The 3 Degree programme on TV3 last night on neoliberalism and economic policy provided good food for ethical thought.

Great to see positive outcome for first stage of court hearings for Kristine Bartlett and the Service and
Food Workers Union in the case for caregivers wages being so poor as this traditionally seen as women's work.

As the article on the Antipodean Perspective on Quality says,  Quality in Health Care is a relatively new phenomenon. Started in the 1980's, when studies showed huge discrepancies in health outcomes at different facilities, length of hospital stays, numbers of errors and adverse events which were far higher than expected and of course probably a major driver in this the expense that inefficiencies and adverse events brought, this came at the same time as health consumers became more vocal in their health care. Quality systems were brought in that originated in post war Japanese manufacturing industries and Total Quality Management follows that through as not being reactive as Quality Improvement was critiques as being but working proactively to improve systems and outcomes. There is always the question of human fallibility, but in Quality it is said that an adverse event usually has precursors of "near misses" and it is important that these are recognised and acted upon. It could be that the human fallibility in an adverse event could have been avoided if near miss episodes had been recognised, reported and followed up, also what systems have been in place that act as supports to prevent the human fallibility element?
Just some thoughts...

How the world changes. When I started my nursing education in 1980, I have no memory of learning anything that was to do with legislation. We did not know about the International Council of Nurses or that there had been a Code of Ethics for nursing from this organisation since 1953. With that sort of background the legislative environment within which we work is accepted as being in existence without explicit knowledge. Certainly that is different now as part of undergraduate nursing education. Over the years aspects of the Health and Safety in Employment Act, The Privacy Act, Code of Rights and Health Practitioners Competency Act have become part of in-service education at the workplace and foundations for policies and guidelines and in the last year or so that has also included the Code of Conduct and Professional Boundaries. Depending on the employer and  their contractual requirements, these in-services that many of us take for granted may not be available to Registered Nurses employed.
"The nurse advocates for equity and social justice in resource allocation" (ICN,2012:p. 3), how often do we hear nurses and our organisations speaking out. I know though that there are some great innovations and programmes out there, but do we celebrate them enough?

I was thinking that the NCNZ Code of Conduct and Professional Boundaries guidelines make very good frames of reference when considering appraisal of self and others, and can provide a constructive and helpful mechanism for feedback.

Follow On

Quick comment before with training from the teenager in the house, now able to go solo - hopefully.
Found the Keenan chapters interesting and readable which was great as I have found the ethics chapters in Johnson's rather like reading mud. My main interest has been the rooting of ethics and law in the cultural mores and based on the views and interests of the most powerful in society. With the discussion re the George Foreman scenario I had to look up "Advanced Directives" and as I thought a grey area legally.
Advance Directives and End of Life decisions are very much part of documentation and discussion in aged care and we tend to be very pragmatic about it. I realised that our pragmatism is not shared by all when working with overseas nurses. Some of them are shocked by our open discussion with clients asking their preferences/choices as this would not be acceptable in their culture.

Reading Check

Found Keenan's Healthcare and the Law chapters surprisingly interesting.