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Medicalisation of life: Are nurses involved?
Margaret Proctor
School of Nursing, University of Canberra, ACT
Abstract
In spite of changes in Nursing Education I believe practise today is still disease centred. Decision making in our health care system is nurse/doctor centred or bureaucratic centred. Beginning practitioners are quickly indoctrinated into practise, as it is today, busy and not patient centered.
Throughout Australia tertiary education students are taught to use nursing models in practice, but in realty the biomedical model is what is used. What is the real difference between these models and does it really matter which one a nurse uses as long as the care is given? Yes, it does matter a great deal to the welfare of patients and families. Let's look at these two models.
The biomedical model focuses on the disease process. It is oriented to pathology, and the actions arising out of it are paternalistic. In this model treatment and cure are the driving forces and these come at any cost. A nursing model of care on the other hand focuses on the response to the disease. The orientation is to the patient and family, in a partnership arrangement. Advocacy and caring acts guide the decision-making process.
If one accepts the biomedical model then I believe that depersonalisation takes place. The nurse begins to see the patient as his/her disease and does not recognise their uniqueness. If a nursing model directs one's practice then the patient and family are guided through the maze of health care with the nurse focused on their individual journey. Decision making becomes patient centred.
Let me give an example of the different outlooks. The patient is a 42-year-old woman diagnosed with breast cancer. The biomedical model suggests that best practice for this disease is surgery (lumpectomy/mastectomy). The patient visits her GP and surgeon and finally meets a nurse on admission to hospital. A nurse working from a biomedical perspective would give the patient information on her impending surgery and what to expect afterwards all from the perspective of her wound and recovery. The nurse's focus would be on what women with breast cancer need to know. She has become a breast cancer patient not a person with breast cancer.
The nurse using a nursing framework would probably meet the woman at the same time but the approach would be very different. The nurse would find out the impact of this diagnosis on the patient and her family. Now you might be thinking yes, but the end result would be the same. I disagree. By developing a relationship with the woman the nurse would be able to help her steer the course, so if the outcome is surgery it will be the patient orchestrating when this will be done. She and her family will be in control. We have turned her from a victim to be acted upon to a willing participant.
Certainly there are nurses who combine the biomedical and nursing models to give comprehensive care. However, I believe as long as nurses practice from a biomedical framework we reduce the patient to their disease and do not then give optimum professional nursing care. I believe that if nurses really want to make a difference in people's lives we must begin to practise from a nursing perspective.
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