Patient Autonomy and Medical Paternity: can nurses help doctors to listen to patients?

Breier-Mackie, Sarah

doi:10.1177/096973300100800605

Cited by 43 publications

(26 citation statements)

References 41 publications

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“…However, this is not meant as a female equivalent of paternalism. Paternalistic nursing is an institutional construction that overrules the preferences, decisions or actions of a patient in support of their overall treatment and evokes a more oppressive fostering of dependence (Breier‐Mackie 2001). The maternalistic approach is personal and individual, used to describe a person who cares about the patient as well as for them.…”

Section: Discussionmentioning

confidence: 99%

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals

Wright

Hacking

2011

Psychiatric Ment Health Nurs

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Adults with anorexia are an under-researched group because the usual focus is on adolescents. The relationships that occur between healthcare professionals and adults with anorexia are often challenging, because they do not necessarily agree on the goals of treatment. The therapeutic relationship is widely recognized as crucial to care, even healing and restorative in its own right but problematic in this setting. This is a phenomenological study of how therapeutic relationships are negotiated and maintained in a day care service. Six women with anorexia nervosa and seven of their healthcare professionals were interviewed in the care setting to explore their lived experience of their relationships. Six important themes emerged from the interviews: the authenticity of the relationship, safety, the externalization of the eating disorder, recovery measured in kilos, the power of hope and optimism and the use and acceptance of maternalism in the care setting. Findings suggest that patients appreciated the safety and security of care, but some were using the service as respite rather than recovery. Patients saw goals and tasks related directly to weight gain as irrelevant to their main concerns, but engagement with people who provided a secure, nurturing and maternalistic context for safety and optimism was seen as supportive.

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Section: Discussionmentioning

confidence: 99%

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals

Wright

Hacking

2011

Psychiatric Ment Health Nurs

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“…One place this is particularly evident is when making a decision to move from aggressive treatment to palliative care. In ‘Patient Autonomy and Medical Paternity: Can Nurses Help Doctors to Listen to Patients?’, Sarah Breier-Mackie argues that nurses have a significant role to play in end-of-life care 18. Given their commitment to patient advocacy and their role in the patient's day-to-day care, Breier-Mackie argues that nurses can help facilitate discussions between physicians and patients about medical futility and shifting approaches to terminal illnesses.

[The relationship between patients and nurses allows for] a triple assessment of the current health state, the influence of this state on the person, and the influence on the person's ability to achieve meaningful life goals that distinguishes nursing from medicine.

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Section: Promoting Patient Autonomy By Supporting Professional Autonomentioning

confidence: 99%

The moral agency of institutions: effectively using expert nurses to support patient autonomy

Charles

2016

J Med Ethics

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Patient autonomy-with an emphasis on informed consent and the right to refuse treatment-is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions. However, the skills of expert nurses also support patient autonomy in more subtle ways. Specifically, nurses develop skills of attunement that help them to find subtle ways to support patient autonomy. However, in order to effectively do this, nurses need institutions that support their professional autonomy. In this paper, I look at the ways nurses have been inhibited in their professional autonomy both as a profession and as individual practitioners. I argue that turning our attention to institutions and the role they play in supporting or undermining nurses' autonomy can help promote nurses' professional autonomy and thereby enhance patient autonomy.

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“…Time and again, in all kinds of medical discourse, empowerment is included as one of the leading principles of today's health care: let them be children, elderly, disabled or simply patients, the patient must be empowered. In all its variety, empowerment stems from the idea that medical professionals should no longer paternalize patients [7]. Instead, patients are considered to manage their medical condition (medication, diet prescriptions, using medical devices) or should be trained towards ‘active and responsible agents’ [8].…”

Section: Empowermentmentioning

confidence: 99%

Foucault at the bedside: a critical analysis of empowering a healthy lifestyle

Devisch

Vanheule

2015

Evaluation Clinical Practice

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Since quite a few years, philosophy is heading towards the bedside of the patient: the practice of philosophy has stepped out of its ivory tower, it seems, to deal with empirical or practical questions. Apart from the advantages, we should keep in mind the importance of a critical analysis of medical or clinical practice as such. If ethics partakes the clinical stage, it runs the risk only to discuss the how question and to forget the more fundamental what or why questions: what are we doing exactly and why is it good for? Starting from the principle of the empowerment of the patient, we will demonstrate how the discourse on empowerment in health care seems to forget a profound reflection upon this principle as such. By rehearsing some basics from the governmentality theory of Michel Foucault and the actualization of it by Nicolas Rose, we will argue how philosophical investigation in medical-ethical evolutions such as empowerment of the patient is still needed to understand what is really going on in today's clinical practice.

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Patient Autonomy and Medical Paternity: can nurses help doctors to listen to patients?

Cited by 43 publications

References 41 publications

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals

An angel on my shoulder: a study of relationships between women with anorexia and healthcare professionals

The moral agency of institutions: effectively using expert nurses to support patient autonomy

Foucault at the bedside: a critical analysis of empowering a healthy lifestyle

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