Contributor: André Mafra Rodrigues
Hospitals and prisons unequivocally have different work objectives. However, they have several similar aspects regarding their operation, organization, and service delivery. Thus, since these organizations have different work objectives, why do behaviors and dynamics persist today that make hospitals so like prisons?
When admitted to any health care facility, patients are immediately assigned a depersonalized identification, either a case number or a bed number. This identification accompanies the patient throughout their stay in the hospital unit and is often used in place of the patient’s name and civil title. Clothing is also provided on admission, the same as for other patients in the hospital unit, and individual props are often not allowed. In daily hospital life, operating routines are established that are superimposed on all patients, whether in the provision of hygiene care, provision of diets, or rest periods. There are also restrictions on visits or the use of personal belongings. Often supported by unclear premises, these practices contribute to depersonalized, undignified, and non-humanized care.
Emergency departments are settings where these practices are exacerbated due to their characteristics. It is essential to reflect on how nursing care can maintain its essence: the holistic care of patients focused on their actual needs and problem-solving, the humanization of care, and the respect for patient’s individuality.
When I think about these aspects in my daily practice as a nurse in an emergency department, I mentally return to the primary and ancestral nursing premises, namely Virginia Henderson’s Fundamental Human Needs or Faye Abdellah’s Twenty-one Nursing Problems. The evolution of time has indeed brought to the knowledge of the science and discipline of nursing. Still, it is also clear that current contexts often affect and disrupt the essence of our actions.
Faye Abdellah’s Grand Theory was presented when the definition of Nursing was becoming blurred (Alligood, 2018) and fell within the School of Needs, along with the works of Virginia Henderson and Dorothea Orem (Meleis, 2018). Abdellah’s work was a crucial stage in the development of nursing as the focus was centered on users rather than techniques (Meleis, 2018)
Abdellah considered nursing to be an art and, simultaneously, a science that shapes each nurse’s attitude, intellectual and technical skills, in what is the desire and ability to help people deal with their health needs. To this end, she formulated 21 Nursing Problems, distributed into three categories: 1) physical, sociological, and emotional needs of the patient, 2) types of interpersonal relationships between the nurse and the patient, and 3) common elements of patient care. For Abdellah, nurses should be able to solve these problems to provide the best care possible (Alligood, 2018).
I believe that nursing should focus on the assumption of practice centered on patients, their needs, and resolving their problems. The provision of nursing care focused on people’s needs is humanizing and dignifying. As an ideology, the person-centered practice focuses on collaboration, sharing, and mutuality so that nursing practice supports patients’ individuality, autonomy, and integrity. These assumptions are based on a collaborative relationship between the person and the nurse, in which needs, wishes, and preferences are actively sought in decision-making, emphasizing the partnership between the person and the nurse (Hesook Suzie Kim, 2015).
During my academic education, I recognized the importance of Advanced Nursing (Schober, 2016). Advanced Nursing is based on a practice with expert knowledge base, complex decision-making skills and clinical competencies for expanded practice (International Council of Nurses, 2020). And, as repeatedly conveyed by the exemplary teaching staff, Advanced Nursing does not mean Nursing with more technology but instead Nursing with more Nursing, i.e., with more scientific knowledge of the body of the discipline and profession. The origin of this knowledge must, undoubtedly, come from Nursing Theories and their fundamental contribution to the daily practice of nurses in any care setting.
Hospitals are not prisons; they should seek to tailor their responses (and those of their professionals) to the problems and individuality of the people who use their services.
− Alligood, M. R. (2018). Nursing theorists and their work (9a th). Elsevier.
− Kim, Hesook Suzie, PhD, RN. (2015). The Essence of Nursing Practice: Philosophy and Perspective. Springer Publishing Company; eBook Nursing Collection. https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=e680sww&AN=981901&lang=pt-pt&site=ehost-live&custid=s1720356
− International Council of Nurses. (2020). Guidelines on Advanced Pratice Nursing 2020. https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf
− Meleis, A. I. (2018). Theoretical nursing: Development and progress (6. ed). Wolters Kluwer.
− Schober, M. (2016). Introduction to Advanced Nursing Practice. Springer International Publishing. https://doi.org/10.1007/978-3-319-32204-9
About André Mafra Rodrigues
I have been a nurse since 2011, and am currently working in an emergency department of a university hospital in Lisbon, Portugal. Since September 2022 I have been attending the Master Nursing Course of the Health Sciences Institute of Universidade Católica Portuguesa (Lisbon). This post was created in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).