Conflicts of Care Hospital Ethics Committees in the USA and Germany
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Helen Kohlen
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Conflicts of Care Hospital Ethics Committees in the USA and Germany
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Campus Verlag
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9783593405391
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1
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CHF 31.70
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Allgemeines
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English
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251
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Wasserzeichen/DRM
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PC/MAC/eReader/Tablet
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PDF
Ethikkomitees sind neu an deutschen Kliniken. Mit Blick auf die US-amerikanische Geschichte dieser Einrichtung beleuchtet Helen Kohlen deren Praxis und den Nutzen im medizinischen und pflegerischen Feld. Wem dienen die Beratungsgremien und wessen Stimme wird bei der Definition ethischer Konflikte gehört? Sie erkennt, dass die Logik und Sprache des Managements zunehmend die klinische Ethik prägt und dass fürsorgliche Praxis im Klinikalltag keine Selbstverständlichkeit mehr ist. Nachwuchspreis des Instituts für Mensch, Ethik und Wissenschaft (IMEW)
Helen Kohlen, Dr. phil., ist Juniorprofessorin für Care Policy und Gemeindenahe Pflege an der Hochschule Vallendar.
3 Concerns of Care, Conflicts and Nurses' Participation in Hospital Ethics Committees The complexity of the health care system makes it difficult to locate the problems and concerns experienced by nurses. One way of sorting it out is as suggested above, to divide the places of action and decision-making into three levels. Described by an inside-out perspective there can be understood: First, the individual level; second, the institutional level, and third, the societal-political level. While conscientious objection is the resource to take a stand on the individual level, raising one's voice in public debates and going on strike marks taking a stand on the societal-political level. Besides joining the works council, participation in Hospital Ethics Committees offers a way to take a stand on the institutional level. One would expect that taking a stand on caring concerns and conflicts falls into the realm of nurses since they represent the biggest group to be involved in care practices. But, as this chapter will focus on: Empirical studies will reveal different findings. Concerns of Care in Hospital Nursing Practice Concerns of care in nursing practice are not uniquely a North American or German phenomena. Nurses in countries with distinctly different health care systems like England and Scotland, report similar shortcomings in their work environments and the quality of hospital care. A study in 2001 of more than 43,000 nurses practicing in more than 700 hospitals in five countries indicates that fundamental problems in the design of work are widespread in hospitals in Europe and North America (Aiken, Clarke, Sloane et al. 2001). Several studies have shown: while discontent among hospital nurses is high, a vast majority believes that the competence of and relation between nurses and physicians is satisfactory. In North America and Germany, nurses reported spending time performing functions that did not call upon their professional training (delivering and retrieving food trays or transporting patients), while care practices requiring their skills and expertise (oral hygiene, skin care) were left undone (Aiken, Clarke, Sloane et al. 2001). Nevertheless, the problems of hospital nursing do not represent the entire profession. Tasks and settings vary widely. Everyday Nursing Concerns and Invisibilities The dominant concerns found in stories and narratives of everyday nursing practice are the ones of caring, responsiveness to the other, and responsibility (Benner, Tanner, Chesla 1996). Since responsiveness and responsibility can be described as elements of a caring practice (see Tronto in Relational Analysis, chapter two), it is the caring practice itself to be the issue of concern. What else has been found about nursing conflicts and concerns? When the nurse scientist, and director of the Kennedy Institute Carol Taylor (1997) interviewed nurses to get to know their ethical concerns, she had to realize that most of the nurses felt hard-pressed to describe the nature of these everyday nursing concerns that had ethical significance. She states '[...] while some everyday nursing concerns are unique to nursing, most derive from tensions that involve the interdisciplinary team and raise broader issues about the human well-being that are best addressed by the institution or health care system at large' (1997: 69). In order to reveal their concerns, she then analyzed her collected case studies that lead nurses to request ethical consultation. She identified that nurses mostly struggle for (1) the respect for human dignity, (2) a commitment to holistic care, (3) a commitment to individualized care which is responsive to unique needs of the patient, and (4) the responsibility for a continuity of care and the scope of authority, and (5) identifying the limits of care-giving (Taylor 1997: 69-82). Taylor dissses that none of the concerns are unique to nursing although they may be experienced with greater immediacy and urgency by nurses as well as other care givers. She also observed that more nurses described their moral orientation as care-based rather than justice-based (Holly 1986). The US-American nurse researcher, Joan Liaschenko (1993a) and the Canadian nurse researcher Patricia Rodney (1997) have specifically investigated into concerns of practicing nurses. In an ethnographic study of nurses practicing on two acute medical units, Rodney has explored the situational constraints that made it difficult for nurses to uphold their professional standards. Other research (Varcoe et al. 2004) supports her findings of experienced serious structural and interpersonal constraints, e.g. excessive workloads for nurses, the absence of interdisciplinary team rounds, conflicts between team members inside and outside nursing, and conflicts with patients and family members. Rodney gives examples of interviews with nurses where they described their attempt to provide nursing care for the elderly and critically ill patients as a race against the clock (Rodney 1997). She explains that the inability of nurses to arrange space to talk with patients, constrains their ability to truly focus and being attentive to the authentic needs of the patients and families. In a further study with her colleagues (Storch et al. 2002), in addition to a lack of time, an
Contents
6
Acknowledgement
10
Introduction
12
State of the Art, Theoretical Framework and Methodological Considerations
22
1 State of the Art in Social Science Research
24
2 Theoretical Framework and Research Design
28
3 Method and Sources of Information
32
Historical Analysis Bioethics and Hospital Ethics Committees
36
1 US-American Bioethics and the Move into the Practical Arena
38
2 Traces and Beginnings of Consultation by Committees
54
3 The Development of Contemporary Hospital Ethics Committees
70
4 Summary
96
Relational Analysis Care and Hospital Ethics Committees
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1 The Care Ethics Debate and Nursing since 1980
102
2 Feminist and Nursing Studies in Care Ethics since 1990
116
3 Concerns of Care, Conflicts and Nurses’ Participation in Hospital Ethics Committees
136
4 Summary
162
Practical Arena Analysis Practices in Hospital Ethics Committees in Germany
164
1 Introduction of the Field Research
166
2 Analysis of the Field Data
178
3 Summary
220
Résumé
226
List of Abbreviations
232
References
234
