Geoffrey Hunt

Exploring Nursing Values in the Development of a Nurse-Led Service

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients’ experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care.

Moral Crisis, Professionals and Ethical Education

Western civilization has probably reached an impasse, expressed as a crisis on all fronts: economic, technological, environmental and political. This is experienced on the cultural level as a moral crisis or an ethical deficit. Somehow, the means we have always assumed as being adequate to the task of achieving human welfare, health and peace, are failing us. Have we lost sight of the primacy of human ends? Governments still push for economic growth and technological advances, but many are now asking: economic growth for what, technology for what? Health care and nursing are caught up in the same inversion of human priorities. Professionals, such as nurses and midwives, need to take on social responsibilities and a collective civic voice, and play their part in a moral regeneration of society. This involves carrying civic rights and duties into the workplace.

A Sense of Life: the future of industrial-style health care:

In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of ‘a sense of life’ to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of others to be given a chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness.

Treatment, custody, support: an exploratory qualitative dialogue to map the ethics of interagency co-operation in hospital emergency departments in the UK and the Netherlands

Interviews with senior professionals in accident and emergency (A&E) healthcare, policing and social services to map the ethical dimensions of interagency collaboration suggest that the main ethical themes for systematic research are information sharing and confidentiality, consent, professional values and autonomy, human rights, formal (organisational) accountability, staff safety and public interest collaboration. An emerging specific issue is the extent of A&E disclosure to the police and to the social services and its legal and ethical parameters.

The Human Condition of the Professional: discretion and accountability

This article takes issue with procedural reductionism, which is the inclination to reduce all matters of judgement and responsibility to the following of some procedure or rule. Two scenarios provide content for a discussion of professional discretion in the context of accountability. The author shows that in professional life there will always be situations that stand beyond the rules of procedures and require the unique judgement of the professional at the time. While this judgement may be determined by the facts available in a situation of uncertainty, it cannot be reduced to the facts (including facts about rules and procedures). The moral judgement will still have an essential indeterminancy about it.

Research on the Societal Impacts of Nanotechnology: A Preliminary Comparison of USA, Europe & Japan

We initiate some comparisons between Japan, Europe and USA on how far there is governmental support for the ethical, legal, social and environmental dimensions of nanotechnology development. It is evident that in the USA and Europe nanotechnology is now firmly embedded in the consideration of ELSI. Yet Japan has not yet adequately recognized the importance of these dimensions. The history of bioethics in Japan is short. In Europe, as early as 2004, a nanotechnology report by the UKs Royal Society referred to the possibility of some nanotubes and fibres having asbestos-like toxicity. The negative history of asbestos in Europe and USA is not yet fully identified as a Japanese problem. Japan is therefore in the process of seeking how best to address societal aspects of nanotechnology. Should the precautionary principle be applied to Japans nanotechnology initiative as in Europe? Should 5-10% of the governments nanotechnology budget be allocated to ELSI research and measures? We propose that the government and industrial sector in Japan play a much more proactive part in the regional and international growth of research into the wider risk assessment, social, health and environmental context of nanotechnologies, not simply try to borrow lessons from the West at a later date.

A tool for the consensual analysis of decision-making scenarios

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4–12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.