Catálogo de publicaciones - libros

Caring for patients with chronic diseases, including diabetes, causes ethical dilemmas and challenges healthcare professionals constantly during their daily work, particularly nurses. This qualitative case study concentrates on home-care nurses’ experience in diabetes care practice, where complex care takes place in a multi-professional team. The research findings show that home-care nurses experience tensions in the diabetes care context. Tensions can be identified around three themes: identification of care receivers, performance of care actions and foundations of care relationships. The healthcare environment revealed a sense of responsibility without authority, while professional caring responsibilities are not made explicit. Nurses are observably overwhelmed in diabetes care. The research findings may assist in improving diabetes care practice by clarifying the nursing professional’s roles, intensifying nurses’ professional awareness and caring competencies, as well as establishing a nourishing care environment in which all care team members share responsibility and caring.

Nurses in countries with distinctly different healthcare systems like Germany, Norway, the USA and Canada report similar shortcomings in their work environments and the quality of hospital care. Engagement in caring about care in the hospital arena from an ethical perspective and trying to bring in nurses’ voices in HECs can be seen as a reaction to care deficits and loosening care practices that harm patients. In this chapter, nurses’ ethical problems in hospital care and their participation in HECs are traced over the last 30 years on the basis of studies in nursing ethics. The question is whether caring issues can be brought to a head in HECs and, if so, how?

The influence of spatial aspects on patients’ well-being has been described as crucial for more humanizing care. The notion of lived space is usually introduced in this context. In Europe, over the last decade, a lifeworld awareness has increasingly been applied to healthcare. Care given from a lifeworld perspective could provide important ideas and values that are central to the humanization of healthcare practice. This lifeworld perspective is grounded in phenomenological philosophy, which will briefly be described in this chapter, followed by an examination of how lived space is understood and illustrated by examples from empirical research. From a care ethical perspective, however, a broader notion of space is needed that better reflects the practice of care. The lifeworld approach remains focused on care as too narrow an interaction between two people, the patient and the healthcare professional. Therefore, a three-dimensional perspective of space will be explored, as described by philosopher and sociologist Henri Lefebvre. His view allows a shift in focus from the experiencing subject to social practice and changes the object of analysis when studying the (de)humanization of care. This perspective offers a lens to reflect upon and enhance care practices. Also, studying the dynamic interplay between these dimensions may enable a better understanding of spatial vulnerability as it emerges in care practices.

The dyadic relation between a person in need and a person who provides help is one of the core elements of care. Nonetheless, identifying core elements of care alone cannot supply simple solutions to the challenges that are rooted in the ambivalences and tensions of the notion of care in healthcare. Care practices are extensive, situated, and complex. Questions concerning ambivalences and tensions within care include: Can care practices include coercion? Is care compatible with exclusion? Can it be passive or invisible? Can it be incorporated into standardised and regulated routines? Can care and its vocabulary be adjusted to clinical procedures and medical terminology?