one in Tuskegee, Alabama. To study the course of sexually transmitted diseases and the effect of penicillin, the US Public Health Service deliberately infected soldiers, prostitutes, prisoners and mental patients with syphilis without their knowledge or consent.

Summary

At the heart of many contemporary healthcare ethical debates is the question of when does human life begin. In February 2012, the prestigious Journal of Medical Ethics published an article titled ‘After birth abortion: Why should the baby live?’ by Australian ethicists Alberto Giubilini and Francesca Minerva (2012). This controversial article affirmed the authors’ position that ‘after-birth abortion’ should be morally permissible in all cases where abortion is also permissible, including cases where the newborn is not disabled. Following its publication, the large portion of international responses to the article vehemently opposed the moral premises articulated by the authors that essentially supported infanticide. However, such a controversial premise is not new in historical or ethical discourse. Infanticide – the intentional killing of an infant by the mother – has been a part of many cultural practices over the centuries, from ancient Sparta to the more recent practice of intentionally killing newborn infants due to economic, cultural or social pressures placed on mothers and families. In 1988, Australian ethicists Helga Kuhse and Peter Singer also presented the argument that infanticide may be ethically justifiable in their book Should the Baby Live? The Problem of Handicapped Infants. A theological, philosophical and scientific analysis of the question of when human life begins can present some accord, but with contemporary ethical discourse from healthcare ethicists such as Kuhse and Singer (1988, 1990), Giubilini and Minerva (2012) and Julian Savulescu, there is an increasing divergence on what was once a universally accepted norm: that human life has moral inviolability from conception. This chapter will explore this issue by presenting some of the contemporary views, including theological, philosophical and scientific perspectives, as well as the cultural and historical influences on the question of when does human life begin. A particular focus to this discussion will be from a Christian anthropological framework, with an emphasis on the moral teachings of the Catholic Church.

Summary

Empathy for the patient is a key attribute that is much prized in the healthcare professional. It is much harder, however, to specify what empathy is. It is to be distinguished from sympathy and compassion, as well as sentimentality. This chapter will explore the nature of empathy, drawing on the work of Edith Stein (1989). Care is central to healthcare but, in view of the discussion on empathy presented, this chapter will take a look at the ethics of care. The ethics of care argues for the importance of contextualising the relationships between caregivers and care-receivers.

The great advances in medical technology and the discovery of new, powerful drugs in recent times have led to a belief that almost all diseases and health problems can be treated efficaciously. We are told that the frontiers of what is medically possible are continually being pushed back, and that medical advances in areas such as nanotechnology and stem cell research promise to be able to treat currently incurable diseases. These advances are truly exciting, but healthcare is much more than the treatment of bodies that have succumbed to disease, or suffer from some disability. It is a truism to say that healthcare professionals do not treat bodies, but persons. Human beings who are suffering from health problems need much more than simply attention paid to their physical needs; they also need comfort and reassurance. Furthermore, it is also recognised that they need to have their psychological and spiritual needs met. In the healthcare setting, these needs are recognised through the provision of counselling and chaplaincy services. This, however, does not mean that the individual healthcare professional – such as a doctor or nurse – is relieved of a responsibility to treat patients as people by an assumption that the comforting and reassurance are the jobs of other members of the healthcare team.

Summary

Providing good care – medical and nursing – to people whose lives are drawing to an end continues to pose challenges for Australians. The challenges include both practical and ethical ones. Among the practical issues are those to do with how to ensure access to good end-of-life care – in particular, palliative care – to everyone to whom it is owed. Among the ethical concerns are questions to do with how best to understand what is owed to whom. This discussion will focus on the ethical issues. Although the writer of the Hippocratic Oath insists that it is part of a doctor’s duty to keep his patients free from injustices they can do to themselves, justice is generally understood to be what is owed to others. The idea of what is owed to others can be understood in a range of ways – from the relatively specific idea of fulfilling responsibilities defined by prior undertakings to the relatively inclusive idea of acting uprightly in any actions that have a bearing on others. In the former sense, justice is often referred to as ‘fairness’, and in the latter sense it is often a label for the whole of virtue. In the first section of this chapter, I outline four ways in which justice as what is owed to others is understood: a ‘utilitarian’ understanding, a ‘libertarian’ understanding, an ‘egalitarian’ understanding and a ‘pluralist’ understanding. I will briefly indicate what I take to be the strengths and weaknesses of each approach, explaining why I think the pluralist view is the most reasonable. I will also touch on an independent but related issue: how each approach tends to view the other – the person to whom justice is owed. In the second section, I will assume a ‘pluralist’ understanding of justice, and spell out one of its implications for the treatment and care of people at the end of their lives so that they have genuine choices in treatment and forms of care.

Summary

Utilitarian thought in the Western world could be said to originate with Jeremy Bentham, an eighteenth-century philosopher and social reformer. Bentham introduced the principle of acting for the greatest good for the greatest number, which is at the heart of utilitarianism. Also known as consequentialism, utilitarianism has various forms, such as act and rule utilitarianism and preference utilitarianism. In its modern form, utilitarianism proposes that an action will be morally good if the good outcomes of the action outweigh the bad. This is irrespective of the nature of the action itself, so achieving the desired consequences is at the heart of judging the moral nature of the action. Its appeal is due to the conception of weighing up courses of action and deciding to pursue the one that results in the greatest benefits to all. However, it has its weaknesses, and these will also be considered in this chapter.

There is something appealingly intuitive about consequentialism and its offshoot, utilitarianism. Our daily lives are filled with choices, and unless we are prepared to simply act at random, in order to make the best choice we need to be able to evaluate them all. While in some cases there may be little to distinguish between choices, we normally try to choose the option that affords us most satisfaction. We choose a new car, a new phone or a new job by first working out a set of criteria that will help us to make up our minds and then by applying these to the available choices. For example, in buying a car we might compare different models on engine size, fuel economy, reliability and other relevant factors. In the end, our deliberations lead us to buy the particular car that best satisfies the set of criteria we have chosen. It would be odd if we chose a car we did not like or that we knew had major faults, such as bad brakes or poor steering. Our deliberation is directed towards weighing up our options in terms of good or optimal consequences.

Summary

Virtue ethics is one of the major normative ethical theories, and has a very long history, having its origins, among other places, in the eudemonic ethics of Aristotle. Virtue ethics begins by considering the question of what is meant by the good for human beings and answers that it is to live a life of moral virtue. For Aristotle (1976), four cardinal moral virtues were required: courage, temperance, justice and prudence. Added to these in the Christian era are the theological virtues of faith, hope and charity, which also make a distinctive contribution to ethical decision-making in the healthcare context.

Character and virtue

The beginnings of virtue ethics can be found in reflecting on the kind of healthcare practitioner by whom we would like to be treated. If we are facing delicate brain surgery to alleviate a particular condition, we would want a good brain surgeon, not a poor one. Similarly, when we are later returned to the ward after a successful operation, we would want to be looked after by a competent nurse, rather than one who is incapable of performing their duties. This is true in every area of life. No one wants their MRI scans interpreted by an incompetent physician or to be represented by an inept lawyer. The slow lane at the checkout at the supermarket, where the checkout operator is bumbling and unskilled, is also to be avoided. In all these cases – as in every situation where we rely on the skills and competencies of others – we want those providing various services not simply to have some minimal competence, but to carry out their roles or activities well.

Summary

This chapter begins with the question ‘What is ethics?’ It is not just a list of prohibitions, but rather a reflection on what we consider to be good or bad. It involves an evaluative and disciplined study of what we regard as morally good and what we see as morally bad. This is required if we are to decide how to act. Moral judgements, it will be shown in this chapter, are not simply based on what we think, but on ethical theories. There are two kinds of ethical theories: meta-ethical theories and normative ethical theories. The former are about the kinds of ways in which we can think about the nature of ethical principles and judgements, such as whether they are conventional or universal. Normative ethical theories provide a framework of moral principles that can help us decide whether or not an action is morally right.

Introduction: What is ethics?

Ethics, as it is commonly understood, is connected with various bans against wrong-doing – particularly in business or in the professions. In people’s private lives, it is seen as demanding that, as far as possible, the actions someone chooses to perform have minimal effect on others around them – in some sense, that what people do is morally right. According to such a view, ethics is a means of regulating human behaviour, and so acts as a constraint on human action. This is, in fact, a very simplistic understanding of ethics. Ethics is not about any of the following:

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1780 results in Nursing

7 - Exploring prejudice, understanding paradox and working towards new possibilities

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5 - Culture and ethnicity

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13 - Culturally safe care for ethnically and religiously diverse communities

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14 - Working with the aged

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Part 3 - Fields of practice

4 - Personhood and human dignity

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Contents

11 - Conscience and the healthcare professional

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1 - Why study healthcare ethics?

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10 - A historical analysis of feminism and an application to contemporary healthcare ethics

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Foreword

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List of contributors

Frontmatter

13 - When does human life begin? A theological, philosophical and scientific analysis

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5 - Empathy and care

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16 - Just care at the end of life

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Dedication

7 - Rationality in utilitarian thought

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6 - Healthcare and virtue

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2 - Ethical theories

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