Participation in German nursing
„Participation“ is no usual, conversational term in the German nursing language. Translated as “part taking” and “co-determination” participation means the political co-determination of the public in bills and in democratic elections. If the German nursing literature and language speaks of participation we rather use terms like “patient self-government” and “self- determination” which mean cooperation or participation in nursing and caring processes. Saunders (1995) who explicitly uses the term of patient participation defines it as „active process of participation in and advancement of therapeutic or general self nursing abilities or the participiation in decisions concerning from reception to dismissal“
My presentation follows the central Theme “Participiation” in this way of definition.
I will give you an overview about the concepts of Participation in the vocational training of nurses, in nursing sciences and especially in the practice of nursing. Therefore i give you an outline of the different areas.
1. Participations in the educational laws of nursing profession
In 2003 the training of nurses was based on new educational laws. With the withdrawal from bio-medical concepts of focussing only on illness and instead putting the focus on health salutogenetic views and focussing on abilities become highly important in training. The motivating question in nursing is no longer “What makes you ill?” but “What keeps you healthy?” and by this consequently includes the clients right of self determination and self nursing abilities.
Accordingly our educational aim is as follows:
“According to the generally accepted degree of knowledge in nursing sciences, medical and other sciences…the education of nurses ...is supposed to teach specialized, personal, social and methodical competences for responsible cooperation in healing, discovering and preventing diseases. Nursing is to focus on the restoration, the improvement, the preservation and the advancement of the physical and psychological health of the client by including preventive, rehabilitative and palliative measures.
In doing this the diverse nursing and living situations as well as the living phases and the independence and self determination of the clients have to be considered.“(vgl. GROSSKOPF 2007)
2. Participation in nursing sciences and research
Though nursing sciences and research is a rather young branch of science pretentious standards of self determination, autonomy and self nursing are evident in its theories, concepts and results of research. Several theories and studies often adopted from the AngloAmerican are based on these central ideas.
For example the american nursing scientist Dorothy E. Orem, obliged to the principle of subsidiary as a principle of Christian social science, speaks of the standards of „self-care“ and „dependent-care“. The latter meaning the care thorugh relatives.
Only if both systems - the system of self-care and the system of dependent -care (care through relatives, neighbours, friends) is not sufficient to fulfil the requirements of care, professional nursing-care is justified.
The principle of participation is also reflected in the various nursing practises (nursing practice systems) that are carried out in cooperation with the client and/or his relatives depending on the degree of decision making abilities and competency (partial-compensatory or supportive-educating nursing practice system).
According to Orem the complete overtaking of nursing (complete compensatory nursing practice system) by a professional nurse is only justified in exceptions and usually in a temporally very restricted way.
Most nursing theories and concepts work with the so called nursing process meaning a working method that structures the complexe nursing practice comprehending several systematically combined phases: assessment of the situation and of the requirements of nursing setting of nursing aims and measures of nursing the actual nursing its evaluation.
Hereby the process of nursing is understood as a process of solving problems and a process of relation that is jointly shaped throughout all phases by both parties - the professionals and the client with his relatives.
Although if a client is able and willing to consume such an active self determining role it depends among other things on the kind and development of his desease. A study of I.Brüggemann using the example of chronically diseased dialysis patients shows that especially chronically diseased assumes a passive patient’s role.
The restrictions and dependencies of dialysis go together with strong physical and particularly with psychological burdens.
The life of the afflicted person depends on the dialysis. That means he permanently threatened by death.
 (BRÜGGEMANN S.73)