Cuidar del cuidado: Ética de la compasión, más allá de la protocolización del cuidado de enfermería / Caring for care: Ethics of compassion, beyond the protocolization of nursing care / Cuidando do cuidado: Ética da compaixão, além da protocolização do cuidado de enfermagem

El objetivo de este artículo de carácter reflexivo es analizar cómo se sostiene la relación entre el cuidado de enfermería y la ética de la compasión y algunos efectos de la protocolización del cuidado en dicha relación. METODOLOGÍA: La delimitación del tema de análisis surge en el marco de un ejercicio de narrativa de experiencias de cuidado, en el que las categorías conceptuales cuidado de enfermería - compasión - protocolo se encuentran interrelacionadas. Se realiza un análisis teórico reflexivo principalmente desde la fenomenología de M. Heidegger y la filosofía de la finitud de JC Melich. CONCLUSIÓN: la relación entre cuidado y compasión es consustancial. No puede haber cuidado sin compasión y tampoco puede haber compasión sin cuidado, la compasión exalta el cuidado de enfermería y este a su vez es la cúspide de una ética de la compasión. Sin embargo, esta puede verse disgregada por la protocolización del cuidado y las practicas de enfermería, alejando al cuidado de su verdadera esencia, la ética de la compasión

The objective of this reflective article is to analyze how the relationship between nursing care and comparison ethics is maintained and some effects of the protocolization of care in said relationship. METHODOLOGY: The delimitation of the analysis topic arises within the framework of a narrative exercise of care experiences, in the conceptual categories nursing care - comparison - protocol are interrelated. A reflective theoretical analysis is carried out mainly from the phenomenology of M. Heidegger and the philosophy of finitude from JC Melich. CONCLUSION: the relationship between caring and compassion is inherent. You can't be careful without compassion and you can't have compassion without care, compassion exalts nursing care and this is your time is the hope of an ethic of compassion. However, this can be broken down by the protocolization of nursing care and practices, taking care away from its true essence, the ethics of compassion

O objetivo deste artigo reflexivo é analisar como se mantém a relação entre o cuidado de enfermagem e a ética da comparação e alguns efeitos da protocolização do cuidado nesse relacionamento. METODOLOGIA: A delimitação do tópico de análise surge no marco de um exercício narrativo de experiências de cuidado, nas categorias conceituais protocolo de assistência de enfermagem - comparação - protocolo. Uma análise teórica reflexiva é realizada principalmente a partir da fenomenologia de M. Heidegger e da filosofia da finitude de JCMelich. CONCLUSÃO: a relação entre cuidar ecompaixão é inerente. Você não pode seimportar sem compaixão e não pode tercompaixão sem se importar, a compaixãoexalta os cuidados de enfermagem e este é oseu tempo é a esperança de uma ética dacompaixão. No entanto, isso pode ser quebrado pela protocolização dos cuidados e práticas de enfermagem, afastando o cuidado de sua verdadeira essência, a ética da compaixão

Towards Integrating the Principlist and Casuist Approaches to Ethical Decisions via Multi-Criterial Support.

An interactive decision support tool based on Multi-Criteria Decision Analysis (MCDA) can help health professionals integrate the principlist (principle-based) and casuist (case-based) approaches to ethical decision making in both their training and practice. MCDA can incorporate generic ethical principles as criteria; then draw on case-based reasoning as the basis for specifying, in the individual case, the available options, the ratings of each option on each criterion, and the relative weighting of the criteria. This produces a personalised, transparent and decomposable opinion on the merits of each option, as a contribution to enhanced deliberation. As proof of concept and method an exemplar aid adds veracity and confidentiality to beneficence, non-maleficence, autonomy and justice, as the criteria, with case-based reasoning supplying the necessary inputs for the decision of whether a nurse should disclose the poor prognosis of a patient to a close relative of the patient, when asked, on their first encounter.

Personalised Multi-Criterial Online Decision Support for Siblings Considering Stem Cell Donation: An Interactive Aid.

Person-centred decision support combines the best available information on the considerations that matter to the individual, with the importance the person attaches to those considerations. Nurses and other health professionals can benefit from being able to draw on this support within a clinical conversation. A case study and storyline on four siblings facing a transplant coordinator's call to donate stem cells to their brother [1] is 'translated' and used to demonstrate how an interactive multi-criteria aid can be developed for each within a conversational mode. The personalized dialogue and decision aid are accessible online for interaction. Each sibling's decision exemplifies the communication including physical and psychosocial complexities within any decision cascade from call-to-test and to donate, if compatible. A shared template can embrace the informational and ethical aspects of a decision. By interactive decision support within a clinical conversation, each stakeholder can gain a personalised opinion, as well as increased generic health decision literacy [2].

Adaptación de un «Listado de verificación» para la realización de procedimientos en las Unidades del Dolor / Adaptation of a «Checklist» for procedures in pain management

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Unethical conduct by the nurse: a critical discourse analysis of Nurses Tribunal inquiries.

The aim of this study was to uncover and critically examine hidden assumptions that underpin the findings of nurses' unethical conduct arising from inquiries conducted by the Nurses Tribunal in New South Wales. This was a qualitative study located within a post-structural theoretical framework. Transcripts of five inquiries conducted between 1998 and 2003 were analysed using critical discourse analysis. The findings revealed two dominant discourses that were drawn upon in the inquiries to construct nurses' conduct as unethical. These were discourses of trust and accountability. The way the nurses were spoken about during the inquiries was shaped by normalising judgements that were used to discursively position the nurse through narrative.

Veracity for children in pediatric forensics.

Child sexual abuse is a heinous crime, and school-age children are the age group most commonly victimized. When occurring within the family, it is particularly difficult and confusing for the child to disclose. The role of the sexual assault nurse examiner, and the challenges in applying the ethical concept of veracity when caring for these young victims is examined, using vignettes based on actual situations. It is essential for the forensic nurse to be able to understand and apply theories of childhood development to these cases in order to facilitate communication with the child, while providing assurance that they are believed.

Unresolved pain in children: a relational ethics perspective.

It is considered the right of children to have their pain managed effectively. Yet, despite extensive research findings, policy guidelines and practice standard recommendations for the optimal management of paediatric pain, clinical practices remain inadequate. Empirical evidence definitively shows that unrelieved pain in children has only harmful consequences, with no benefits. Contributing factors identified in this undermanaged pain include the significant role of nurses. Nursing attitudes and beliefs about children's pain experiences, the relationships nurses share with children who are suffering, and knowledge deficits in pain management practices are all shown to impact unresolved pain in children. In this article, a relational ethics perspective is used to explore the need for nurses to engage in authentic relationships with children who are experiencing pain, and to use evidence-based practices to manage that pain in order for this indefensible suffering of children to end.

The ethical dilemmas of aesthetic medicine: what every provider should consider.

The purpose of aesthetic medicine is embellishment and enhancement. As these procedures are elective in nature, media messages and misleading advertisements do influence those consumers seeking to improve or enhance their appearance. The role of provider demands that prudent guide these treatment options and not only succumb to patient demands. This article discusses the ethical principles of autonomy, beneficence, nonmaleficence, and justice, and presents a framework to guide practice to enhance resolution of ethical dilemmas confronting the provider of aesthetic medicine.

Consent and capacity: a guide for district nurses.

The Mental Capacity Act 2005, which came into force in 2007, sought to provide a statutory framework to facilitate empowerment and provide protection to individuals who lack capacity. District nurses must be aware of the legislation regarding mental capacity (Nursing and Midwifery Council, 2008) and understand how and when they may need to assess decision-making capacity. The article explores the legal and ethical issues surrounding consent, and seeks to inform district nurses as to the guidelines used in assessing a person's capacity to consent, along with best interests policy.

Models of knowledge in the assessment of postoperative pain.

This article illustrates a process of knowledge development and the interrelationship between knowledge and practice using Carper's fundamental patterns of knowing. It explores two kinds of knowledge, theoretical knowledge and practical knowledge, using postoperative pain assessment as an illustration. By using their theoretical knowledge and their practical experience, nurses can maintain and develop their professional knowledge and competence.

Legal implications regarding self-neglecting community-dwelling adults: a practical approach for the community nurse in Ireland.

This paper explores the current literature related to legal issues encountered by the public health nurse in Ireland in visiting clients exhibiting self-neglecting behavior. Nurses working in community settings where home visiting of clients is required will at some point encounter situations of client self-neglect. Possession of a clear legal framework for the local area that addresses both the nurse's professional responsibility and the client's rights is needed. Because a high incidence of depression and dementia seen in self-neglecting adults has prompted calls for wider screening of the agreeable client, an understanding of the definition of competence and capacity in the national legal system for that client becomes critical. In Ireland, as in many other countries, refusal of care or screening is the right of any competent adult. However, issues of mandatory reporting, confidentiality, and trespass may differ from other areas. Nursing care delivered at the community level to a client exhibiting self-neglecting behavior involves a delicate balance of trust and support. Through this overview of the legal implications for self-neglecting clients in Ireland, nurses have the opportunity to begin an exploration of similarities and differences in approach on a global level.

Promoting ethical development in nursing education and beyond.

Ethical nursing practice can be referred to as doing what is best for those who are the recipient of one's services, according to the recipient. However, clear-cut lines of what is and is not in the best interest of the patient can become blurred. Nurses often encounter situations that require them to use ethical judgment. This article discusses how ethical decision making can be developed in students, new graduates, and nurses in practice.

[Cura sui--selfcare and its relationship to nursing]. / CURA SUI - Die Selbstsorge und ihre Beziehung zur Pflege.

Self care is an answer to the response of finiteness, which is given through the fact of the human body. The article demonstrates in reference to the Selfcaredeficit-Theory (Orem, 2006) how self care in everyday life, ancient roman called it cura sui, is related to nursing practice, specially to acutecare. Self care turns out as an category of ambivalence between ethics and power.

Special observations in forensic psychiatric practice: gender issues of the watchers and the watched.

Special observations in psychiatric practice may create tensions for both the patient under surveillance and the staff undertaking the procedure. This study reports on special observations undertaken in forensic settings focusing specifically on the gender-sensitive issues. The aim of the study was to investigate the specific gender issues relating to special observations in relation to those under the procedure and those engaged in observing. Three medium secure units in the UK formed the sampling frame, and the population studied was eight female and seven male clinical Registered nurses. Semi-structured interviews were conducted, audio-tape-recorded and transcribed for analysis. The analysis involved a Grounded Theory approach to explicate categories and formulate two overarching themes: (1) the psychosocial fusion; and (2) the private as spectacle. There are implications for practice in relation to policy formulation and the implementation of special observations following risk assessment and individual skill identification. It is concluded that gender issues are extremely important for all concerned in this intrusive practice.

Do-not-resuscitate. Orders in surgery: decreasing the confusion.

Patients have the right to make decisions regarding their medical care, including the right to refuse treatment or to issue do-not-resuscitate orders as part of an advance directive. Health care providers must comply with the patient's wishes regarding care. Automatic suspension or continuation of a do-not-resuscitate order for a patient undergoing surgery cannot be justified. Surgical team members should consult with the patient and, if necessary, with an ethics expert or committee to determine whether the do-not-resuscitate order is to be maintained or completely or partially suspended during anesthesia and surgery. All surgical departments should have a written policy and procedure concerning the treatment of patients with do-not-resuscitate orders.

Considerations of informed consent and decision-making competence in older adults with cognitive impairment.

Including older adults with cognitive impairment in research studies is necessary to ensure that interventions designed to improve care are effective for all older adults. However, issues related to capacity to consent raise many difficult questions that nurse researchers must address. Protecting vulnerable participants while simultaneously maintaining autonomy and moving important research forward can be challenging. Assessing the decision-making abilities of understanding, appreciation, reasoning, and expressing a choice is an important aspect of determining decision-making capacity. Yet although this is the prominent rational method for judging decision-making competence, it does not take into consideration the importance of culture, values, and emotions. This article focuses on the assessment of decision-making capacity to consent, recommendations for obtaining informed consent in older adults with cognitive impairment, the use of surrogate decision makers, strategies to maximize research participation, and directions for future research.