Profesjonsetiske utfordringer i et helseforetak : en kvalitativ studie av sykepleiere ved to psykiatriske akuttposter i et helseforetak
Doctoral thesis, Peer reviewed
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“Professional Ethical Challenges within a Health Enterprise” is a qualitative study of 14 nurses and 2 unity heads of two psychiatric emergency posts in a psychiatric health care enterprise. The study explores modern challenges that these nursing personnel meet at work: challenges that require of them an increasing degree of regulation and standardization. The study is defined and limited by two research questions: 1. Which ethical and moral challenges do these nurses experience? 2. Does the implementation of governmental reforms affect the nurses` possibilities for acting as professional nurses, and if so, in what way? A study of ethical challenges should perhaps end on a normative note. I have therefore chosen in the final chapter to undertake an ethical reflection over the data I have gathered and my own experience and presuppositions. The questions I address in this chapter are as follows: -What are the central ethical and moral challenges met by nurses in a hospital psychiatric ward? - What implications do these challenges have for other relevant actors? The background for the study In 2002 the Norwegian government overtook responsibility for the hospitals. This led to new organizational changes in specialized health care, the implementation of a health enterprise reform, and new health laws. The dissertation is a study of professional ethics, and my starting point is the reflections of nurses on their own praxis. My interpretation of these reflections draws on theories from the fields of 8 ethics, sociology and profession studies. The focus of the dissertation is on what the professional ethic of the nursing profession is and/or should be. Should professional nurses adhere to the political mandate alone, or should nurses base their professional conduct on the relational aspect where behavioural ethics are in focus? Based on the challenges indicated above, I have chosen to utilize a qualitative study in order to obtain depth knowledge of the nurses’ experiences and reflections on praxis. The aim has been to study relationships and variations among the nurses in their understanding of the social reality. A triple hermeneutical approach is used to explore the nurses’ interpretations, my interpretations, and those social factors that affect both the nurses and me. It is essential to understand all these aspects, as they together describe context into which the reforms, amended laws, rules and procedures described in the dissertation were introduced. The data collection is based on documents and interviews. The analysis of documents was used to provide a background context for the interviews, and an overview of the changes that have occurred since the health enterprise reform was implemented and the amended laws introduced. The analysis indicates that the nurses’ practice is based on ethical concepts for rules and duty. They perform their duties loyally to the system and to the practice of the work place, even though they may to a certain extent disagree with the ideology that the post espouses. The health enterprise reform therefore impacts on the possibilities for the nurses to act professionally. They use their expertise, but they don`t seem to reflect on their actions in terms of their professional ethics. Central objections to the ethical rules in sway are that they might weaken nurses’ personal commitment, empathy and morale, and for this reason are not substantial enough in light of the important social function of the profession. In my view, the nurses themselves must contribute to establishing a good culture for reflection in their posts, among other things by taking initiative to establishing meeting places where different challenges may be discussed in order to create good practice. The nurses have a responsibility for exercising good professionalism in their meetings with the patients.
Avhandling for graden philosophiae doctor Universitetet i Agder, Fakultet for humaniora og pedagogikk