A Theoretical Framework for Emancipatory Nursing With a Focus on Environment and Persons' Own and Shared Lifeworld

Nurses' discursive construction of older adult immigrant patients in hospitals

BACKGROUND

The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses.

METHODS

An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses' narratives were analysed using critical discourse analysis (CDA) as described by Fairclough.

RESULTS

The analysis identified an overarching, stable, and dominant discursive practice; 'The discourse of the other', with three interdiscursive practices: (1) 'The discourse on the immigrant patient versus an ideal patient'; (2) 'The expert discourse'; and (3) 'The discourse of adaption'. Older immigrant adults were constructed as 'othered' patients, they were different, alienated, and 'they' were not like 'us'.

CONCLUSION

The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient's autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses' norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as 'othered', have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient's wishes.

Scandinavian Online Cancer Information as Expressions of Governmentality: A Comparative Qualitative Study

We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the "right" decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses.

Primary healthcare nurses' involvement in patient and community participation in the context of chronic diseases: An integrative review

BACKGROUND

Primary healthcare nurses' potential to enable patient and community participation has been increasingly acknowledged. A conceptual understanding of their contributions within a broad range of participation processes is still lacking.

AIMS

The aims of this study were to develop a conceptual framework that provides information on the role of primary healthcare nurses in shaping participation processes with patients and communities in the context of chronic diseases and to identify conditions that enable or hinder the promotion of patient and community participation by nurses.

DESIGN

An integrative review was conducted.

DATA SOURCES

Twenty-three articles published from 2000 to 2019 were included in the analysis: 19 retrieved from PubMed and CHINAL and 4 added through other sources.

REVIEW METHODS

An inductive data analysis and quality appraisal of studies were conducted.

RESULTS

The analysis reveals four areas where nurses are involved in facilitating patient and community participation: (1) sharing understanding of health problems and needs, (2) developing resources and facilitating patient education for self-management, (3) raising patients' voices as an advocate in service development and (4) supporting individual and community networks. The conditions affecting nurses' engagement in fostering participation processes are as follows: (1) care priorities and overall workload, (2) nurses' attitudes towards participation and (3) users' acceptance of nurses as partners.

CONCLUSIONS

Future research can use the framework as a basis for empirical studies investigating nurses' involvement in pursuing patient and community participation. Interventions should focus less on indirect forms of participation, like patient education or advocacy, but should also focus on active forms of participation. Research is needed on nurses' involvement in community participation processes.

IMPACT

This framework can be used and adapted in future research on patient and community participation in primary healthcare. It describes areas of participation and the facilitators and barriers within the broad range of activities of primary healthcare nurses.

Qualitative Observational Research in the Intensive Care Setting: A Personal Reflection on Navigating Ethical and Methodological Issues

The aim of this theoretical paper is to critically reflect on the ethical and methodological issues that arose during a study that observed nurses’ care-giving in an intensive care unit setting. The authors critically discuss the methodological and ethical issues as well as the practical realities that were encountered when evaluating a complex intervention using unstructured qualitative observations. We describe the process with negotiating access and entering into the clinical field. Moreover, we reflect on experiences related to methodological issues such as the observer role, how to construct field notes, and how to encounter ethical dilemmas and other problems when being an observer in a closed and protected setting like an intensive care unit. We argue that qualitative observations give an insider perspective when studying the conditions for health and well-being. Our experiences can be transferred to other contexts and guide researchers interested in doing qualitative observational studies.

Space and place for health and care

Purpose: This discussion paper aims to contribute to a greater understanding of the state of the art of research engaged with conceptual matters of space and place for health and care. Method: The authors, who represent a variety of academic disciplines, discuss and demonstrate the conceptual recognition of space and place in research in health and caring sciences building upon own work and experience. Results: To explore the concepts of space and place for health and care is a research pursuit of utmost importance, and should be made through transdisciplinary research collaborations, whereby spatial theories from various disciplines could be communicated to cultivate truly novel and well-informed research. Furthermore, engaging with relational and topological perceptions of space and place poses methodological challenges to overcome in future research on health and care. Conclusions: We argue that there is a need for accelerating spatially informed research on health and care that is informed by current theories and perspectives on space and place, and transdisciplinary research collaborations are a means to achieving this.

Work-integrated learning as a pedagogical tool to integrate theory and practice in nursing education - An integrative literature review

It can be challenging for nursing students to navigate between theory and practice and to implement theoretical knowledge in real work situations and vice-versa. Work-integrated learning can support the students by enabling them to combine theoretical studies with practical work experience during their clinical placement. The aim of this integrative literature review was to identify models for the integration of theory and practice during clinical placements in nursing education by using work-integrated learning. Sixteen articles were found and analyzed using an integrative review method. Three themes were identified: 1) Supervisor support to enable students to develop a professional identity 2) Variety of modalities for teaching and 3) Collaboration between academic lecturers and clinical supervisors aimed at integrating theoretical and practical knowledge. Work-integrated learning enables students to integrate theory and practice, develop skills for knowledge-in-practice and prepares them for working life. It also supports the sharing of experiences between various healthcare professionals. This review identified a need for further research on work-integrated learning as a method for enhancing nursing students' workplace learning.

Parents' reasons for not attending parental education groups in antenatal and child health care: A qualitative study

AIMS AND OBJECTIVES

To explore expectant and new parents' reasons not to participate in parental education (PE) groups in antenatal care or child health care.

BACKGROUND

In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups.

DESIGN

A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines.

RESULTS

Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents' different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups.

CONCLUSIONS

Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence.

RELEVANCE TO CLINICAL PRACTICE

Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each other's differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.