'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing

Abstract This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.     

Characteristics of patients referred for discharge planning from a geriatric ward at a national university hospital in Japan: Implications for improving hospital programs

Abstract The purpose of the present study was to identify the characteristics of patients from a geriatric ward who were referred for discharge planning support, a service provided by the first multidisciplinary department for discharge planning among the national university hospitals in Japan. From October 1997 to May 1999, 335 patients were discharged; 23 patients (6.9%) were referred. The referred patients were older and more frequently diagnosed with malignancy, dementia and respiratory infection. In addition, they had lower activities of daily living (ADL) and instrumental ADL scores. Those characteristics, which may be related to the longer hospital stay and lower rate of returning home of the referred patients, can be assessed early in hospitalization to identify patients at risk for difficult discharge planning. It is important to identify patients who need earlier intervention by formalized discharge planning so that the current situation of overly long hospitalization in Japan will improve.     

Utilization of the Iowa Modelin establishing evidence-based nursing practice

Clinical practice based on tradition or established rituals appears to be widespread amongst a variety of nurses and practice settings. However, tradition-based practice may not necessarily be based on sound scientific evidence and could potentially be harmful to patients or result in inappropriate utilization of resources. Conversely, evidence-based practice is the utilization of the best available empirical evidence in the practice setting, to facilitate sound clinical decision-making. Suctioning ventilated patients is a necessary and important aspect of patient care. However, normal saline instillation prior to suctioning, in order to loosen secretions, remains a common nursing procedure despite research suggesting that there is no clear benefit and in some instances may be harmful. Several models have been developed over the past few years to facilitate nursing practice that is based on research or the best available evidence. The Iowa Model, developed at the University of Iowa Hospitals and Clinics, serves as a framework to improve patient outcomes, enhance nursing practice and monitor health care costs. Moreover, it facilitates the application of empirical evidence to clinical practice. This paper will discuss the utilization of the Iowa Model to promote evidence-based nursing practice, with regard to normal saline instillation prior to suctioning, in the critical care unit of a 100-bed hospital in Hong Kong. Patient, staff and fiscal outcomes will also be reported.