ABSTRACT
This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing dialogues among various stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars. We present a case example concerning the quality of freedom restrictions for intellectually disabled people. Issues for discussion include the role and required competences of the ethicist and dealing with asymmetrical relationships between stakeholders.
Subject(s)
Communication , Ethicists/psychology , Ethics, Nursing , Freedom , Interprofessional Relations , Patient Advocacy/ethics , Commitment of Mentally Ill/legislation & jurisprudence , Cooperative Behavior , Ethical Theory , Ethicists/legislation & jurisprudence , Humans , Morals , Narration , Netherlands , Nurse's Role/psychology , Nursing Theory , Patient Advocacy/legislation & jurisprudence , Persons with Mental Disabilities/legislation & jurisprudence , Philosophy, Nursing , Power, Psychological , Problem Solving , Professional Autonomy , Professional Role/psychology , Quality of Health Care/ethicsABSTRACT
AIM: This article describes the contents of an interactive computer-tailored program. The program is based on previous studies of the practice of care for persons with Prader-Willi syndrome. This genetic condition is associated with a constant overeating behaviour with the risk of obesity. The aim of the program is to start a process of awareness, reflection, and discussion by caregivers who are confronted with the moral dilemma of respect for autonomy versus restricting overeating behaviour. The program focuses on values (such as health and well-being) that are relevant to caregivers in daily practice. Furthermore, the focus is on various ways of interaction with the client. Caregivers were expected to focus mainly on health, and on both paternalistic and interpretive/deliberative forms of interaction. METHODS: Sixteen professionals and 12 parents pilot-tested the program contents. With a pre-test, responses on one central case were collected for tailored feedback; with a post-test, the effects of the program were measured. RESULTS: Significant correlations were found between the values of autonomy and consultation and between autonomy and well-being. In contrast to our expectations respondents valued all categories (autonomy, consultation, health, well-being, and liveability for others) as equally important in the pre-test. No significant changes in scores were found between pre- and post-test. The open answers and remarks of participants support the program contents. CONCLUSIONS: Participants' responses support previous research findings, advocating a concept of autonomy in terms of positive freedom, through support by others. The promotion of the client's self-understanding and self-development is central in this concept.
Subject(s)
Caregivers/ethics , Health Behavior , Health Promotion/ethics , Obesity/prevention & control , Patient Education as Topic/ethics , User-Computer Interface , Attitude to Health , Caregivers/education , Caregivers/psychology , Humans , Obesity/psychology , Parents/education , Parents/psychology , Patient Education as Topic/methods , Patient Participation , Personal Autonomy , Prader-Willi Syndrome/psychology , Professional AutonomyABSTRACT
OBJECTIVE: The present study examined caregivers' preferences for intervention strategies in dealing with the dilemma of respecting autonomy of intellectually disabled persons versus providing high-quality care. METHODS: Twenty-four parents and 14 professional caregivers of persons with Prader-Willi syndrome were asked to rate four different kinds of intervention strategies according to their preferred way of dealing with 8 presented cases. RESULTS: In general, caregivers preferred to intervene more actively in eating problems compared to behavioural problems, more in acute than in chronic situations, and more in situations at home than in community-based settings. Significant differences were found between parents and professionals. CONCLUSION: Parents and professionals prefer intervening above laissez-faire. Parents prefer active intervention stronger than professionals. PRACTICE IMPLICATIONS: Awareness of various intervention strategies can help caregivers to develop a practice that does justice to the need for intervention on the one hand, and the possibility of using a variety of intervention strategies on the other hand. Communication about intervention strategies might foster understanding between professional caregivers and parents and improve mutual cooperation.
