But not always. Sometimes adverts coax us to form certain desires in a manner which is compatible with our having autonomy with respect to them. This is something which is commonly forgotten about advertising in practical ethics, given our tendency to suspect advertisers of manipulative practices. This initiative involves three major components: First, the overall promotion and encouragement of breastfeeding. Second, prohibiting the display and distribution of promotional materials for formula milk, and third, discontinuing the distribution of promotional or free formula milk.
Nursing Science Quarterly, 13, Organizationally, a visionary nurse executive who trusts and values nursing staff is essential for creating the context Autonomy relating to breastfeeding high levels of autonomy and CONP. It would stop their tasks to be subordinated to medical practice, as it is now defined in the work organization of the Autonomy relating to breastfeeding model. Porto Alegre: Artmed Panamericana; However, I breastfedding there will always be a deceptive element to advertising infant formula in healthcare facilities. Studies find that clinical nurses participate to a greater extent in decisions related relatiing clinical patient care decisions than to unit or organizational decisions Anthony, ; Blegen et al. Creating an environment that supports both formal and informal continuing educational opportunities and learning provides for autonomous clinical practice.
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- There are four fundamental ethical principles and five major ethical theories.
- Workplace barriers contribute to low rates of breastfeeding.
- Patient autonomy has increasingly become an issue in a health care system that often promotes dependence in decision making.
But not always. Sometimes adverts coax us to form certain desires in a manner which is compatible with our having autonomy with respect to them. This is something which is commonly forgotten about advertising in practical ethics, given our tendency to suspect advertisers of manipulative practices. This initiative involves three major components: First, the overall promotion and encouragement of breastfeeding.
Second, prohibiting the display and distribution of promotional materials for formula milk, and third, discontinuing the distribution of promotional or free formula milk. However, let us consider the second measure. Accordingly, the defence of the measure seems to be that prohibiting the promotion of formula milk will help safe-guard the autonomy of New York mothers with respect to decisions concerning how to nurture their infant. Now this might be a convincing defence if all the promotions for formula milk involved manipulative measures which would coax mothers to abandon breast-feeding in favour of formula in an autonomy-undermining manner.
However, this is very hard to believe. By prohibiting non-manipulative informative advertisements about formula milk, the second measure of the Latch On initiative, far from safe-guarding the autonomy of New York mothers actually undermines it; by cutting off an important information source about a viable alternative to breast-feeding, as well as implicitly suggesting the false view that there is something wrong about using formula, the initiative may serve to reduce the number of options which mothers may consider in their decision about how to nurture their child.
Indeed, we may go so far as to claim that the initiative thus represents an attempt to coerce mothers into breast-feeding. Although we may laud the attempt to encourage women to breastfeed in so far as it has been shown to have various health benefits, it is less clear that we should be coercing women into doing so.
Would it not be better to rely on the first measure, which involves providing mothers with information regarding the benefits of breastfeeding, and which allows women to make an informed, and autonomous choice on the matter? This is true in so far as advertising can serve to increase our autonomy by making us aware of options that are in our choice set, and the facts that count as the actual reasons in each options favour.
I think there are a couple of flawed points in this piece. While information about a product and its existence may be a component of the advertising message, the primary aim is to sell the product.
To provide information produced by the infant formula industry seems inappropriate, at best, and unethical, at worst. Healthcare providers should be equipped to provide evidenced-based care to patients, and in this case this includes both explaining the benefits of breastfeeding for moms and babies, and explaining how to properly use infant formula if desired or required.
The NYC initiative does not prevent the latter. The infant formula industry is well-known for failing to provide such accurate information. There is a big question that needs to be answered and that is what is the baseline here? By this I mean should we describe breast feeding as having benefits as the author does thus implicitly imputing formula feeding as the norm and breast feeding as above and beyond this norm or should we describe not breast feeding as being harmful thus imputing breast feeding as the norm and formula falling below this norm.
You make a good point, But is the consumers autonomy really being undermined? Who then really benefits from formula milk? Corporations are not altruistic. In the former case, it seems that formula may be regarded as the norm, and breast-feeding as going beyond that norm, since I take it that we do not want to say that infants sustained on formula cannot be healthy. However, as the NHS info page suggests, the benefits of breast milk seem to lie in the fact that, unlike formula, it contains certain enzymes and antibodies which will protect the baby in later life.
Liz; thank you for referring to your articles in your reply; I read them with great interest. However, if I may, I shall reply to you solely on the basis of the content of your reply on here, so that others can follow the discussion. But, the point I am trying to make is that a fundamental part of selling a product is informing consumers that it exists.
The fact that the advertiser is trying to sell us something by giving us true information about the product does not seem to undermine our autonomy. What would undermine our autonomy is if the advertisement misinformed us, or otherwise attempted to manipulate our preferences. But this latter property of advertisements does not seem to be necessary to them, in the same way that having an aim of informing a consumer about the product is.
I would agree with you if the information that the industry provided was necessarily deceptive and manipulative. And in its current state, industry advertisement might provide information in such a way.
However, my point was that it need not; it seems perfectly possible to advertise formula using non-deceptive information. As long as the information is true, and based on good evidence, its provision does not seem to me morally objectionable just because it is in an advertisement.
The above piece was written primarily as a general reflection on the nature of the relationship between autonomy and advertising which was prompted by my reading about the Latch On initiative. So let me thank you all once again for your comments; I am learning a great deal! Thanks for the response. However, I think there will always be a deceptive element to advertising infant formula in healthcare facilities.
But in the vast majority of cases wherein women are able to breastfeed, it would run contrary to public health for a provider to endorse the use of infant formula over breastfeeding. As with many health recommendations, patients can and do follow them to different degrees, taking into account their life circumstances and desires. Anyway, the main point is that the context within which advertising is taking place matters when we assess the degree to which it undermines autonomy.
Here, the context lends the product being advertised undue legitimacy, which means that there is something inherently deceptive about advertising for commercial products in that context, particularly when they do not reflect accepted public health recommendations.
There is a straw man in your piece. That formula advertising is not coercive is hypothetical. Is it misleading and. There will always be women who require formula, for many reasons, and that is fine. But babies who are breast fed are healthier. It is sensible for hospitals to nudge women in this direction. One other thing to bear in mind isthat formula is a highly regulated product. There is very little difference between brands other than price.
Practical Ethics Ethics in the News. Advertising, Autonomy and Breastfeeding: Some Reflections. Published August 8, By Jonathan Pugh. August 8, at pm. I think this an interesting and open question which has obvious implications for policy.
August 9, at am. Thanks for the comments. Allow me to make a few short responses. August 9, at pm. August 10, at am. A Sad Victory. What if schizophrenics really are possessed by demons, after all? Select Author Subscribe Via Email. All Rights Reserved.
Increasing recognition of the need to protect, promote and support breastfeeding within the framework of CRC but not that of CEDAW suggests that breastfeeding is regarded primarily as a children's rights issue but only minimally as a women's rights issue. Possible reasons for this minimisation are contextualised with regard to particular political, social and economic forces, especially those influencing notions of gender equality. Six states and the District of Columbia broadly prohibit employers from discriminating on the basis of breastfeeding activities or breastfeeding status. Groleau D, Rodriguez C: Breastfeeding and poverty: negotiating cultural change and symbolic capital in Quebec, Canada. In , the revised MPC ILO C stipulated that nursing breaks were to be paid, but that the decision regarding their number and duration be left to national laws and regulations. Journal of the American Dietetic Association , 9 , —
Autonomy relating to breastfeeding. Background
Professional autonomy of the nurse: some reflections
Clinical nurse autonomy and control over nursing practice CONP have been associated with increased nurse satisfaction and improved patient outcomes - both elements of a healthy work environment. This article outlines strategies for enhancing autonomy as well as strategies for enhancing CONP and describes the importance of articulating expectations for autonomous practice, enhancing competence in clinical expertise, establishing participative decision making, and developing nurses' skills in making decisions.
In addition, the critical role of nurse leaders and the need to work upstream to influence the social, political, and economic factors affecting nursing practice are discussed. Citation: Weston, M. Key words: autonomy, control over nursing practice, decision making, empowerment, healthy work environment, leadership, nurse satisfaction, nursing practice participative decision making, professional practice, professionalism.
A healthy work environment is one that is invigorating, robust, flourishing, and able to flexibly adapt to a constantly changing set of circumstances. A healthy work environment not only establishes a desirable workplace, but also provides the infrastructure to positively impact the effectiveness of the work itself.
They perceived that the organization supported their nursing actions and clinical judgment. In addition, they have been associated with increased respect, status, and recognition for nurses Hinshaw, Nursing work environments with higher levels of autonomy and CONP have also been associated with increased performance and improved patient outcomes.
Autonomy and CONP have been identified as important work environment attributes for enhancing patient safety Institute of Medicine, In addition, even when controlling for nurse staffing and education, hospitals with better care environments, i. Similarly, in the management literature, employee autonomy and control have been associated with improved outcomes. In light of the importance of autonomy and CONP, understanding these concepts and their applicability in practice can support the development and sustainability of a healthy work environment.
This article will provide strategies that nurses can use to strengthen nurse autonomy and CONP in the healthcare setting. In addition the critical role of nurse leaders and the need to work upstream to influence the social, political, and economic factors affecting nursing practice will be discussed.
The Table offers a concise summary of these strategies. As described in the following section, strategies for enhancing autonomy are based on setting clear expectations for autonomous decision making and providing support for increasing the knowledge and expertise of nurses.
Nurses can enhance autonomy by clearly communicating and organizing their work to ensure that they have the freedom to act on nursing decisions using sound clinical judgment. Describing expected behaviors involves communicating that nurses are expected and encouraged to make decisions about clinical patient care that are based on the science and art of nursing.
This involves setting an expectation of independent nursing action and supporting decision making within the scope of nursing practice.
Examples of such identifications include outlining expectations related to verbal physician orders and establishing protocols for over-the-counter medications.
Behavioral expectations can be formally outlined in orientation programs, demonstrated by preceptors, and highlighted through ongoing discussions about clinical practice. In addition to clearly defining expectations for autonomous clinical practice, incorporating nursing knowledge and expertise into clinical practice embeds autonomous practice into patient care. For example, patient care rounds can be organized in a way that ensures that nurses contribute to decision making about the treatment plan of patients.
Including nurses in clinical rounds maximizes the valuable contribution of their unique perspective and information in the care of patients. Recognizing autonomous practice can reinforce verbally communicated expectations. For example, acknowledging exemplary performance by having nurses share clinical examples that highlight autonomous practice provides a venue for displaying sanctioned autonomous practice.
In addition, emphasizing expected behaviors through recognitions and rewards outlines for nurses the realm of autonomous actions. Clinical ladder programs formally reward and recognize clinical practice, further delineating expected autonomous actions.
Role modeling expected behaviors also reinforces autonomous clinical practice. Clinical nurse leaders and clinical nurse specialists in the practice setting can engage in behaviors reflective of autonomy and serve as an ongoing resource for role modeling, coaching, and mentoring excellence in clinical practice. A component of coaching for autonomous behavior includes addressing when behaviors are not within the range of expected actions.
Addressing inappropriate actions using constructive feedback can guide autonomous nursing practice. If nurses take clinical actions that are not appropriate or not successful, constructive feedback can redirect their practice patterns. Studies have suggested that creating a climate that is supportive of nursing practice will augment the level of autonomous practice.
Building trust in the clinical setting by supporting nursing actions that may be risky, yet are safe, encourages innovative practice and enhances autonomy. The establishment of the sound clinical judgment needed for autonomous practice requires a foundation of nursing expertise.
Although difficult to define, nursing expertise is a combination of knowledge and skill along with extensive experience Jasper Thus, implementing strategies to increase the competence of nurses by creating a learning environment can foster autonomy. Stewart, Stansfield, and Tapp reported that autonomy can be fostered by enhancing competence and confidence through strategies such as teaching rounds, formal continuing education, and a climate of inquiry in everyday practice.
Also during staff meetings, clinicians can share complicated patient scenarios that have challenged their autonomous decision making to both exemplify excellence in practice and receive feedback on how to further enhance patient care. Promoting evaluation of autonomous practice in this way allows for unique variation in culture and norms between units.
Encouraging the continuous examination of practice allows nurses to reflect on the degree of autonomy present in their decision making. In addition, establishing an evidence-based practice approach may develop and enhance autonomy.
By identifying and evaluating relevant research while simultaneously assessing and incorporating information about patient preferences into their plans, nurses have the opportunity to make autonomous patient care decisions. Further, development of skills related to communication, interdisciplinary teamwork, and negotiation can assist nurses to master the skills necessary to advocate for their patients.
Creating an environment that supports both formal and informal continuing educational opportunities and learning provides for autonomous clinical practice.
Baccalaureate-prepared nurses have reported a higher preference for both clinical autonomy and CONP Blegen et al. Further, Ericsson, Whyte, and Ward found that nurses with specialty nurse certification and specific clinical training demonstrated higher levels of expertise. Tuition reimbursement and support for returning to school can enhance the development of skills and competence needed to support autonomous practice.
The importance of the culture of learning cannot be stressed enough. For example, while nurse managers at non-Magnet hospitals focused on adequate staffing as a critical element, managers at Magnet hospitals emphasized educational opportunities and an autonomous climate as being a vital factor for nurse satisfaction Upenieks, In summary, autonomy can be increased by strategies that incorporate the unique knowledge and expertise of nurses into clinical patient care.
Clarifying the expectation that valuable nursing knowledge should be applied in the practice setting provides the framework for enhancing clinical autonomy. Professional enrichment and education build the clinical knowledge and competence that is a necessary foundation for nurse autonomy.
To truly control their practice, nurses must have both the right and the power to make decisions affecting the rules surrounding their practice. Nurses must create and use decision-making structures at the workgroup, organizational, and professional levels of practice.
Historically the concepts of empowerment and participatory management have been laden with a paternalistic tone of people in positions of authority allowing staff to provide input and participate in some operations. An organized structure for nurse participation in decisions, along with an explicit communication processes contribute to enhancing CONP. Kramer and Schmalenberg b have shared that nurses in organizations with high levels of CONP describe an operative structure that is in place, one that is recognized as authoritative by others.
The representatives in the structure are known and some input is sought and expected from all nurses. In addition, staff nurses have responsibility and accountability for the issues and solutions discussed within the structure.
The classic example of such a structure is a shared governance council with nurses actively managing decisions related to their practice. The importance of nurses having responsibility and accountability for professional and practice issues cannot be stressed enough. The structure for CONP is one in which the responsibility for nursing care of patients is placed with staff nurses Hinshaw, Fundamentally, this is where many shared governance programs go awry.
In these situations, although an organizational structure is established and nurses are permitted to provide input into key decisions, the ultimate authority for the decision making continues to reside with managers and administrators.
Because nurses typically work as employees within a larger structure and within the healthcare system itself, nurses must have a formal structure for participating in organizational and system decisions. For example, within employment settings, nurses should be included along with physicians and administrators on key organizational committees that establish patient care policies and procedures.
The expectation should be set that nurses will share a full and equal voice in, and responsibility for making patient care decisions McKay, Not only does this foster strong, productive nurse-physician and nurse-administrator relationships, it also contributes to necessary interdisciplinary richness Hinshaw, ; Ponte, Whatever organizational structure is used, nurses should be able to make program and resource decisions without going through layers of bureaucracy that stifle innovation and implementation.
In addition, to be involved, nurses must be active on hospital and professional committees. Nurses can maximize the opportunity for colleagues to attend meetings or complete committee work by adequately staffing for patient care. Fundamentally, nurses need to foster the understanding that their work involves both the direct clinical care of patients as well as the management of the context in which that care is delivered.
As a result, both clinical patient care and organizational and committee work are within the realm of nursing practice. Nurses cannot effectively practice without the right resources including an appropriate amount and mix of caregivers, supplies, and supporting systems or without the necessary evidence-based policies and practices.
To control practice, nurses must have some influence over necessary resources and policies for their practice Hess, To do so, nurses must ensure that they and their colleagues are well-represented and able to be influential whenever and wherever key decisions are being made that will impact the nature, scope, and context of their practice.
Although it is important that clinical nurses serve on committees, they are generally underprepared to do so; hence they are challenged in representing their needs. Studies find that clinical nurses participate to a greater extent in decisions related to clinical patient care decisions than to unit or organizational decisions Anthony, ; Blegen et al.
As a result, investing in teaching nurses about the decision-making process, coaching them through early decision making, and supporting both successful and unsuccessful decisions will foster an environment for increasing autonomy and also CONP. Expecting nurses to participate without allowing opportunities to acquire prerequisite skills will result in either frustration or apathy Hess, Ensuring that nurses develop the skills to manage meetings, gather and analyze existing evidence, explore alternatives, and make sound decisions will support CONP.
In this way, nurses will have the knowledge and ability to not only make recommendations but also be empowered to enact decisions. Nurse leaders, whether in management, clinical, educational, or research positions, can be taught facilitation skills to enhance their ability to garner discussion that leads to identification of group expertise without dominating the discussion or decision making.
Naturally, during decision making, creative tensions will emerge by exposing differences in perspectives and gaps between organizational visions and current realities Burns Teaching leaders to pose questions that expose assumptions and challenge sacred cows can help to illuminate tensions and paradoxes, thus ultimately fostering creative new solutions. In summary, CONP can be increased by strategies that ensure nurse participation in key decisions within the organizational and professional structure.
Establishing the structures and processes for active nurse input and decision making provides the framework for enhancing CONP. Because many nurses have little such experience, investing in teaching and supporting decision making related to the context of nursing care is necessary to build competence for CONP.
Nurse managers in particular are instrumental in producing the conditions for autonomy and CONP. Although leadership can come from any nurse, designated leaders remain extremely influential for enhancing both autonomy and CONP. Consistently the recommendation is made to create strong, visible nursing leadership in the nursing department and at the unit level to increase autonomy and CONP Hinshaw, In a qualitative study, seven staff-nurse focus groups identified and rank ordered the skills needed by a nurse manager to effectively manage a patient care unit.
The top three management skills in descending order were effective communication, remaining available to staff, and involving staff in decision making Maceri, Nurse manager actions, specifically those encouraging nurses to communicate openly with other healthcare team members, supporting nurses to resolve conflicts, and encouraging leadership, were associated with increased nurse participation in patient care and conditions of work decisions Mrayyan, In addition to the critical role of the nurse manager, executive leadership is critical to creating an environment that is supportive of autonomy and CONP.