Zusammenfassung
Ethische Fragen der Pflegepraxis haben sich in den letzten Jahren zugespitzt. Sie sind häufig verbunden mit einer grundsätzlichen Sorge um eine kompetente und verantwortliche Pflege, die den Bedürfnissen von Patient*innen gerecht wird. Forschungen aus drei Jahrzehnten zeigen, dass strukturelle Beschränkungen, Konflikte mit Kolleg*innen, Patient*innen und Angehörigen sowie eine Managementorientierung und die Unsichtbarkeit der Pflegearbeit, Ursachen für die grundsätzlichen Sorgen sind. Sie führen zu moralischem Stress, fehlenden Beziehungen und einer Fragmentierung der Pflege. Teilweise reagieren Pflegende widerständig, indem sie beispielsweise die Regeln beugen und eine passive „wait and see“ Position einnehmen. Einige Pflegende erheben ihre Stimme und suchen ein Klinisches Ethikkomitee auf. Klinische Ethikkomitees bieten eine Möglichkeit, die komplexen ethischen Fragen der Pflegepraxis zu thematisieren. Allerdings verweisen die Studien aus drei Dekaden auf einen Mangel der Thematisierung. Die Analyse der Ursachen lässt die Schlussfolgerung zu, demokratischen Lernprozessen Raum zu geben.
Abstract
Definintion of the problem
Ethical questions regarding nursing practice have become an increasing topic of discussion in recent years. They are often associated with a fundamental concern about competent and responsible nursing that meets the needs of patients. Research of the last three decades reveals that structural constraints, conflicts with colleagues, patients and relatives as well as a management orientation and the invisibility of nursing work leads to moral stress, a lack of connectedness, and a fragmentation of nursing.
Arguments
In part, nurses react with resistance by bending the rules and taking over a passive “wait and see” position. Some nurses raise their voice and seek clinical ethics committees (CECs), which offer a possibility to address the complex ethical questions of nursing practice. Nevertheless, studies from the last three decades refer to an insufficient thematization.
Conclusion
The analysis of the reasons allows the conclusion that it is necessary to give space to democratic learning processes.
Notes
Siehe den Beitrag zu Ethikkompetenzen und Ethik-Leitlinienentwicklung von Annette Riedel in diesem
Themenheft.
Übersetzung der Autorin.
Übersetzung der Autorin.
Siehe hierzu den Beitrag von Settimio Monteverde in diesem Themenheft.
Siehe hierzu den Beitrag von Constanze Giese in diesem Themenheft.
Übersetzung der Autorin.
Übersetzung der Autorin.
Übersetzung der Autorin.
Übersetzung der Autorin.
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Karen Quinlan ware eine US-amerikanische junge Frau, die 1975 einen Kreislaufstillstand hatte und ein apallisches Syndrom entwickelte. Durch den Rechtsstreit ihrer Eltern um die Einstellung ihrer Beatmung wurde sie zu einer wichtigen Figur in der kontroversen Debatte um die passive Sterbehilfe durch Behandlungsverzicht. Die Analyse ihres Schicksals war bedeutsam für die Einführung Klinischer Ethikkomitees.
Übersetzung der Autorin.
Übersetzung der Autorin.
Übersetzung der Autorin.
Literatur
Ahern K, McDonald S (2002) The beliefs of nurses who were involved in a whistleblowing event. J Adv Nurs 38:303–309
Aiken LH, Clarke SP, Sloane DM, Sochalski JA et al (2001) Nurses’ reports on hospital care in five countries. Health Aff 20:43–53
Aiken LH, Clarke SP, Sloane D (2000) Hospital restructuring: does it adversely affect care and outcomes? J Nurs Adm 30:457–465
Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Sermeus W (2013) Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. Int J Nurs Stud 50:143–153
Aroskar MA (1984) Health care professionals and ethical relationships on IECs. In: Cranford RE, Doudera AE (Hrsg) Institutional ethics committees and health care decision making. Health Administration Press, Michigan, S 218–225
Aroskar MA, Moldow GD, Good CM (2004) Nurses’ voices: policy, practice and ethics. Nurs Ethics 11:268–276
Aström G, Faraker C, Norberg A (1995) Nurses skills in managing ethically difficult care situations: interpretation of nurses’ narratives. J Adv Nurs 21:1073–1080
Bartels D, Youngner S, Levine J (1994) Healthcare ethics forum’94: ethics committees: living up to your potential. AACN Clin Issues Crit Care Nurs 5:313–323
Bartholomeyczik S, Donath E, Schmidt S et al (2008) Arbeitsbedingungen im Krankenhaus. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Dortmund, Berlin, Dresden
Benner PE, Tanner CA, Chesla CA (1996) Expertise in nursing practice. Caring, clinical judgement, and ethics. Springer, New York
Bosk C, Frader J (1998) Institutional ethics committees: sociological oxymoron, empirical black box. In: De Vries RG, Subedi J (Hrsg) Bioethics and society. Constructing the ethical enterprise. Prentice Hall, New Jersey, S 94–116
Conradi E, Vosman F (2016) Praxis der Achtsamkeit. Schlüsselbegriffe der Care-Ethik. Campus, Fankfurt New York
Cusveller B (2012) Nurses serving on clinical ethics committees: a qualitative exploration of a competency profile. Nurs Ethics 19:431–442
Deutscher Evangelischer Krankenhausverband e. V., Katholischer Krankenhausverband Deutschlands e. V (1997) Ethik-Komitee im Krankenhaus. Freiburg i.Br.
Dodd SJ, Jansson BS, Brown-Saltzman K, Shirk M, Wunch K (2004) Expanding nurses’ participation in ethics: an empirical examination of ethical activism and ethical assertiveness. Nurs Ethics 11:15–27
Dryzek JS (2000) Deliberative democracy and beyond. Liberals, critics, contestations. Oxford University Press, Oxford
Edwards BJ, Haddad AM (1988) Establishing a nursing bioethics committee. J Nurs Adm 18:30–33
Erlen JA (1993) Empowering nurses through nursing ethics committees. Orthop Nurs 12:69–72
Erlen JA (1997) Are nursing ethics committees necessary? HEC Forum 9:55–67
Finkenbine R, Gramelspacher G (1991) Physicians’ attitudes toward hospital ethics committees. Indiana Med 84:804–807
Fins J (2016) Understanding and utilizing the convening power of ethics consultation. AMA J Ethics 5:540–545
Fleming CM (1997) The establishment and development of nursing ethics committees. HEC Forum 9:7–19
Fost N, Cranford RE (1985) Hospital ethics committees: administrative aspects. J Am Med Assoc 253:2687–2692
Fowler M (1997) Nursing’s ethics. In: Davis AJ, Aroskar MA, Liaschenko JA, Drought TS (Hrsg) Ethical dilemmas and nursing practice. Prentice Hall, New Jersey, S 17–34
Fry ST, Harvey RM, Hurley AC, Foley BJ (2002) Development of a model of moral distress in military nursing. Nurs Ethics 4:373–387
Gaudine A, Beaton M (2002) Employed to go against one’s values: nurse managers’ accounts of ethical conflict with their organizations. Can J Nurs 34:17–34
Gaudine A, Lamb M, LeFort SM, Forne L (2011b) Barriers and facilitators to consulting hospital clinical ethics committees. Nurs Ethics 18:767–780
Gaudine A, LeFort SM, Lamb M, Forne L (2011a) Ethical conflicts with hospitals. The perspective of nurses and physicians. Nurs Ethics 18(6):756–766
Hardingham LB (2004) Integrity and moral residue: nurses as participants in a moral community. Nurs Philos 5:127–134
Holly CM (1986) Staff nurses’ participation in ethical decision making: a descriptive study of selected situational variables. University Microfilms International, Ann Arbor
Jameton A (1984) Nursing practice. The ethical issues. Prentice Hall, New Jersey
Kalisch BJ (2006) Missed nursing care: a qualitative study. J Nurs Care Qual 21:306–313
Kohlen H (2009a) Conflicts of care. Hospital Ethics Committees in the USA and Germany. Campus, Frankfurt am Main
Kohlen H (2009b) Klinische Ethikkomitees und die Themen der Pflege. Institut für Mensch Ethik und Wissenschaft (IMEW), Berlin
Kohlen H (2018a) Evaluation for moving ethics in health care services towards democratic care. A three pillars model: education, companionship and open space. In: Visse M, Abma T (Hrsg) Evaluation for a caring society. Information Age Publishing, Charlotte, S 143–159
Kohlen H (2018b) Caring about care in the hospital arena and nurses’ voices in Hospital Ethics Committees: three decades of experiences. In: Krause F, Boldt J (Hrsg) Care in health care. Reflections on theory and practice. Palgrave Macmillan, London, S 237–226
Kumbruck C, Rumpf M, Senghaas-Knobloch E (2010) Unsichtbare Pflegearbeit. Fürsorgliche Praxis auf der Suche nach Anerkennung. LIT, Berlin
Liaschenko J (1993) Faithful to the good: morality and philosophy in nursing practice. Dissertation. University of California, San Francisco
Liaschenko J (2001) Thoughts on nursing work. Bioeth Exam 5:2–6
Lützen K, Schreiber R (1998) Moral survival in a nontherapeutic environment. Issues Ment Health Nurs 19:303–315
McDaniel C (1998) Hospital ethics committees and nurses’ participation. J Nurs Adm 28:47–51
Nock L, Hielscher V, Kirchen-Peters S (2013) Dienstleistungsarbeit unter Druck: Der Fall der Krankenhauspflege. Hans Böckler Stiftung, Düsseldorf
Oddi LF, Cassidy VR (1990) Participation and perception of nurse members in the Hospital Ethics Committee. West J Nurs Res 12:307–317
Pederson R, Akre V, Førde R (2009) Barriers and challenges in clinical ethics consultations: the experiences of nine clinical ethics committees. Bioethics 23:460–469
Penticuff JH, Walden M (2000) Influence of practice environment and nurse characteristics on perinatal nurses’ responses to ethical dilemmas. Nurs Res 49:64–72
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research (1983) Deciding to forego life-sustaining treatment. U.S. Government Printing Office, Washington DC
Rankin J, Campbell M (2006) Managing to nurse: inside Canada’s healthcare reform. University of Toronto Press, Toronto
Redman BK (1996) Responsibility of Healthcare Ethics Committees towards nurses. HEC Forum 8:52–60
Redman BK, Fry ST (2000) Nurses’ ethical conflicts: what is really known about them? Nurs Ethics 7:360–366
Rodney P (2005) Power, politics, and practice: towards a better moral climate for health care delivery. The 9th International Philosophy of Nursing Conference. University of Leeds, Leeds (Book of Abstracts)
Rodney PA (1997) Towards connectedness and trust: nurses’ enactment of their moral agency within an organizational context. Dissertation. University of British Columbia, Vancouver
Rodney P, Varcoe C (2001) Towards ethical inquiry in the economic evaluation of nursing practice. Can J Nurs Res 33:35–57
Schmidt MG (2000) Demokratietheorien, 3. Aufl. Leske + Budrich, Opladen
Schubert M, Glass TR, Clarke SP, Aiken LH, Schaffert-Witvliet B, Sloane DM, De Geest S (2008) Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the international hospital outcomes study. Int J Qual Health Care 4:227–237
Sichel BA (1992) Ethics of caring and the institutional ethics committee. In: Bequaert Holmes H, Purdy LM (Hrsg) Feminist perspectives in medical ethics. Indiana University Press, Bloomington, S 113–123
Sleutel MR (2000) Intrapartum nursing care: a case study of supportive interventions and ethical conflicts. Birth 27:38–48
Storch JL, Griener GG (1992) Ethics committees in Canadian hospitals: report of the 1990 pilot study. Healthc Manage Forum 5:19–26
Storch JL, Rodney P, Pauly B, Brown H, Starzomsky R (2002) Listening to nurses’ moral voices: building a quality health care environment. Nurs Leadersh 15:7–16
Sundin-Huard D, Fahy K (1999) Moral distress, advocacy and burnout: theorizing the relationship. Int J Nurs Pract 5:8–13
Taylor CR (1997) Everyday nursing concerns: unique? Trivial? Or essential to healthcare ethics? HEC Forum 9:68–84
Tronto JC (1993) Moral boundaries: a political argument for an ethic of care. Routledge, New York
Varcoe C, Doane G, Pauly B, Rodney P, Storch JL, Mahoney K, McPherson G, Brown H, Starzomski R (2004) Ethical practice in nursing: working the in-betweens. J Adv Nurs 45:316–325
Varcoe C, Rodney P, McCormick J (2003) Health care relationships in context: an analysis of three ethnographies. Qual Health Res 13:957–973
Wurzbach ME (1995) Acute care nurses’ experiences of moral certainty. J Adv Nurs 30:95–119
Youngner SJ, Jackson DL, Coulton C, Juknialis BW, Smith E (1983) A national survey of hospital ethics committees. In: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research (Hrsg) Deciding to forego life-sustaining treatment. U.S. Government Printing Office, Washington DC, S 443–449
Zink MR, Titus L (1994) Nursing ethics committees—where are they? Nurs Manage 25:70–76
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Kohlen, H. Ethische Fragen der Pflegepraxis im Krankenhaus und Möglichkeiten der Thematisierung. Ethik Med 31, 325–343 (2019). https://doi.org/10.1007/s00481-019-00547-0
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DOI: https://doi.org/10.1007/s00481-019-00547-0