Re-reading nursing and re-writing practice: towards an empirically based reformulation of the nursing mandate.
This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real-life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future.
Allen
Davina
D
Nursing, Health and Social Care Research Centre, School of Nursing and Midwifery Studies, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff CF24 0AB, Wales, UK.
D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D004282:Documentation; D004645:Empathy; D015276:Health Care Rationing; D007722:Health Knowledge, Attitudes, Practice; D006694:Holistic Health; D006801:Humans; D016294:Models, Nursing; D017008:Negotiating; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D015404:Nursing Methodology Research / Q000458:organization & administration*; D009742:Nursing Theory; D010687:Philosophy, Nursing; D012938:Social Perception; D012945:Social Values; D014956:Writing