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Hillestad AH, Petersen EK, Roos MC, Iversen MH, Jansen TL, Kvande ME. Judith Butler's theoretical perspectives within a nursing context-a scoping review. Nurs Ethics 2024:9697330241257569. [PMID: 38840300 DOI: 10.1177/09697330241257569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Philosopher Judith Butler has influenced how people talk about vulnerable bodies and sees vulnerability as universal, existential, and relational. Being vulnerable is part of the human condition. The main theoretical areas that run across Butler's work; power, knowledge and subjectivity, performativity, and ethics-are of particular relevance to nursing practice. This review aims to explore how Butler's theoretical work is reflected in research literature within a nursing context. We conducted a scoping review guided by Arksey and O'Malley's methodological framework. A systematic literature search of CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science identified 15 papers. Butler's theoretical work was applied at an individual and social level in research literature within a nursing context. Nurses need to reflect on their clinical practice and role as health professionals in relation to power and performativity in encounters with patients who are marginalized. Nurses' working conditions, recognition, and understanding are strongly influenced by society, and calling nurses heroes undermines their capacity to challenge and resist the hero identity. The healthcare system's impact on patient-nurse encounters challenges patients' and nurses' subjectivity, performativity, and power relations. The review allowed us to describe how Butler's theoretical work can facilitate a reflection on nursing practice which is a prerequisite for caring, ethical relationships, and working conditions within a nursing context. Butler's concepts can provide useful perspectives on how nurses understand, communicate with, and care for patients, as well as a nuanced understanding of the nursing role and power relations and structures.
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Rattner M, Cait CA. Nonphysical Suffering: An Under-Resourced and Key Role for Hospice and Palliative Care Social Workers. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:8-25. [PMID: 37948164 DOI: 10.1080/15524256.2023.2272590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This article highlights recent research findings that have significance for hospice and palliative care social work in Canada, and for the field of hospice and palliative care more broadly. A 2020 discourse analysis study examined the experiences of 24 interdisciplinary palliative care clinicians across Canada in their work with patients' nonphysical suffering. Nonphysical suffering is suffering that may be emotional, psychological, social, spiritual and/or existential in nature. The study found an absence of specialist social workers on hospice and palliative care teams or limited time for specialist social workers to address patients' nonphysical suffering due to high caseloads and complex practical needs. While the study recognizes social workers have expertise in supporting patients' nonphysical suffering, a competency and skill that has not been sufficiently captured in the existing literature, the systemic barriers they face in providing care may leave patients' needs unmet. The study also highlights the unique pressure social workers may feel to relieve patients' nonphysical suffering due to the psychosocial focus of their role. The need for specialist social workers to be included and adequately resourced on hospice and palliative care teams across diverse settings in Canada is evident.
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Affiliation(s)
- Maxxine Rattner
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Cheryl-Anne Cait
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
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Khorram-Manesh A, Gray L, Goniewicz K, Cocco A, Ranse J, Phattharapornjaroen P, Achour N, Sørensen J, Peyravi M, Hertelendy AJ, Kupietz K, Bergholtz J, Carlström E. Care in emergencies and disasters: Can it be person-centered? PATIENT EDUCATION AND COUNSELING 2024; 118:108046. [PMID: 37924742 DOI: 10.1016/j.pec.2023.108046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES While person-/patient-centered care aims to influence policymakers' rules and regulations to improve the care of individuals worldwide, exploration of the concept in the context of disaster and public health emergencies as an alternative ethical approach is lacking. This study aims to provide a nuanced understanding of the advantages and challenges of diverse ethical approaches in emergencies, to improve patient care. METHODS A survey, created after several rounds of Delphi methodology, with 22 statements, was applied to 39 participants from nine different countries. The questionnaire's results, including participants' comments, were analyzed. RESULTS The results show that practitioners chose to use a combination of diverse ethical approaches in managing victims of disasters and public health emergencies. CONCLUSION The selection of an approach is context- and situation-dependent and seems to primarily respond to the nature of underlying etiology, creating a possibility to use diverse approaches to offer individualized care on a later occasion and when a flexible surge capacity is available. PRACTICE IMPLICATIONS The outcomes of this study will enhance the future ethical discussion in person/patient-centered care during situations with limited resources and help to develop necessary ethical and educational guidelines.
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Affiliation(s)
- Amir Khorram-Manesh
- Centre for Person-centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Disaster Medicine Center, Gothenburg University, 405 30 Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden.
| | - Lesley Gray
- Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand; Joint Centre for Disaster Research, Massey University, Wellington, New Zealand
| | | | - Annelise Cocco
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Griffith University, Gold Coast, QLD 4215, Australia; Menzies Health Institute, Griffith University, Gold Coast, QLD 4215, Australia
| | - Phatthranit Phattharapornjaroen
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden; Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Nebil Achour
- School of Allied Health, Anglia Ruskin University, East Road, Cambridge CB1 1PT, United Kingdom
| | - Jarle Sørensen
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA; Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Kevin Kupietz
- Department of Aviation and Emergency Management, Elizabeth City State University, Elizabeth, NC, USA
| | - Jana Bergholtz
- Centre for Person-centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Disaster Medicine Center, Gothenburg University, 405 30 Gothenburg, Sweden; European Cavernoma Alliance, Rare Diseases Sweden, P.O. Box 1386, 17227 Sundbyberg, Sweden
| | - Eric Carlström
- Centre for Person-centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Disaster Medicine Center, Gothenburg University, 405 30 Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden; USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
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Damps M, Gajda M, Kowalska M, Kucewicz-Czech E. Limitation of Futile Therapy in the Opinion of Nursing Staff Employed in Polish Hospitals-Results of a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16975. [PMID: 36554855 PMCID: PMC9778965 DOI: 10.3390/ijerph192416975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The debate on limiting futile therapy in the aspect of End of Life (EoL) care has been going on in Poland over the last decade. The growing demand for EoL care resulting from the aging of societies corresponds to the expectation of a satisfactory quality of life and self-determination. The authors designed a cross-sectional study using a newly designed questionnaire to assess the opinions of 190 nurses employed in intensive care units (ICUs) on futile therapy, practices, and the respondents' approach to the issue. The problem of futile therapy and its clinical implications are known to the nursing community. Among the most common reasons for undertaking futile therapy in adult patients, the respondents declared fear of legal liability for not taking such actions (71.58%), as well as fear of being accused of unethical conduct (56.32%), and fear of talking to the patient/patient's family and their reaction (43.16%). In the case of adult patients, the respondents believed that discontinuation of futile therapy should be decided by the patient (84.21%), followed by a doctor (64.21%). As for paediatric patients, two-thirds of the respondents mentioned a doctor and a court (64.74% and 64.21%, respectively). Overall, 65.26% of the respondents believe and agree that the comfort of the patient's last days is more important than the persistent continuation of therapy and prolonging life at all costs. The presented results clearly show the attitude of the respondents who defend the patient's dignity and autonomy.
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Affiliation(s)
- Maria Damps
- Department of Anaesthesiology and Intensive Care, Upper Silesian Child Health Centre, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 16, 40-752 Katowice, Poland
| | - Maksymilian Gajda
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Malgorzata Kowalska
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Ewa Kucewicz-Czech
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life. Palliat Med 2022; 36:1522-1531. [PMID: 36267044 PMCID: PMC9749007 DOI: 10.1177/02692163221127168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community. AIM To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration. DESIGN A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes. SETTING/PARTICIPANTS Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand. RESULTS Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a "talking service" and District Nursing as a "task service." There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration. CONCLUSION Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Rebekah Irwin
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Nagington M, Holman D, Mumford C, McCann L. Theorising the hospice gaze: A Foucauldian collaborative ethnography of a palliative day care service. Soc Sci Med 2021; 291:114470. [PMID: 34662763 DOI: 10.1016/j.socscimed.2021.114470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the "hospice gaze". We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services.
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Affiliation(s)
| | - David Holman
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Clare Mumford
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK; Manchester Metropolitan University, Oxford Road, Manchester, M15 6BH, UK
| | - Leo McCann
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK; University of York, Heslington, York, YO19 5DD, UK
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Vera‐Catalán T, Gallego‐Gómez JI, Rivera‐Caravaca JM, Segura‐Melgarejo F, Rodríguez‐González‐Moro MT, Simonelli‐Muñoz AJ. A new tool to assess patients’ comfort during hospitalization: The Hospital Discomfort Risk questionnaire. J Nurs Manag 2019; 27:1485-1491. [DOI: 10.1111/jonm.12834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/25/2019] [Accepted: 07/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - José Miguel Rivera‐Caravaca
- Faculty of Nursing Catholic University of Murcia (UCAM) Murcia Spain
- Department of Cardiology, Centro de Investigación Biomédica en Red – Enfermedades Cardiovasculares (CIBERCV) Instituto Murciano de Investigación Biosanitaria (IMIB‐Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca Murcia Spain
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Nagington M, Walshe C, Luker KA. A poststructural rethinking of the ethics of technology in relation to the provision of palliative home care by district nurses. Nurs Philos 2016; 17:59-70. [PMID: 26333295 PMCID: PMC5049488 DOI: 10.1111/nup.12099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of 'plugged in' as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care.
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Affiliation(s)
- Maurice Nagington
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchester
| | - Catherine Walshe
- International Observatory on End of Life CareDivision of Health Research C52Lancaster UniversityLancasterUK
| | - Karen A. Luker
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchester
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Nagington M, Walshe C, Luker KA. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care. Nurs Inq 2015; 23:12-23. [PMID: 26189362 PMCID: PMC5034813 DOI: 10.1111/nin.12109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 11/29/2022]
Abstract
Quality of care is a prominent discourse in modern health‐care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi‐structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health‐care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved.
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