Marsha Fowler

Pain management at home. Struggle, comfort, and mission.

This article presents findings from an exploratory, descriptive study that investigated the experiences of pain in the home from the perspective of the patient, the primary family caregiver, and the home care nurse. The following research questions are addressed: What are the special problems associated with pain management at home as identified by patients, care-givers, and nurses? What are the similarities and differences among patients, caregivers, and nurses regarding issues of managing pain at home? Qualitative techniques were used to collect and analyze data. The sample included 10 cancer patients with pain and their respective caregivers and nurses. After the in-depth interviews were transcribed, a multidisciplinary research team performed content analysis on the data. Overall, the findings suggest that patients approach pain management with a struggle for control, whereas self-denying caregivers seek to provide comfort, and nurses attempt to fulfill an urgent mission to eradicate pain.

Conceptualising spirituality and religion for healthcare.

AIMS To discuss some of the challenges of conceptualising spirituality and religion for healthcare practice. BACKGROUND With the growing interest in spirituality in healthcare, has come the inevitable task of trying to conceptualise spirituality, a daunting task given the amorphous nature of spirituality, the changing understandings of spirituality among individuals and the diverse globalised society within which this task is taking place. Spiritualitys relationship to religion is a particularly challenging point of debate. DESIGN Critical review. CONCLUSIONS Three social and historical conditions - located in the context of Western thought - have contributed to current conceptualisations of spirituality and religion: the diminishment of the social authority of religion as a result of the Enlightenment focus on reason, the rise of a postmodern spirituality emphasising spiritual experience and current tensions over the ideological and political roles of religion in society. The trend to minimise the social influence of religion is a particular Western bias that seems to ignore the global megatrend of the resurgence of religion. Current conceptualisations are critiqued on the following grounds: that they tend to be ungrounded from a rich history of theological and philosophical thought, that a particular form of elitist spirituality is emerging and that the individualistic emphasis in recent conceptualisations of spirituality diminishes the potential for societal critique and transformation while opening the door for economic and political self interest. RELEVANCE TO CLINICAL PRACTICE Constructing adequate conceptualisations of spirituality and religion for clinical practice entails grounding them in the wealth of centuries of philosophical and theological thinking, ensuring that they represent the diverse society that nursing serves and anchoring them within a moral view of practice.

Particularizing spirituality in points of tension: enriching the discourse

The tremendous growth in nursing literature about spirituality has garnered proportionately little critique. Part of the reason may be that the broad generalizing claims typical of this literature have not been sufficiently explicated so that their particular implications for a practice discipline could be evaluated. Further, conceptualizations that attempt to encompass all possible views are difficult to challenge outside of a particular location. However, once one assumes a particular location in relation to spirituality, then the question becomes how one resolves the tension between what are essentially theological or philosophical commitments and professional commitments. In this study, we discuss the tension between these perspectives using the idea of a responsible nursing response to spiritual pluralism. We then problematize three claims about spirituality in nursing discourse based upon our location as scholars influenced by Christian theological understandings: (i) the claim that all individuals are spiritual; (ii) the claim that human spirituality can be assessed and evaluated; and (iii) the claim that spirituality is a proper domain of nursings concern and intervention. We conclude by suggesting that the widely shared values of social justice, compassion and human dignity may well serve as a grounding for the critique of spiritual discourses in nursing across particularized positions.

Ethical issues occurring within nursing education

The large body of literature labeled “ethics in nursing education” is entirely devoted to curricular matters of ethics education in nursing schools, that is, to what ought to be the ethics content that is taught and what theory or issues ought to be included in all nursing curricula. Where the nursing literature actually focuses on particular ethical issues, it addresses only single topics. Absent from the literature, however, is any systematic analysis and explication of ethical issues or dilemmas that occur within the context of nursing education. The objective of this article is to identify the spectrum of ethical issues in nursing education to the end of prompting a systematic and thorough study of such issues, and to lay the groundwork for research by identifying and provisionally typologizing the ethical issues that occur within the context of academic nursing.

Heritage ethics Toward a thicker account of nursing ethics

The key to understanding the moral identity of modern nursing and the distinctiveness of nursing ethics resides in a deeper examination of the extensive nursing ethics literature and history from the late 1800s to the mid 1960s, that is, prior to the “bioethics revolution”. There is a distinctive nursing ethics, but one that falls outside both biomedical and bioethics and is larger than either. Were, there a greater corpus of research on nursing’s heritage ethics it would decidedly recondition the entire argument about a distinctive nursing ethics. It would also provide a thicker account of nursing ethics than has been afforded thus far. Such research is dependent upon identifying, locating, accessing and, more importantly, sharing these resources. A number of important heritage ethics sources are identified so that researchers might better locate them. In addition, a bibliography of heritage ethics textbooks and a transcript of the earliest known journal article on nursing ethics in the US are provided.

Preface to Thematic Section: Religions, Spirituality, Ethics and Nursing

All religions, whether theistic or non-theistic, pray. When we ask people ‘what do you pray about?’ most often the response is related to health, either their own or that of a loved one. Despite the fact that religious persons link faith with health, nursing has not done so. Nursing has largely neglected rigorous study of this domain of human experience. Basic nursing textbooks customarily indicate that one tradition may have food restrictions and that another has religious objects indicating devotion. Nursing has ventured little beyond this except to indicate that cultural sensitivity is essential, confidentiality and trust should be maintained, and patients’ religious beliefs should be respected. All of this is true and applicable to any and every patient, but it is not specific to religion. For those whose religious adherence is intentional, faith is a matter of life and breath. Religion and the inner life and subsequent actions that emanate from it (referred to as piety or spirituality) is the way in which persons understand and live life in view of their ultimate meaning, beliefs and values. When lived intentionally, it is the unifying and integrative aspect of a person’s life and is experienced as increasingly pervasive and integrative, that is, as a process of growth and maturity. It is the ground motive for life. It integrates, unifies, and vivifies the whole of people’s narratives or stories, embeds their core identity, establishes the fundamental basis for their relationship with others and with society, includes a sense of the transcendent, and is the interpretive lens through which they see the world, including health and illness. It is the basis for community, for it is in spirituality that we experience our consanguinity, our co-participation in the shared human condition (adapted from: Fowler M. Course syllabus: ‘Spiritual care’, Azusa Pacific University, September 1990). The cosmology of a faith tradition can profoundly influence the way in which a person views life and health, and the ethics of the tradition can shape the person’s health care decisions. There are also nurses who are religious; and these nurses’ bioethical analyses and decisions will be informed by their faith tradition. It is critical that religion be removed from nursing’s blind spot. There is a need to move beyond general description to rigorous ethical analyses of religion that will inform and guide clinical practice. For example, a description of the

Commentary on Paley J (2009) Religion and the secularisation of health care. Journal of Clinical Nursing 18, 1963-1974

All propaganda or popularization involves a putting of the complex into the simple, but such a move is instantly not constructive. For if the complex can be put into the simple, then it cannot be as complex as it seemed in the first place; and if the simple can be an adequate medium of such complexity, then it cannot after all be as simple as all that. Terry Eagleton (http://quotationsbook.com/quote/32781/; retrieved 6 February 2009)

Why the history of nursing ethics matters

Modern American nursing has an extensive ethical heritage literature that extends from the 1870s to 1965 when the American Nurses Association issued a policy paper that called for moving nursing education out of hospital diploma programs and into colleges and universities. One consequence of this move was the dispersion of nursing libraries and the loss of nursing ethics textbooks, as they were largely not brought over into the college libraries. In addition to approximately 100 nursing ethics textbooks, the nursing ethics heritage literature also includes hundreds of journal articles that are often made less accessible in modern databases that concentrate on the past 20 or 30 years. A second consequence of nursing’s movement into colleges and universities is that ethics was no longer taught by nursing faculty, but becomes separated and placed as a discrete ethics (later bioethics) course in departments of philosophy or theology. These courses were medically identified and rarely incorporated authentic nursing content. This shift in nursing education occurs contemporaneously with the rise of the field of bioethics. Bioethics is rapidly embraced by nursing, and as it develops within nursing, it fails to incorporate the rich ethical heritage, history, and literature of nursing prior to the development of the field of bioethics. This creates a radical disjunction in nursing’s ethics; a failure to more adequately explore the moral identity of nursing; the development of an ethics with a lack of fit with nursing’s ethical history, literature, and theory; a neglect of nursing’s ideal of service; a diminution of the scope and richness of nursing ethics as social ethics; and a loss of nursing ethical heritage of social justice activism and education. We must reclaim nursing’s rich and capacious ethics heritage literature; the history of nursing ethics matters profoundly.

Healthcare Professional Narratives on Moral Distress: Disciplinary Perspectives

Moral distress, although not always recognized or named as such, is a phenomenon experienced by healthcare professionals from most disciplines and in diverse settings. Although the causes and experience of moral distress may vary with role responsibilities and practice context, powerlessness and lack of control over the situation are common themes across the spectrum. This chapter captures the perspectives of contributors who are nurses, doctors, social workers, chaplains, and pharmacists about their experience of moral distress as healthcare professionals.

Duties to Self: The Nurse as a Person of Dignity and Worth

There is a historical emphasis on duties to self, or self-regarding duties, in nursing’s ethics heritage literature from the 1860s to 1965. Yet, as nursing education shifted to university settings and society and nursing moved away from a virtue-based ethics to a duty-based ethics, the emphasis on self-regarding duties was lost. In the 2001 revision of the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements, that emphasis is reclaimed and restored. The 2015 version of the Code further develops and expands the ethical obligation of duties to self. The aggregate duty or principle of “duties to self” includes attention to personal health, safety, and well-being, preserving one’s wholeness of character and integrity, maintaining competence, and continuing personal and professional growth.