European Journal for Nursing History and Ethics (ENHE)
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Dealing with Scarcity of Resources in Nursing. The Scope and Limits of Individual Responsibility
Get PDFEmpirische Studien zeigen, dass Pflegefachkräfte häufig nicht in der Lage sind, all diejenigen Pflegetätigkeiten auszuführen, die von ihnen als notwendig erachtet werden. Das Phänomen der unvollständig ausgeführten Pflegetätigkeiten stellt eine Folge der Ressourcenknappheit in der Patientenversorgung und Form der Rationierung von Pflegeleistungen dar. Obwohl die Pflegefachkräfte nicht für den Ressourcenmangel selbst verantwortlich gemacht werden können, ist dennoch ein ethisch reflektierter Umgang mit Priorisierungs- und Rationierungsentscheidungen, ebenso wie mit Effizienzerwägungen in der pflegerischen Versorgung von Patient*innen zu fordern. Das Phänomen der unvollständig ausgeführten Pflegeleistungen ist nicht nur in einem pflegewissenschaftlichen und gesundheitsökonomischen Kontext zu thematisieren, sondern gleichermaßen in einen ethischen Interpretationsrahmen zu stellen. In einem derartigen Rahmen lassen sich auch Reichweite und Grenzen der individuellen Verantwortung von Pflegefachkräften unter Knappheitsbedingungen in Grundzügen bestimmen.Empirical studies show that nursing staff are often unable to perform all the nursing tasks they consider necessary. The phenomenon of incompletely performed nursing tasks is a consequence of the scarcity of resources in patient care and represents a form of rationing of nursing care. Although nursing staff cannot be held responsible for the lack of resources, an approach that has considered ethical aspects is necessary for decisions regarding prioritisation and rationing, as well as for considerations regarding efficiency in nursing care for patients. The phenomenon of incompletely performed nursing care should be addressed not only in the context of nursing science and health economics, but also in the context of ethical interpretation. Within the latter context, it is also possible to define in broad terms the scope and limits of individual responsibility of nursing staff under conditions of scarcity
Material Configurations of Nursing and their Ethical Implications. The Prolonged Bath Treatment in Psychiatry
Get PDFDie Einführung der Dauerbadbehandlung in psychiatrische Anstalten und Kliniken um 1900 führte zur Einrichtung eigener Behandlungsräume, in denen die medizinischen Kenntnisse der Zeit (Hydrotherapie) unter Nutzung des technischen Fortschritts (fließendes Wasser) zur Anwendung kommen sollten. Für die Pfleger*innen ging die Behandlung mit einer erhöhten Verantwortung für die Patient*innen einher, denn immer wieder kam es im Dauerbad zu schweren Unfällen. Die technischen Apparaturen sowie materiellen Adaptionen, die nach und nach in den Räumen vorgenommen wurden, sollten die Arbeit der Pfleger*innen erleichtern. Sie fungierten als Ko-Akteure der Behandlung. Der Beitrag geht der Frage nach, welchen Einfluss diese materielle Konfiguration des Baderaumes auf die Pflegepraxis und damit auf pflegeethisches Handeln nahm und welche Erkenntnisse daraus für aktuelle Fragen der Pflegeethik gezogen werden können.When “prolonged” or “permanent” baths were introduced as a treatment in psychiatric institutions around 1900, special treatment rooms had to be created that utilised medical knowledge of the time (hydrotherapy) and technically progressive features (running water). The nurses, who were co-agents in the treatment regimens, had a high level of responsibility for the patients, as serious accidents repeatedly occurred in the prolonged baths. Technical apparatus was gradually installed and material adaptations were made to the rooms that served to lighten the nurses’ workload. This article examines the influence the material configuration of the bathroom had on nursing practice and also explores which insights can be drawn for current issues in nursing ethics
Bad Nursing? Workhouse Nurses in England and Finland, 1855–1914
Get PDFThis article discusses workhouse nursing in England and Finland by analysing the ways in which local-level poor law records reflect the contemporary understandings of bad nursing. The article shows that in England, the workhouse system was established long before the emergence of the principles of medical nursing in the 1850s, which is why the evolution of workhouse nursing is long and versatile. In Finland, by contrast, these two developed simultaneously at the turn of the nineteenth and twentieth centuries, which explains the attempts to combine professional nursing with workhouse management from the beginning. Local-level records show that in both countries the definition of ‘good nursing’ and ‘bad nursing’ – in other words the expectations associated with a nurse’s duties and her ethical principles – changed over time as nursing became more medicalised and professionalised. However, the local poor relief agents were often slow to adopt new ideals and practices, and instead tended to stick to their own understandings of nursing. Both in England and Finland pauper nurses remained a common phenomenon well into the twentieth century
How Much Politics is Permissible in the Nursing of the “Insane”? The History of the Unionisation of Psychiatric Nurses in the German Reich through the Lens of the Uchtspringe Prussian State Asylum 1900–1933
Get PDFDer Beitrag beleuchtet frühe Vorstöße gewerkschaftlichen Engagements von Pflegekräften, er untersucht exemplarisch Voraussetzungen, Umstände und Hindernisse einer gewerkschaftlichen Organisierung von Psychiatriepflegenden im Deutschen Reich zu Beginn des 20. Jahrhunderts. Hierzu werden Personalakten ausgesuchter Pflegekräfte der ehemaligen preußischen Landes-Heil- und Pflegeanstalt Uchtspringe herangezogen, um Fallgeschichten von gewerkschaftlich engagierten Pflegenden zu rekonstruieren. Sogenannten „Irrenpflegern“ war ein von der Anstaltsleitung unabhängiges Agieren in einem Gewerkschaftsverband bis zur Aufhebung des Koalitionsverbotes im Jahre 1918 strengstens untersagt. Dessen ungeachtet lässt sich für mehrere Uchtspringer Pflegende eine Mitgliedschaft im christlichen „Deutschen Verband der Krankenpfleger und Krankenpflegerinnen“ noch vor Beginn des Ersten Weltkrieges nachweisen. Die 1919 gegründete Uchtspringer Ortsgruppe des SPD-nahen „Verbandes der Gemeinde- und Staatsarbeiter“ (VGS) etablierte sich zur Zeit der Weimarer Republik zum wichtigsten gewerkschaftlichen Vertreter des Uchtspringer Personals. Erst die Machtübernahme der Nationalsozialisten beendete die Arbeit der als „politisch unzuverlässig“ gebrandmarkten Ortsgruppenvorsteher abrupt. Durch die Erschließung diverser historischer Quellen, so auch von Egodokumenten, wird die Selbst- und Fremdwahrnehmung der gewerkschaftlich tätigen Pflegekräfte vor dem Hintergrund wechselnder Direktionen und politischer Systeme unter Beachtung des Genderaspektes untersucht. Darüber hinaus wird der Beitrag des VGS zur Ausformulierung von neuen Konzepten der Pflegeethik in Abgrenzung zu konfessionellen und weltlichen Pflegeorden erschlossen.This article sheds light on nurses’ early ventures into union work, it analyses the conditions, circumstances and boundaries the unionisation of psychiatric nurses entailed during the German Reich in the early 20th century. I use the staff files of selected nurses and orderlies from the former Uchtspringe Prussian State Asy-lum to reconstruct case histories of unionised nursing staff. We can say that until the ban on organising was lifted in 1918, the nurses of the “insane” were strictly forbidden to act independently of the institution’s man-agement within a trade union. Nonetheless, there is evidence that a number of nurses and orderlies of Uchtspringe were members of the German Association of Nurses and Orderlies (Deutscher Verband der Krankenpfleger und Krankenpflegerinnen) even before the beginning of the First World War. In 1919, a branch of the Association of Municipal and State Workers (Verband der Gemeinde- und Staatsarbeiter, VGS), which had close ties to the Social Democratic Party of Germany (SPD), was founded at Uchtspringe, and dur-ing the Weimar period it became the main union representative of Uchtspringe’s committed staff. When the National Socialists seized power, they abruptly ended the activity of the Uchtspringe branch board members, which were branded as “politically unreliable”. Through the investigation of diverse historical sources includ-ing ego documents this article focuses on the self-perception and perception others had of the unionised nurses, in the context of changing management and political systems and the impact of gender issues. Be-yond that I investigate the input the VGS headquarters had to a new concept of nursing ethics which provid-ed an alternative to the ethical basis of denominational and secularised sisterhoods
The “Curative-Protective Hospital Regime” Concept in the Medical and Nursing Practice of 1950s USSR
Get PDFThe introduction of the “curative-protective hospital regime” was one of the results of the Pavlovian Session in Moscow (1950). This regime was elaborated at Makarovo Hospital (a small hospital near Kiev) and then introduced into hospitals all over in the USSR and in Eastern Bloc countries. It was propagated as a great achievement of Soviet medicine in contrast to the old Western “Virchovian” medicine. The regime was based on the explanation of disease as caused by an imbalance between the cortex processes of excitement and inhibition. The aim of the regime was to provoke “protective inhibition” as a tool to minimise this imbalance. This concept led to the widespread implementation of both sleep therapy and the elaboration of the “curative-protective hospital regime”, which changed hospital organisation in the early 1950s. Although the new regime was explained in physiological terms, its dissemination and implementation were never politically neutral; instead, they were always were placed in a set of party-political and health-policy relationships as well as the general epistemological framework of a materialistic understanding of nature. Changes in hospital care began in 1950 and intensified after the Seventh Session of the USSR Academy of Medical Sciences in May 1952, which stressed the need to transform clinical work.
The introduction of the “curative-protective hospital regime” was a general measure to transform practical work according to Pavlov’s doctrine. Nurses were tasked with implementing the new regime into daily hospital routine. This paper aims to present the implementation of the Pavlovian Session from the perspective of nursing history. It places the topic of the Pavlovian Session and the “curative-protective hospital regime” within the official narrative of the time in relation to the “two sciences”: the “proletarian” (Soviet) and the “bourgeois” (Western). The paper also aims to discover how the “curative-protective regime” was propagated and introduced into everyday professional hospital work. The main sources for the research are official medical periodicals (Medical Nurse [Meditsinskaya sestra] and Medical Worker [Meditsinskiy rabotnik]) and publications from the 1950s as well as various memoirs and novels in which the introduction of the “curative-protective regime” is described
Eugenics and Healthy Families. Interdependence and Legitimation
Get PDFThere was significant popular support for eugenics in the first part of the twentieth century. Discourses from various organizations promoting the health of children and families interacted with eugenic discourses and provided support for eugenics to health care providers and the general public. Linking eugenics with better health of the population was an essential aspect of legitimizing eugenics among the general population. The American Journal of Nursing (AJN) provided an avenue for informing nurses about eugenics, gaining their support, and encouraging them to gain support for the movement among their patients and the public. This paper provides an overview of organizations in the US focused on or encompassing the eugenics movement and an analysis of eugenic discourses in AJN. All issues of AJN from 1900–1950 were read for eugenic and related language. These texts then were analyzed for authoritative, moral, rational, and story-telling support for eugenics. Nursing leaders worked closely with eugenic societies and organizations that were designed to improve the health of infants, children, and families. Eugenics was seen as a tool to reduce social and health problems, and eugenic leaders looked to these organizations and nursing to gain broad public support. AJN participated in the work of legitimizing eugenics through various means of legitimation, including appeals to authority, nurses’ moral values, the rationality of science, and moral tales
Electroconvulsive Therapy (ECT) and Nursing Practice in the Netherlands, 1940–2010
Get PDFElectroconvulsive therapy (ECT) has been applied in mental and general hospitals in the Netherlands since 1939, but we know little about nurses’ role in the transformation brought about by the ECT machine and its use. Based on archival documents, interviews and a case study of nurses’ work in ECT at the university hospital in the city of Groningen, this article shows how nurses’ professional identity was depicted and changed within the application and practice of ECT. Although nursing was an integral part of ECT practice from the outset, it was also affected and changed by it, especially as public debate and controversy over ECT arose in 1970s. During this time mental health grew as an interdisciplinary field, pressuring nurses to articulate their psychiatric nursing expertise. New governmental ECT guidelines in the 1980s also shaped nurses’ work. Once protest over ECT subsided in the 1990s, reflecting a new acceptance of biological psychiatry, use of ECT increased again and nurses obtained a specialized role in ECT. The article concludes that whereas nursing’s traditional close ties to medical knowledge and practice has been a source of professional tension, the connection also gave nurses new opportunities to renegotiate their expertise when the use of ECT increased during the 1990s. It realigned them with medicine in new ways, opening new professional avenues in specialized ECT nursing practice
The Fake Three-Sided Key. Patient-Fabricated Duplicate Keys in Psychiatry around 1900
Get PDFDieser Beitrag analysiert anhand einer Sammlung nachgemachter Schlüssel aus der Klinik Waldau bei Bern die historische Bedeutung von Objekten in der Psychiatrie, insbesondere für die zeitgenössische Lehre und die Ausbildung des Pflegepersonals. Die Sammlung besteht aus rund 90 Objekten, die von Patienten angefertigt worden waren, in der Absicht damit zu fliehen. Der Psychiater Walter Morgenthaler (1882–1965) hatte die Schlüssel Anfang des 20. Jahrhunderts gesammelt und auf Schautafeln für den Unterricht der angehenden Pflegenden mit Aktennummern versehen. Dort lassen sich Schlüsselgeschichten nachlesen und die Gegenstände im Kontext der materiellen Kultur analysieren, was hier erstmals unternommen wird.This paper analyses the historical importance of objects in psychiatry – particularly their use in the contemporary teaching and training of nurses – with reference to a collection of duplicate keys from the Waldau clinic near Berne. The collection consists of approximately 90 objects, made by patients with the aim of using them to escape. The psychiatrist Walter Morgenthaler (1882–1965) collected these keys at the beginning of the 20th century, attached them to plates, gave them patients’ record numbers and used them for teaching. In these patient’s records, stories of the keys can be found. For the first time, these records allow for an analysis of the keys in the context of material culture