Advancing nursing practice: an evaluation study of Parse's theory of human becoming

The purpose of this study was to evaluate the changes in nursing practice and the patient/family perspectives of nursing care when Parse's theory of human becoming was used as a guide for nursing practice in an acute care surgical setting. The patterns of transition in nursing practice were: understanding the unique contribution of nursing from a theoretical perspective; living value priorities to enhance quality of care for patients and families; shifting the focus of care from problems to the nurse-person relationship; finding meaning in nursing through reflection on self and others; supporting colleagues to move towards patient centred care; persisting with new ways while facing resistance to change; and enhancing personal and professional growth. It is evident from the positive patterns of change in nursing practice and patient and family experiences of nursing care that Parse's theory of human becoming is congruent with and supports patient centred nursing practice.

Imaging ourselves: nurses' metaphors of practice

Metaphors are vivid, expressive tools popularly used in everyday conversations. The familiarity of metaphors combined with their capacity for generating meaning make the metaphor a powerful heuristic device for effecting nursing discoveries and pedagogical shifts. Exploring nursing metaphors can provide opportunities to develop new understandings of nursing and challenge metaphorical images that may be constraining and/or obscuring significant elements of holistic nursing practice. A research study that examined the metaphorical images of practicing nurses uncovered a wide variety of images. The thematic analysis of the metaphorical descriptions illuminated four major themes: (a) the character of nursing work, (b) power and empowerment, (c) nursing as a growth process, and (d) the relational nature of nursing. Nurses' metaphorical images provide a window into the complexities and ambiguities within nursing practice. The images highlight the significance of social and organizational constraints that influence how nurses take up their practice, the ways in which nurses feel unable to practice holistically, and the struggles nurses encounter when they try.

Developmental differences in the ability to inhibit the initial misinterpretation of garden path passages

The Hamm and Hasher (1992) procedure was used to examine whether children abandon their initial misinterpretation of garden path passages. Children (mean ages: 9 years-2 months and 12 years-4 months) and young adults (22 years-11 months) listened to either expected or unexpected (garden path) versions of passages that differed in the degree to which they provided contextual support for the final, correct interpretation. The first half of garden path passages initially led the listener to generate an incorrect interpretation. The second half of the passage provided information that clearly supported the correct inference and required the abandonment of the previous misinterpretation. Correct target inferences were formed and were equally available to all age groups. However, both groups of children were more likely than adults to accept competing inferences as being consistent with their understanding at the conclusion of garden path passages. The results suggest that developmental differences exist in the ability to inhibit thoughts that are no longer relevant in a listening comprehension and memory task.

The experience of living with persistent pain

This article reports themes from a descriptive exploratory study conducted with 17 persons who live with persistent pain. The purpose of the research was to enhance understanding of what it is like to live with persistent pain from the perspectives of those who live the experience. Participant narratives of living with persistent pain included descriptions of physical pain as well as the pain of loss and restriction. The theory of human becoming provided the framework for guiding researcher-participant discussions and interpretation of findings. Three themes arose from the analysis: forbearance surfaces with the drain of persistent anguish; isolating retreats coexist with comforting engagements; and hope for relief clarifies priorities for daily living. The findings expand understanding about quality of life for persons who live with persistent pain. They also challenge nurses to begin focusing on the person who lives with pain as the messenger of how to endure. Recommendations, based on new understanding, are offered for practice and additional research.

A holistic view of nursing concepts and theories in practice

This article offers an alternative view to Hall's statements concerning concepts and theories in nursing practice. This article also represents an example of how journal articles can be forums for ongoing dialogue about the complex matters related to developing nursing knowledge. New ideas are presented by which the concept of self-transcendence, developmental theory, and theory in general are viewed from a holistic perspective rather than the perspectives offered in Hall's article. In contrast to Hall's claims about theory and about developmental theory in particular, theory is discussed as integral to holistic nursing practice.

An investigation of dental student values

The development of a dental student's professional values system is an important issue in dental education. The purpose of this study was to assess the relative importance of different values of dental student and instructor populations at a single dental school. Data was collected from surveys disseminated to dental students and faculty. Statistical analysis of the data indicated faculty showed a different set of values than students. Faculty placed greater value on patient care and clinical education. Students were more focused on passing licensure examinations, completing course requirements, and personal satisfaction. Junior and senior dental students placed greater value on the requirements of becoming a licensed dentist than did their younger student colleagues. Freshman and sophomore dental students placed higher values on additional academic pursuits and personal growth. This study also revealed no statistically significant difference between males and females in any of the values ranked.

Knowledge enrichment and conceptual change in folkbiology: evidence from Williams syndrome

Ten participants with Williams syndrome (WS) (average verbal mental age of 11;5) were compared to two groups of normally developing children (average mental ages 10;11 and 6;7 years) with respect to intuitive biological knowledge about people, animals, and plants. Participants in the older control group were individually matched to the participants with WS on verbal mental age. The probes for biological understanding were drawn from the existing literature on the development of folkbiology and were divided into two batteries based on the hypothesized distinction of (1) general knowledge consistent with the conceptual repertoire of normally developing preschool children (the T1/T2-Neutral Animal Knowledge battery) and (2) folkbiological concepts normally acquired between ages 6 and 12 which require conceptual change for their construction (life, death, people-as-one-animal-among-many, species kind as determined by origin of the animal; the T2-Dependent battery). The two task batteries were equated for task demands, differing only in the content of the concepts probed. It was hypothesized that if this distinction is a false one, and the construction of folkbiology is accomplished entirely by enrichment of the preschooler's knowledge, there should never be a population with differential performance on these two batteries. People with WS were nonetheless found to be differentially impaired on the T2-Dependent battery. They performed at the level of the older control group on the T1/T2-Neutral battery, but at the level of the 6-year-olds on the T2-Dependent battery. These data support the distinction between two types of conceptual knowledge acquisition: acquisition of new knowledge formulated over an existing conceptual base (enrichment), on the one hand, and knowledge acquisition that results in genuine conceptual change, on the other. The implication of these results for a precise characterization of how concepts of people with "cocktail party syndrome" may be "superficial" is also discussed.

Coping in young women: theoretical retroduction

Although there is increasing interest in women's health, there remains little empirical evidence concerning concepts related to health and women's life trajectory. Our purpose in conducting this research was to examine women's developmental stressors and coping during young adulthood. Lazarus and Folkman's coping model provided sensitizing concepts for data generation in a retroductive research methodology. The sample included 26 women of diverse perspectives who participated in interviews and groups. Philosophical concerns of subjectivity, context and gender sensitivity were actualized in iterative stages of data collection, analysis and comparison to extant theory. Rapidly expanding multiple roles were identified as developmental stressors for young women. Decontextualized coping strategies are arranged on a behavioural continuum: avoidance, distraction, and confrontation. Contextualized descriptions of coping are presented in two representative accounts: Lauren and Mary Ellen. A philosophical stance, assumed at about the age of 30, provides a lens for assessing developmental stressors that influence the appraisal process. Rich descriptions of young women's coping and developmental influences move beyond abstract theory to a contextual understanding of young women's experiences.

From acorn to oak tree: a neoplatonic perspective of reflection and caring

This paper provides a meta-analysis of reflection and caring. Placed within a philosophical framework, the nurse's call to care is explored. Drawing upon Rosemarie Parse's theory of human becoming (1981) and Plato's myth of Er (Hillman, 1996), the author discusses the idea of caring as an 'innate image'. This image is expanded throughout the paper as the author uses the analogy of the acorn as containing the becoming oak tree.

Helping adolescents who have disabilities negotiate transitions to adulthood

Adolescents who have disabilities face unique challenges as they progress through the transitions necessary to achieve optimum functioning in adulthood. These youths often need professional assistance to successfully negotiate these important transitions. Our article describes processes for collaborating with these adolescents, their families, and other professionals to facilitate successful transitions to a more healthy, productive, and satisfying adulthood.

A commentary on Newman's theory of health as expanding consciousness

This is an explication of Newman's theory of health. The authors provide concrete examples of its application and note its points of intersection with certain aspects of Eastern thought and alternative medicine. Ideas from other disciplines are brought in order to illuminate Newman's theory from a variety of perspectives. Certain aspects of the theory the authors find problematic also are noted.

The 1998 Herbert L. Needleman Award Lecture. Adolescent health: priorities for the next millennium

There have been dramatic changes in adolescent health status over the past decade that have resulted from successful interventions. Overall mortality rates are down 14%, and many morbidities have declined. Today we know many of the elements that reduce risk: parental caring and connectedness, parental expectations for school and parent availability all outweigh family structure, ethnicity, and income. Likewise, schools can be extremely protective when young people feel connectedness. Factors associated with successful interventions include: strengthening families; strengthening educational involvement; expanding economic opportunities; and supporting youth development, not just problem reduction. Priorities for the next decade include: establishing resiliency-building interventions; developing positive correlates of negative behaviors; establishing broader multisectorial interdisciplinary teams; and formulating a new, more inclusive framework for adolescent health and development.

Reflections on health in development and human rights

As the end of the 20th century draws near, the goal of health for all by the year 2000 will not have been achieved. Social and economic development, sporadic and biased in terms of regions, countries and social groups, has been inhibiting the achievement of health for all, just as gender, age and ethnic discrimination has been preventing access to health care and other essential goods and services. On the other hand, the intrinsic value of health and its contribution to the realization of human rights have been increasingly recognized. The need to promote the full enjoyment of all human rights as being essential to the achievement of health for all has also been increasingly acknowledged. WHO's renewed health-for-all policy seeks to realize the right to health as the most basic tenet of the WHO Constitution by creating the conditions whereby people everywhere, throughout their lives, have the opportunity to reach and maintain their own health potential. This article traces the evolution of the concept of health in development in WHO and highlights the importance of putting health at the centre of development efforts if we are to achieve health for all in the next century. It also calls attention to the need for using a health-in-development approach to work towards the progressive realization of the right to health as enshrined in the WHO Constitution and in numerous international and regional instruments. Major lines of action that WHO will be pursuing in its commitment to health in development and human rights are also outlined.

HIV informal caregiving: emergent conflict and growth

Findings are reported from a prospective study of 20 persons on the experience of providing informal care to partners or family members with HIV syndrome. In-depth, focused interviews were completed. Data were initially coded using an inductive technique and thematically analyzed. The informal care providers were found to engage in a variety of interacting, and often conflicting, psychosocial and instrumental processes that occurred over three emergent phases: (a) transitions to care, (b) living the burden, and (c) facing the void. Although the care providers struggled with various sources of uncertainty and distress, when periods of equanimity were realized, they experienced a heightened sense of coherence and personal growth.

Health profile of the ageing population: the Swedish experience

Sweden is demographically one of the oldest countries in the world. The average life expectancy is comparatively high. However, the total number of physical and mental disorders, which may affect the elderly, seems to be increasing and becoming more and more complicated to prevent and treat. The rapid changes in the human biotope, threatening the quality of life of Man, play an important role in this development. The elderly in the future will, thus, have a health profile which may differ significantly from that of today's elderly. As general health is largely dependent on the 'health' of the environment and oral health may be the mirror image of general health, dentistry has a key position and responsibility in the international action programme for a sustainable development (Agenda 21, UNCED, 1992). Therefore, traditional curricula in, for example, odontology should be supplemented with interdisciplinary courses with a focus on a holistic view of the human condition. In collaboration with UNESCO, such an educational programme has been developed at Göteborg University. It aims at assisting each person to take on an increased self-responsibility for his or her immediate environment and health ('individual Agenda 21'). At present, an educational network is being established in Eastern Europe, in collaboration with medical and odontological faculties at the national universities.

Patients' views of quality of life: transforming the knowledge base of nursing

Nurses in advanced practice roles are leaders of the transformative process that will further define the discipline of nursing as a human science of lived experience. Essential to the transformation is a change in nursing's knowledge base, a change that defines practice and research as participative, open, and quality enhancing. To demonstrate the transformation of knowledge in practice, the authors present findings from a qualitative research study guided by the nursing theory called human becoming. The purpose of the study was to enhance understanding of quality of life for patients receiving acute psychiatric care. A descriptive exploratory design was used to guide data gathering and analysis of 24 people. Findings are presented in themes that represent quality-of-life issues, including feelings of loss and shifting value priorities, the complex nature of relationships that ease and upset, and the hopes that fuel the intense struggle to go on living. Directions for practice and research are suggested.

Developmental expression of cytochrome P450 enzymes in human liver

Drug-metabolizing cytochrome P450 enzymes, the major phase I enzymes, are active in human liver already at very early stages of intrauterine development, although presumably at fairly low concentrations and in low numbers. During maturation, these enzymes go through various developmental programmes towards adulthood. The major increase both in abundance as well as in number of different enzymes takes place after birth, probably during the first year of life. Detailed information concerning these developmental changes is still limited. The major drug-metabolizing P450 enzymes appear to be primarily members of the CYP3A subfamily in all stages of development. The balance between different members of this subfamily, however, undergoes significant switches from the foetal predominant CYP3A7 to the major adult form CYP3A4. The ontogeny of the other cytochrome P450 enzymes is less well characterized, but the major switch-on appears to occur mainly after birth. Developmental expression of P450 enzymes is one of the key factors determining the pharmacokinetic status of developing individuals both pre- and postnatally.

Clarifying the relationship of medical education and moral development

PURPOSE

To assess the development of the moral reasoning skills of medical students through the course of their education, and to determine whether their scores would reflect the increases usually found at this age range and education level.

METHOD

Using Rest's Defining Issues Test (DIT), the authors assessed the moral reasoning of a total of 95 Texas A&M medical students from the classes of 1991-94 at the beginning of their first semester, at the end of a required first-semester medical ethics course, and at the end of the students' fourth year.

RESULTS

The mean score on the first test was 47.7; on the second, 53.7; and on the third, 56.5. The +6.0 change in mean scores from the first to second test was statistically significant (p < .0001), as was the +8.8 change from the first to final test (p < .0001). The +2.8 change from the second to final test was also significant, although at a lower level (p < .0302). Analysis revealed no significant correlation between moral reasoning scores and age; however, there was a significant correlation between moral reasoning scores and sex, with women scoring higher than men on all three tests.

CONCLUSIONS

While data from the current study seem to contradict earlier findings that medical education inhibits an increase in moral reasoning skills, the current findings may alternatively be interpreted as resulting mainly from the required first-semester medical ethics course, which involved small-group discussion of moral dilemmas, an educational method shown elsewhere to be effective in enhancing moral reasoning skills.