PubMed · 876849
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J Clark. 1977-05-12. Authority patterns in nursing management structures.. https://pubmed.ncbi.nlm.nih.gov/876849/
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AIMS: This paper provides a critique of how Heron's six-category intervention analysis framework has been adopted by nursing in the United Kingdom (UK) as a theoretical framework in nursing research and model for clinical supervision. From this, its merits as an analytic framework and model for clinical supervision in nursing are discussed. BACKGROUND: Heron's six-category intervention analysis has been acknowledged as a means by which nursing could develop its therapeutic integrity. It has also been used as a theoretical framework in nursing research focusing on nurses' perceptions of their interpersonal style. More recently descriptions of this framework have been proposed as a structure for clinical supervision. However, its use as a theoretical framework to underpin research investigating the interpersonal skills of nurses and as a model of clinical supervision must firstly be scrutinized. FINDINGS: Returning to Heron's original description and comparing this with its current adoption in the UK, misconceptions of this framework can be identified. Its value as an analytic tool investigating interpersonal relations in nursing has still to be evaluated. Furthermore, nursing's emphasis on certain intervention categories has undermined the potential potency of this framework and its contribution as a model for clinical supervision in nursing. CONCLUSION: We argue that Heron's six-category intervention analysis as a framework to investigate the interpersonal competence of nurses, particularly mental health nurses, requires investigation. This, in turn, would provide an opportunity to challenge the framework's theoretical standpoint. In addition to its value as an analytic tool, all six categories of Heron's framework have equal relevance to its contribution in nursing as a supervision model.
Mental health nursing occurs within a legal and ethical framework that presents conflicts between a paternalistic custodial role and an ethical commitment to autonomy. This paper considers the ethical conflict for nurses posed by acting as second health professional at judicial reviews under Section 16 of the Mental Health (Compulsory Treatment and Assessment) Act. Issues of advocacy and paternalism are discussed in light of the conflict between therapeutic and legislated roles. Strategies aimed at protecting the therapeutic relationship are outlined as a response to the current lack of guidelines in this area. Participation in legal processes of committal requires that nurses reflect carefully and critically on the ethical issues raised.
Several decision-making models have been advanced to characterize the patient-physician relationship. These include the parental model, the informed decision-making model, the interpretive model, and the deliberative model. Although these models are useful to consider in reflecting on the care we give to critically ill patients at the end of life, they require adaptation to the intensive care unit (ICU). Many clinicians adapt their approach to each individual patient and change their approach to the same patient over time. Moreover, instead of the dyadic model of one patient and one physician, multiple voices often speak for the patient and a team of clinicians care for the ICU patient. Analysis of human relationships and communication with critically ill patients and their families require transdisciplinary, multicultural, and multidisciplinary interpretation.