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PubMedDate not supplied

Autonomy and clinical practice. 1: Identifying areas of concern.

This article, the first of three parts, presents an analysis of the use of the concept of autonomy in the nursing and healthcare ethics literature in the UK. It commences by considering some definitions of autonomy as they appear in the literature. Some of the confusions with the use of autonomy in the nursing literature are also identified and discussed, e.g. the frequent lack of clarity regarding how closely the concept is tied to notions of freedom. In addition, it also examines the lack of any indications in the nursing literature and that when one is considering the notion of autonomy it is also useful to consider the idea of constraining factors. In the nursing literature, discussions of autonomy largely appear to centre around the power imbalance between nurses and doctors. Issues of patient autonomy thus appear to be often of only secondary concern.

Ethics, Nursing↗
PubMed2002

Trust in medicine.

Trust relations in medicine are argued to be a requisite response to the special vulnerability of persons as patients. Even so, the problem of motivating trust remains a vital concern. On this score, it is argued that a strong motivation can be found in recognizing that professional self-interest actually entails cultivation of patient trust as a means to maintain professional self-governance. And while the initial move to restore trust must be provoked from such narrow concerns, the process of sustaining trust will require educational initiatives aimed at restoring attitudes and skills suggestive of Percival's concept of empathic care. By including such initiatives, future waves of medical professionals are apt to sustain trust with deepened commitments to character, care, and trust as constitutive properties of their professional mission.

Attitude of Health Personnel↗
PubMedDate not supplied

Influence of practice environment and nurse characteristics on perinatal nurses' responses to ethical dilemmas.

BACKGROUND: Previous research on nurses' responses to ethical dilemmas has focused either on nurse characteristics or on practice environment characteristics, but has not examined both influences concurrently. OBJECTIVE: To explore the relative contributions of practice environment characteristics and nurse personal and professional characteristics to perinatal nurses' willingness to be involved in activities to resolve clinical ethical dilemmas. METHODS: A descriptive correlational design and hierarchical multiple regression were used to examine responses of 127 perinatal nurses to three instruments: the Nursing Ethical Involvement Scales (NEIS), Perinatal Values Questionnaire (PVQ), and Demographic Data Sheet (DDS). RESULTS: The organizational variable, nursing influence, accounted for the greatest amount of variance in nurses' reported resolution actions, with nurses' concern about ethics and consequentialist values also contributing significantly. The three predictors together accounted for 31% (24% adjusted) of the variance in actions to resolve clinical ethical dilemmas. Level of nursing education was not a statistically significant influence. CONCLUSIONS: These results suggest that nurses are more likely to be involved in dilemma resolution activities when they perceive themselves to have higher levels of influence in their practice environments and higher levels of concern about the ethical aspects of clinical situations. Nurses who emphasize consideration of morally relevant aspects of individual patient situations (consequentialist value orientation) and deemphasize adherence to abstract standards, rules, and policies also are more likely to be involved in dilemma resolution.

Adult↗
PubMed1993

The nurse under physician authority.

A medical centre is an institution established for a specific purpose: to facilitate the health and health-related welfare of the medical centre's patients. Within this institution, there are a variety of professionals who act and interact to serve this purpose. Of particular interest is the interaction between physician and nurse. Generally, the nurse is thought to be under a certain obligation to implement a physician's orders unless there is good reason not to do so. This qualifier places a conflicting obligation upon the nurse not to implement some physician orders. How should a judgement about which orders there is 'good reason' not to implement be made? I propose to approach this question through an analysis of the obligation the nurse has to implement the order of a physician, and the conditions under which the order does not pose such obligations. This analysis will consist of an examination of the obligation in terms of the purposive authority of the physician. For example, in the context of the medical centre, the physician's medical training qualifies her as best able to make determinations of what treatment would promote the patient's health. However, this purpose not only serves as the basis of the physician's authority, but also serves as a limitation upon the physician's authority (for example, an order which would harm the patient would not reflect the purpose for which the physician has been given authority). Thus, a philosophical investigation into the nature of the obligation to implement a physician's orders can help to clarify those occasions when a nurse should not implement an order.

Ethics, Nursing↗
PubMed2002

How should physicians approach a hunger strike?

In the last year many prisoners and their supporters in Turkey have gone on hunger strike. This paper from a Turkish physician and ethicist discusses problems faced by physicians. It is followed by a background note on the situation in Turkey and, more generally, on medical responses to hunger strikers.

Coercion↗
PubMed2000

The legal significance of clinical guidelines in The Netherlands.

In The Netherlands the use of clinical guidelines has increased rapidly. To a growing extent, judges also refer to them. Although they are not regarded as legal rules, clinical guidelines do play various roles in judicial decision making. In attaching importance to clinical guidelines, judges sometimes speak about the qualities they look for. Scientific credibility, the prestige of the developing organisation, the way they come about, positiveness, clarity, carefulness and cognizability are mentioned. However, the importance attached to clinical guidelines by the courts does not endanger clinical autonomy. Except for one very instructive incident, Dutch judges have shown respect for clinical autonomy.

Decision Making↗
PubMed1999

Resurrecting autonomy during resuscitation--the concept of professional substituted judgment.

The urgency of the resuscitation and the impaired ability of the patient to make a reasonable autonomous decision both conspire against adequate consideration of the principles of medical ethics. Informed consent is usually not possible for these reasons and this leads many to consider that consent is not required for resuscitation, because resuscitation brings benefit and prevents harm and because the patient is not in a position to give or withhold consent. However, consent for resuscitation is required and the common models employed for this purpose are presumed consent or consent from a patient proxy. However, if we are to honour the principles of respect for patient autonomy, as well as beneficence and non-maleficence, when starting and continuing resuscitation we must try and achieve the best balance between benefit and harm from the patient's perspective. The concept of professional substituted judgment involves the resuscitators gathering as much information about the patient as they possibly can, including any previously expressed attitudes towards such a situation, and combining this with their acquired professional knowledge of the likely benefits and harms of the resuscitation endeavour and then exercising their moral imagination, imagining themselves as the patient, and asking "would I want this treatment?" By employing professional substituted judgment resuscitators should recognise when the balance of benefit and harm becomes unfavourable from the patient's perspective and at this point they have a moral obligation to withdraw resuscitation as they can no longer presume the patient's consent. In this way the principles of beneficence, non-maleficence and respect for patient autonomy are more favourably balanced than under other resuscitation decision making processes.

Ethics, Medical↗
PubMed1997

Critical care nurses, ethical decision-making and stress.

Considerable attention has focused on describing ethical issues that critical care nurses face in their practice: however, less attention has been directed at describing the process of ethical decision-making. Systematic research linking aspects of ethical-decision making and stress is lacking. This cross-sectional study examines the relationship between selected aspects of ethical decision-making, stress and selected nurse characteristics. Sixty-one critical care nurses completed the Nurse's Ethical Decision Making--ICU Questionnaire and the Health Professions Stress Inventory. Findings revealed that nurses who selected the patient advocacy model had significantly higher nurse autonomy scores, that perceived anxiety had a negative association with nurse autonomy, and that workplace restrictions and stress were related.

Adult↗