What are nurses doing to patients? A review of theories of nursing past and present

Of bedpans and ivory towers? Nurse academics’ identities and the sacred and profane: A Bernsteinian analysis and discussion paper

AIM

In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics' identities.

BACKGROUND

The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it.

METHOD

Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated.

FINDINGS

Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics' attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills.

CONCLUSIONS

To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.

Nursing involvement in euthanasia: a ?nursing-as-healing-praxis? approach

In an earlier article, it was found that the terms of preference utilitarianism are insufficiently sound for guiding nursing activity in general, including in relation to nursing involvement in euthanasia. In this article, I shall examine the terms of a more traditional philosophical approach in order to determine the moral legitimacy, or otherwise, of nursing engagement in measures intended to end the lives of patients. In attempting this task, nursing practice is considered in light of what I shall call a 'nursing-as-healing-praxis' approach which includes an account of the moral purpose of nursing and the virtues necessary for realizing that purpose. Ultimately, it is concluded that the terms of this approach rule out the involvement of nurses in euthanasia such that if euthanasia can be justified at all, those outside the nursing profession must provide for its administration.

From Husserl to van Manen. A review of different phenomenological approaches

This paper traces the development of phenomenology as a philosophy originating from the writings of Husserl to its use in phenomenological research and theory development in nursing. The key issues of phenomenological reduction and bracketing are also discussed as they play a pivotal role in the how phenomenological research studies are approached. What has become to be known as "new" phenomenology is also explored and the key differences between it and "traditional" phenomenology are discussed. van Manen's phenomenology is also considered in light of its contemporary popularity among nurse researchers.

Progress, epistemology and human health and welfare: what nurses need to know and why

Human Progress is often understood to be a rather natural and obvious truth of human existence. That this is not necessarily so, is indicative of the pervasive social, psychological, and educational inculcation that sustains its ubiquitous acceptance. Moreover, the uncritical and ill-informed understanding of Progress as an unquestioned expression of human beneficence has serious consequences for those concerned with the health and welfare of people. It is argued in this paper that, much of what we might consider deleterious in the socio-political milieu that now confronts us is, to a significant extent, a matter of progressive ideological epistemology and its ensuing manner of human institutionalization. Part one contends that the current socio-political structure of the current postmodern affairs is in reality that of a pervasive postmodern economic ideology. Part two provides a brief overview of the historical and philosophical development of Progress as an idea, including some of the profound effects wrought by it on human affairs in the contemporary world. Finally, Part three presents a discussion of the influential effects of the philosophy of Progress on the epistemology of human health and welfare intervention, specifically that of nursing and its claim to a holistic ethic of Caring.

Exploring the relationship between caring, love and intimacy in nursing

This article uses the five distinct perspectives on caring proposed by Morse et al (1990) to illustrate the relationship between love, intimacy and caring. Two distinct types of love, namely Agape (altruism/charity) and filia (brother love) are utilized in nursing. Only some caring relationships with patients reach an intimate level, and this is determined by patient characteristics to which the nurse responds. It is concluded that caring as a moral imperative is the most relevant to discussions on caring in nursing and the perspective on which the other four viewpoints hinge.

Power

When asked to put a mental picture to the word nurse, the image people see is often far removed from the image nurses wish to project. Many see nurses as the handmaidens to physicians, wearing white caps and stockings, and surrendering their chairs to physicians. Others see unflattering images from the media. Nursing's tarnished image is partially responsible for a perception of oppression in nursing. Much of nursing's image problem relates to how nurses perceive and use power. Regardless of how nurses perceive power, it is through power that advanced practice nurses (APNs) will be acknowledged as members of a profession versus an occupation. With a better understanding of power, APNs may be able to improve their use of power to advance the profession. This article presents and discusses power through a review of the literature in order to better understand the term as it applies to advanced practice nursing.

Fuzzy logic and nursing

In empiricism, there are only two answers for a question: black or white. Yet, subjective meanings of human behaviours and responses toward health and illness cannot be simply explained with black and white. Gray zones are needed because they are characterized by complexity and require a contextual understanding. In this paper, we present and suggest fuzzy logic as an example of theoretical bases that help transcend the conflicts between objectivity and subjectivity, respect gray zones between black and white answers for questions, and provide a contextual understanding of complex nursing phenomenon. A historical review of fuzzy logic is followed by a definition of fuzzy logic. Then, fuzzy logic is discussed in terms of its compatibility with nursing epistemological views and philosophical thoughts. Fuzzy logic agrees with three categories of epistemological views of nursing, including correspondence, coherence and pragmatism. Fuzzy logic also agrees with four major philosophical thoughts in nursing, including postempiricism, pragmatism, feminism, and postmodernism. Based on the discussion, we propose that fuzzy logic be further explored, used and developed in research and practice in the nursing areas/situations/phenomena that are characterized by complexity, ambiguousness, and vagueness.

Nursing the clinic, being there and hovering: ways of caring in a British fertility unit

AIM

To explore the meaning of caring in a fertility unit and to present the findings and discuss their implications for practice.

BACKGROUND

Little research has been published internationally on the nature of nursing care in the fertility field. This study was intended to stimulate debate over the nature of care in fertility work.

METHODOLOGY

An ethnographic approach, which included part-time participant observation and in-depth focused interviews with staff and patients. Data were also collected using a field and a research diary. Data were analysed using a modified thematic analysis.

FINDINGS

The data suggest that caring is strongly linked with nurses and that patients' expectations of nurses may be more practically than emotionally focused. I argue that the organization of nursing work, which I call 'nursing the clinic and the doctor', facilitated this practical approach to caring. I discuss two features of nursing the clinic and the doctor: hovering and being there.

CONCLUSIONS

While there may be other factors that influence the practice of this form of non-intimate caring, nursing in this way may be what patients desire and may be congruent with managing emotions. The findings have implications for the discourse on intimacy and caring within fertility nursing as well as in different outpatient settings.

A 'good enough' nurse: supporting patients in a fertility unit

In this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as 'emotional awareness' and 'non-caring' as 'emotional distance' may be forms of nursing akin to Fabricius's (1991) arguments around the 'good enough' nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach to caring and do not expect an emotionally intimate relationship from nurses.

Situation-specific theories: philosophical roots, properties, and approach

It is imperative to further develop theoretical bases in nursing, which incorporate diversities and complexities in nursing phenomena, and which consider sociopolitical, cultural, and historic contexts of nursing encounters. Situation-specific theories are proposed in this work as a future direction of such theoretical bases in nursing. Philosophical roots and properties of situation-specific theories are discussed, and an integrative approach to developing this type of theories is suggested. Situation-specific theories could be based on the assumptions of post-empiricism, critical social theory and feminism, and or hermeneutics. Six properties of situation-specific theories are presented: (1) low level of abstraction, (2) reflection of specific nursing phenomena, (3) context, (4) connection to research and/or practice, (5) incorporation of diversities, and (6) limits in generalization. The proposed integrative approach to developing situation-specific theories includes (1) a nursing perspective, (2) a linkage among theory, research, and practice, and (3) a conceptual scheme based on internal and external dialogues.

Preoperative information-giving: an essential element of perioperative practice

The aim of this article is to review the literature pertaining to the perioperative nursing activity of information-giving. The relationship between anxiety, coping strategies and information giving will be discussed, with further consideration of how informational care is affected by the nurse-patient relationship. Inter-related concepts of information giving will be explored as the article develops.

Nursing's knowledge base: does it have to be unique?

An International Seminar held at the University College of Health Sciences, Jonkoping, Sweden, in May 1996, was the stimulus for this article. The purpose of the seminar was to consider the contribution that nursing theory has made to the development of the profession and to identify ways in which this contribution could be enhanced. This article briefly traces the emergence of nursing theory and argues that despite its relatively short history, theory has failed fully to inform practice and is increasingly seen as irrelevant. It is suggested that two trends--the abstract and esoteric nature of much nursing theory and the desire to create a unique' body of nursing knowledge--must be countered before theory can establish its value. It is argued that these are manifestations of professional and academic insecurity which nursing must overcome before it can reach maturity.

Power and vested interests--tacit influences on the construction of nursing curricula?

Educational reform and the introduction of Project 2000 has presented an opportunity to construct broader curricula with the intention of educating adaptive, critical practitioners who are able to deliver holistic patient care. Evidence within nursing literature, and from a small-scale descriptive research study (N = 38), suggests that there is a lack of consensus about how knowledge from various cognate disciplines should be emphasised and structured within nursing curricula. Findings from the research study suggest that the emphasis placed on different cognate disciplines within nursing curricula may reflect individuals' vested interests and power. A conceptual framework based upon the sociology of knowledge, and conflicts and tensions between groups within a profession, is presented as a construct which lends support to this suggestion. It is hoped that this paper will stimulate reflection and critical debate about how knowledge from a variety of cognate disciplines is selected and emphasised in the construction of nursing curricula.

Liaison mental health nursing: origins, definition and prospects

Liaison mental health nursing is an evolving specialist area of mental health nursing in the United Kingdom (UK). It has many similarities with 'psychiatric consultation liaison nursing' practised in the United States of America (USA), but there have been differences in its development. It is well established in general health settings where psychological problems are most apparent, such as accident and emergency services and oncology. However, it lacks clear definition. The author addresses this by examining the literature for evidence of how the role has developed, and how it is currently described. The position of liaison mental health practice within nursing is discussed, and also its relationship to liaison psychiatry. The theoretical base of this specialty may be seen as an integration of biological, psychological and sociological perspectives. There is no current programme of training for liaison mental health nurses, and this is likely to inhibit its recognition as a specialty in the UK. As interest grows in psychosocial aspects of physical health, liaison mental health nursing has the potential to provide a focus for research within nursing. Areas for further development are reviewed, and a research agenda is proposed.