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首页> 外文学位 >'We can't be nurses anymore': Depersonalizing contexts and community health nurses' responses to market-driven health care.
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'We can't be nurses anymore': Depersonalizing contexts and community health nurses' responses to market-driven health care.

机译：“我们不能再当护士了”：个性化环境和社区保健护士对市场驱动的保健的反应。

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摘要

Going beyond the usual institutional performance measures of cost, efficiency, and market penetration, in this institutional ethics study changing structures in home care were examined as forces shaping morality among a group of community health nurses. The nurses worked at Riverside, a public sector home care agency, purchased by a non-profit integrated health system just prior to this research. Analyzing the nurses' experiences with the market model unfolding in their work world presented a unique opportunity to study the role of institutions in morality and to understand how corporatization is influencing the meaning of caregiving in home care.;Guided by the assumption that understanding morality requires a focus on actual experience, data were generated by this ethnographic inquiry over four years using participant observation, interviews, and organizational archives. The findings show that the nurses were propelled through a disturbing moral career trajectory of depersonalization that left imprints on their identity, relationships, and actions. In that sense, institutions are actually part of personhood.;Starting out as "county nurses" and redefined as "corporate commodities," the nurses reflected, "We can't be nurses' anymore." Signaling the loss of personhood, their conclusion suggests that the marketplace is imposing a concept of nurse on health care that does not include person. Treating nurses as instruments for "making visits and making money," combined with objectifying patients, as "referrals" with "a pay source," transforms the good of caregiving relationships into an impersonal business arrangement.;Suspended in a turbulent liminal period, the nurses' work created a thin line between a humane home care system and a nearly universal mechanistic one. Refusing to fully integrate a corporate persona into their understanding of self, the nurses "adjusted things" on behalf of patients and wrestled with the marketplace to preserve their capacity to nurse. In doing so, their moral comportment serves as a model for resisting depersonalization in complex organizations and simultaneously highlights the schism between corporate health care and persons. If the nurses' stories are heard above the turmoil of the marketplace, it will be an opportunity to put persons into the picture of reform by addressing morally problematic aspects of health care institutions.
机译：超越了通常的成本，效率和市场渗透率的机构绩效指标，在这项机构伦理学研究中，家庭护理的变化结构作为塑造社区保健护士道德的力量进行了检验。在这项研究之前，这些护士在公共部门家庭护理机构Riverside工作，该机构由非营利性综合卫生系统购买。分析护士在工作环境中不断发展的市场模式的经验，为研究机构在道德中的作用以及了解公司化如何影响家庭护理中的护理含义提供了独特的机会。着重于实际经验，该人种学调查使用参与者观察，访谈和组织档案记录了四年来的数据。研究结果表明，护士受到人格解体的令人不安的道德职业轨迹的推动，这给他们的身份，关系和行为留下了烙印。从这个意义上说，机构实际上是人格的一部分。从“县护士”开始，并重新定义为“公司商品”，护士反映，“我们不能再成为护士了。”他们的结论暗示着人格的丧失，市场表明市场正在将护士的概念强加于不包括人在内的医疗保健领域。将护士当作“探视和赚钱”的工具，与客观化患者相结合，作为具有“报酬来源”的“转诊”，将看护关系的好处转变为非个人化的业务安排。护士的工作在人性化的家庭护理系统和几乎通用的机械系统之间划清了界限。护士拒绝将企业角色完全融入他们对自我的理解中，他们代表患者“调整了事情”，并与市场竞争，以维护其护理能力。这样做时，他们的道德举止可作为抵抗复杂组织中人格解体的典范，同时突出了公司医疗保健与人之间的分裂。如果在市场动荡之上听到护士的故事，这将是一个机会，通过解决卫生保健机构的道德问题，使人们进入改革的视野。

著录项

  • 作者

    Olsan, Tobie Hittle.;

  • 作者单位

    University of Rochester School of Nursing.;

  • 授予单位 University of Rochester School of Nursing.;
  • 学科 Health Sciences Nursing.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2003
  • 页码 425 p.
  • 总页数 425
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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