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PubMed2001

Technology and humane nursing care: (ir)reconcilable or invented difference?

UNLABELLED: AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing. BACKGROUND/RATIONALE: Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society. CONCLUSION: The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice.

Conflict, Psychological↗
PubMed2000

Decision analysis in evidence-based decision making.

Many real world decisions have to be made on a limited evidence base, and clinical decisions are at best problematic. We explored some of the reasons why decision making in health care is so complex, and examined how decision analytic techniques might contribute to problem structuring and to implementation of evidence-based practice. We argued that decision analysis could, to some extent, overcome complexity of decision making by a clear structuring of the problem and a formal analysis of the implications of different decisions. Decision-analytic techniques can guide the management of individual patients or can be used to address policy questions about the use of treatment for groups of patients. However, decision analysis is not without its criticisms, e.g. problems are narrowly defined, replacing judgement and dehumanizing care, neglect of process utility and lack of primary data to develop decision analytic models. The development of evidence-based guidelines is a key component of the UK Government's quality strategy led by the National Institute for Clinical Excellence (NICE). However, the guidelines approach may lead to conflict when assessments of the effectiveness of interventions for individuals (whether or not supported by a formal decision analysis) conflict with the recommendations made by NICE for cost and clinical effectiveness for aggregate groups of patients. Decision analysis may or may not help with this but if guidelines are derived from a decision analysis, then the implications of patient preferences should be made clearer. However, decision analysis-derived guidelines will make general recommendations that may not be appropriate for all individuals. Nonetheless, decision analysis does make such implications explicit and propose that the guidelines should be supported by some mechanism for determining individual patient preferences. It will now need to consider whether some of NICE resources should be directed beyond evidence-based guidelines into decision analysis-derived guidelines and into decision analytical techniques to provide support for clinical and cost effective decision making within the patient-clinician encounter.

Decision Making↗
PubMed2002

Formal observations and engagement: a discussion paper.

Formal observation of patients at risk is extremely common in acute psychiatric facilities. Effectively a form of physical containment, observation is resource-intensive, makes significant personal demands upon staff and skews the focus of nursing care towards the small group of patients judged to be most at risk. For patients, the experience of being observed is often less than therapeutic and, in some cases, counter productive. In this paper, the authors draw upon a variety of perspectives, including that of a psychiatrist and a service user. It is argued that the practice of formal observation is ineffective and may actually contribute to the poor state of UK acute psychiatric inpatient units, in terms of direct patient care, clinical decision-making and appropriate risk management. In a recent 'commentary' within this journal, the authors offered 'engagement' as an alternative to observation. In this paper, the meaning of engagement is refined and presented as a process of emotional and psychological containment of distress. The paper concludes that inappropriate over-use of formal observation as a custodial and defensive practice can contribute to a sense of dehumanization and isolation within acute psychiatric patients; engagement may provide a genuine (i.e. not just linguistic) alternative.

Coercion↗
PubMed2002

Visualising the body in art and medicine: a visual art course for medical students at King's College Hospital in 1999.

For many centuries science and art have been studied as completely separate disciplines, and career paths likewise, have diverged. However, in recent years there has been a renewed cultural interest in art/science collaborations, coupled with the perception that a medical education which did not embrace the humanities 'tended to brutalize and dehumanize' (Weatherall, British Medical Journal 309 (1994) 1671-1672) future doctors. It was against this background of the growth of multi-disciplinary collaborative projects and a dissatisfaction with an 'incomplete' medical education, that an opportunity arose for a visual arts course to be set up at a London teaching hospital in 1999. The following dialogue sets out to explore the difficulties, the great joys and the emotions generated by a 'Special Study Module' created by both artists and clinicians.

Attitude of Health Personnel↗
PubMed2000

Body parts and the market place: insights from Thomistic philosophy.

With rare exceptions, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often oversimplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas' (1224-1274) understandings of embodiment and moral uses of the body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas' principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas' texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God's dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation.

Altruism↗
PubMed2006

Mind styles and the hypnotic induction profile: measure and match to enhance medical treatment.

Modern medical technology and economic impositions tend to dehumanize the medical patient. This paper describes a targeted use of the hypnotic modality for relationship building, symptom management, and restoring a sense of self to the patient. To humanize medical care one patient at a time, examples are given for the use of the Hypnotic Induction Profile, the Eye Roll sign and AOD (Apollonian-Odyssean-Dionysian) Mind-Style Questionnaire as a basis for choosing bio-psycho-social treatment strategies. This trio of assessments can be used together, in approximately 10 to 15 minutes, or separately, if treatment decisions need to be made in a few minutes or less. The hypothesis presented is that matching treatment strategies, with or without formal hypnosis, to hypnotic capacity and mind style can increase respectful care and efficacy of treatment outcome. Clinical examples will illustrate this approach to enhance recovery, morale, and maximize patients' ability to become active partners on their own behalf.

Adult↗
PubMed1988

The ethics of pornography in the era of AIDS.

Since the inception of sexology as an academic discipline a century ago, the boundary between sexology, the science, and sexosophy, the philosophy of sex, has been poorly demarcated, especially with respect to the principles of sex-reform movements. Several early 20th centruy sexologists overtly espoused the principles of eugenics reform, which, in the 1930s, Hitler used against them. A large proportion of today's sex therapists, researchers, and educators are among "those who cannot remember the past" and are, therefore, according to Santayana, "condemned to repeat it." That is to say, they follow the example of eugenics reformers by adhering to explanatory principles as if they were apolictically indisputable; whereas, they are, in fact, dangerously political professional platitudes for the criminalization of sex. One such platitude is that pornography is dehumanizing and a socially contagious criminal offense. Social-contagion theory had its origin in Tissot's 18th century revival of semen-conservation theory. In America, Tissot's antisexual health-reform ideas were transmitted by Graham to Kellogg and Comstock. The Comstock Laws of 1873 are still extant and are the basis of contemporary judicial, academic, and public misconceptions regarding the social contagiousness of pornography. These misconceptions render the nation incapable of using pornography constructively in a program of sex-safety to prevent AIDS infection, especially among newly pubertal adolescents and young adults. The model to follow has already been provided by gay JACK and JO masturbation clubs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A diminishing of self: women's experiences of unwanted sexual attention.

The health effects of everyday occurrences of unwanted sexual attention (such as looks, whistles, and comments) were explored in semistructured interviews with 8 women in Seattle, WA. Participants described the strategies they used for avoiding and dealing with unwanted sexual attention, as well as the effects the attention had on their health and sense of self. Grounded theory techniques were used to code the data and identify themes. The women in this study were affected both physically and emotionally by their experiences and their perceived ineffectiveness in dealing with them. On a phenomenological level, these experiences contributed to a "diminishing of self," which included feeling dehumanized and lacking agency. This project begins to describe the complexities of this seemingly simple everyday occurrence and relates the experience to social science and psychological theory.

Adaptation, Psychological↗
PubMed1990

Death and the health professional: organization and defense in health care.

Organizational and technological developments within the health care system have helped consolidate a power structure that dehumanizes clients and fosters defensiveness in professionals. Frequent exposure to death renders health professionals vulnerable to severe anxiety, which they may try to avoid through death denial, leaving them psychologically unable to support dying clients. Professional education, attitudes equating death with professional failure, organizational coping strategies among nurses, and staff burnout interact to perpetuate this atmosphere. As a model for learning, this article analyzes a pediatric case study to illuminate the manifestations of professional defensiveness. Finally, I consider three specific problem-solving strategies: improving morale, opening communication, and expanding professional education to include death studies and psychological study of the health organization. Bringing humanity back into the health care environment is possible to the extent that both the organization and its members are responsive and open to change.

Attitude of Health Personnel↗
PubMed2001

Comments on complementary and alternative medicine in Europe.

Despite the advances in Western medicine, up to one in three people in populations served by this medical system are seeking some form of unorthodox care each year, and Europe is no exception. Patients have driven this change, to the point where complementary and alternative medicine (CAM) is the second biggest growth industry in Europe. Often patients have to rely on the growing numbers of CAM practitioners with a variable standard of care that ranges from excellent to dangerous. Many practitioners work without regulation or even work illegally. Many orthodox health care professionals have shared their patients' concerns. Over the last 15 years, these practitioners have moved from silent interest to open enquiry and growing use. For example, approximately one in five of Scotland's general practitioners have received basic training in integrating homeopathy with orthodox practice. The demand for CAM is in part a search for a broader range of therapies, but is also a call for a different approach to care, with less emphasis on drugs, and a more whole-person approach. Mostly, people look to CAM when orthodoxy has failed. But CAM is also increasingly becoming a first-line intervention for some, because of the worry about the side effects of conventional treatments and a perception that orthodoxy has become dehumanized. With some exceptions, research is still in its early stages and lacks infrastructure. Patient satisfaction, empirical clinical outcome, and cost are beginning to be emphasized over mechanism of action or explanatory models. Recent official reports are calling for national and European-level enquiry and response. Future development is likely to emphasize integrative care. The challenge is to create better medical systems, with a whole-person emphasis, calling on a broader range of approaches than is currently orthodox. We seem to need a reunion of the art and science of medicine.

Attitude of Health Personnel↗
PubMed1999

Observing the process of care: a stroke unit, elderly care unit and general medical ward compared.

BACKGROUND AND PURPOSE: Patients on stroke units have better outcomes but it is not known why. We investigated the process of care on a stroke unit, an elderly care unit and a general medical ward. METHODS: Comparison of the three settings was by non-participant observation of 12 patients in each. Data were analysed using multi-level modelling methods. RESULTS: Stroke unit patients spent more time out of bed and out of their bay or room, and had more opportunities for independence than patients on the medical ward. There were more observed attempts on the stroke unit than on the general medical ward to interact with drowsy, cognitively- or speech-impaired patients. Stroke unit patients spent more time with visitors. Most of these aspects of care were also found on the elderly care unit, where patients also spent less time asleep or 'disengaged', more time interacting with nurses, and were given appropriate help more often than those elsewhere. Stroke unit patients received less eye contact, were ignored and treated in a dehumanizing way more frequently and had more negative interactions or activities than those elsewhere. CONCLUSIONS: We have identified some aspects of the process of care which may help explain the improved outcomes on stroke units. These aspects were also observed in the elderly care unit.

Adult↗
PubMed2004

Imprints on the consciousness: the impact on Palestinian civilians of the Israeli Army invasion of West Bank towns.

BACKGROUND: The dehumanizing aspects of conflict and war are increasingly recognized as serious health and human rights concerns. This paper examines the impact on civilians of the 29 March 2002 Israeli Army invasion and subsequent curfews lasting up to 45 consecutive days, of five West Bank towns. METHODS: Using focus groups, a 10-item scale was devised to measure the effects of the invasion's impact on the social and health-related quality of life. The scale is an aggregate of three constructs measuring housing, financial, and health-related issues. A survey composed of demographic questions and the 10-item social/health scale was administered to a stratified random sample of inhabitants of the five towns. RESULTS: the invasion caused extensive destruction, food and cash shortages, internal displacement of civilians, psychological distress, and serious interruptions of basic services, including crucial health services. Overall, Jenin experienced the most deleterious effects. Using the subscales, Jenin experienced the highest overall housing damage, Bethlehem the most financial difficulties, and Ramallah the most health-related hardships. CONCLUSIONS: civilians inevitably suffer during conflict and war from destruction of the community infrastructure and from personal stress due to disruption of services and the non-fulfilment of basic human needs. In contradistinction to standard damage assessments that focus on collective physical damage, this scale provides richer information on the needs of civilians in conflict-torn areas, and can assist aid workers in the efficient deployment of resources.

Adult↗
PubMed1998

Age differences in attitudes toward computers.

It is commonly believed that older adults hold more negative attitudes toward computer technology than younger people. This study examined age differences in attitudes toward computers as a function of experience with computers and computer task characteristics. A sample of 384 community-dwelling adults ranging in age from 20 to 75 years performed one of three real-world computer tasks (data entry, database inquiry, accounts balancing) for a 3-day period. A multidimensional computer attitude scale was used to assess attitudes toward computers pretask and posttask. Although there were no age differences in overall attitudes, there were age effects for the dimensions of comfort, efficacy, dehumanization, and control. In general, older people perceived less comfort, efficacy, and control over computers than did the other participants. The results also indicated that experience with computers resulted in more positive attitudes for all participants across most attitude dimensions. These effects were moderated by task and gender. Overall, the findings indicated that computer attitudes are modifiable for people of all age groups. However, the nature of computer experience has an impact on attitude change.

Adult↗
PubMed1980

Humanizing the hospital experience: report of a group program for medical patients.

Patients in a medical hospital are often subjected to a dehumanizing, alienation atmosphere. The use of small groups can counteract this atmosphere by increasing communication between patients and staff, helping to educate patients about their conditions, enhancing patients' coping methods, and fostering a sense of family or community.

Adolescent↗
PubMed1997

Homeless veterans: perspectives on social services use.

This study analyzes the nature and scope of homelessness and issues related to social services use. Using focus group interviews, this exploratory study examined the expressed needs of homeless veterans and the obstacles encountered in obtaining health and human services. Types of problems and social services barriers were developed with exemplars from the interviews. These veterans self-reported a high incidence of health and mental health problems, limited resources, negative public perceptions and treatment, insensitive service providers, dehumanizing policies and procedures, and high levels of stress and frustration with the service delivery system. They encountered personal, situational, and bureaucratic barriers to obtaining services and were highly critical of service providers. These findings suggest a need for greater emphasis on advocacy-based case management services, affordable housing, employment opportunities, increased sensitivity in service delivery systems, and empowerment-centered practice.

Adult↗
PubMed1991

The uses and value of autopsy in medical education as seen by pathology educators.

A national meeting of pathology educators in 1989 provided the impetus for an exploration of new uses of autopsy in medical education. A month before the conference, the authors sent a questionnaire about the uses and value of autopsy in medical education to 120 persons registered to attend the conference. They used the 98 responses, representing 69 U.S. and Canadian medical schools, as the basis of a workshop on the place of autopsy in future medical education. The present article is a report of the authors' findings from the questionnaire and workshop. They found that the uses of autopsy go far beyond the traditional uses in teaching clinical pathophysiology, clinico-pathologic correlations, clinical anatomy, gross and microscopic anatomy of disease, and visual skills. Emphasis was placed on the potential role of autopsy in education regarding legal/judicial proceedings, vital statistics, epidemiologic investigations, and public health, and in the understanding of such complex matters as medical fallibility, medical uncertainty, and grief. These purposes were seen as congruent with current societal concerns about the need to reverse the trend toward dehumanization of medicine and physicians. The inability to realize these aims in the face of a precipitous drop in the autopsy rate is discussed.

Autopsy↗
PubMed1996

Navigating the wards: teaching medical students to use their moral compasses.

The upsurge in formal medical ethics training stems from the desire for more compassionate, less "dehumanized" physicians who can competently face the ethical dilemmas posed by technologic advances and resource constraints. How best to encourage ethical thinking and behavior among medical students remains an open question. However, the authors argue that medical ethics education suffers from an overreliance on strategies that target ethical thinking, with relative inattention to students as ethical actors in specific clinical contexts. In order to produce ethically competent physicians, medical educators must not only teach students to understand and learn from the dilemmas that shape their moral world but also train them to respond to those dilemmas appropriately. The authors discuss current practices in ethics education and how traditional approaches may not equip students with the types of moral "navigating skills" they need to become ethical physicians. They illustrate how medical students can and do learn norms of ethical behavior on the wards and argue why medical education ought to focus more explicitly on this aspect of clinical training. They conclude by recommending ways medical educators can encourage ethical thinking and behavior throughout the entire course of medical training.

Clinical Clerkship↗
PubMed1996

Characteristics of the informal curriculum and trainees' ethical choices.

In October 1995, the Association of American Medical Colleges held its first Conference on Students' and Residents' Ethical and Professional Development. In a plenary session and break-out sessions, the 150 participants, representing a wide variety of medical and professional specialties and roles, discussed the factors and programs that affect medical trainees' development of ethical and professional standards of behavior. The main challenge of addressing students' professional development is the enormous range of influences on that development, many of which, such as the declines in civic responsibility and good manners throughout the United States, fall outside the scope of academic medicine. Nonetheless, many influences fall within reach of medical educators. In a pre-conference survey, participants ranked eight issues related to graduating ethical physicians. The respondents ranked highest the inadequacy of the understanding of how best to influence students' ethical development, followed by faculty use of dehumanizing coping mechanisms, and the "business" of medicine's taking precedence over academic goals. The plenary speakers discussed the "informal curriculum" and the "hidden curriculum" and the need for medical faculty to take seriously the great influence they have on students' and residents' moral and professional development as they become physicians. Whether consciously or not, medical education programs are producing physicians who do not meet the ethical standards the profession has traditionally expected its members to meet. In three series of break-out sessions, the participants analyzed the nature of the ethical dilemmas that medical students and residents face from virtually the first day of their training, the use of role playing in promoting ethical development, and ways to improve policies and overcome barriers to change.

Clinical Clerkship↗