en the moral and clinical priorities of patient care vis-a-vis the priorities of bureaucratic institutions and health insurers: Some nurses have been disciplined for documenting patient requests for treatment beyond insurance-covered conditions, and others appear to have been co-opted into the practice of delivering health care by the (HMO) numbers (Gordon & Fagin, 1996), although injunctions toward compassionate interaction with patients and families seem first principles of nursing (Czerwiec, 1996). One voice urges home-health-care nurses to make a project of accommodating and adapting to transcultural or multicultural health-care issues, e.g., ethnic, religious, and educational factors influencing effective nursing care (Grossman, 1996). Another expresses alarm at the ways in which nurses have relinquished their position as patient-care advocates in the clinical setting and instead been positioned by insurance and hospital
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