Theory for nursing practice

[Science and nursing science: What links, what issues and what future development for the discipline of nursing?]

This article examines the terms science, discipline and knowledge from the perspective of the use and advancement of knowledge in the discipline of nursing. It views the notion of organized knowledge as the foundation of a science as well as considering the use of scientific methods as imperative in any discipline that aims to contribute to the world of ideas by relying on rationality. This paper aims to trace the link between science and nursing science, to clarify scientific issues for nursing, and to begin thinking about understanding the concept of diversity and the effective contribution of doctoral training in nursing as a guarantee of the future evolution of this discipline.

Relational Inquiry Approach: Nursing Practice in Pakistan - A Case Study

The relational inquiry approach enables nurses to understand and examine different nursing situations within complex healthcare contexts using the ideologies of pragmatism, critical theory, and hermeneutic phenomenology. In this paper, the author presents the application of the relational inquiry approach using Newman's theory to analyze a case of a man who refused coronary artery bypass surgery in Pakistan. This analysis demonstrates that relational inquiry is useful in examining patients' experiences and related healthcare needs and helps the nurses to perform appropriate actions to produce desirable outcomes.

Health as Expanding Consciousness

The authors of this column explore the implications of Newman’s theory of health as expanding consciousness for health policy. One aim is to expand the theory’s practice methodology and praxis methods to the development of health policy, an under-represented area in the health as expanding consciousness literature. The second aim is to suggest a framework for policy development, the health as expanding consciousness policy protocol, and explore the possible impact that theory-guided policy may have on community and nursing efforts to transform health and public policy.

Health in partnership: family nursing practice for people with breathing difficulties

Reorienting the focus of health systems to incorporate a multifaceted approach that allows for comprehensive and humane health care is pending. Using the participatory paradigm approach, we describe a study of a partnership-based family nursing practice for people with breathing difficulties. We generated data through nine conversations with eight patients accompanied by a close family member (n = 6) and one wife, 15 conversations between the authors, and through a reflective journal. Narrative data analysis was conducted. Results that reveal the meaning and experience of the family nursing practice are presented in four interlacing descriptive statements: (a) surfacing and contextualizing health problems, (b) responsiveness of services, (c) security-stability-self-direction, and (d) unified family efforts- transformation. We conclude that the conceptual framework of partnership is a useful approach to nursing practice within a nurse clinic for people with advanced breathing difficulties and their families.

The relational core of nursing practice as partnership

BACKGROUND

Consideration of the relational core of nursing has gained significance in today's health systems, where the work of nurses is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. This has led to disregard for individual experiences of living life with diverse health conditions.

AIM

The aim of this paper is to articulate the relational core of nursing practice as partnership.

DISCUSSION

The relational core of nursing practice is explicated as a process of professional partnership, focusing on the evolving dialogue between nurse and patient. In partnership, the dialogue is open, caring, mutually responsive and non-directive. The nurse attends to that which is of concern to patients in relation to their health predicaments and the meaning in the health experience unfolds. Nurse and patient reach insight that represents more useful ways of comprehending and acting on their health predicaments.

CONCLUSIONS

Partnership represents theoretically-driven practice that invites nurses to meet patients where they are in understanding their health predicaments and what can be done about them. As such, partnership strengthens the resolve of nurses to resist the pressures of contemporary health service delivery to provide a technical form of practice and it protects the relational core of a fully professional practice.

Partnership in practice

Modern health care has increasingly focused on prescriptive, outcomes-oriented, and cost-effective practices concomitantly obscuring the humanness of the health experience. A reconsideration of partnership between nurse and client as the core of the discipline might call nurses back to what is essential to nursing: a caring relationship centered on that which is meaningful as health. This article points to the significance of the relational nature of partnership, differentiating its features and form from the prevalent understanding associated with prescriptive interventions to achieve predetermined goals and outcomes. The meaning of partnership is presented as nursing practice as it unfolds: a process of nurse and client relationship through which the caring presence of the nurse becomes integral to the health experience of the client as the potential for action. Exemplars provide illustration of this emerging view in practice and research. The article is intended to contribute to the expanding dialogue on nursing practice, inviting discussion of the relevance of partnership in different health systems.

Nursing theory views on how to support the process of ageing

BACKGROUND

An important purpose of theories is to challenge practice, create new approaches to practice and remodel the structures of rules and principles. Therefore, it is of interest to study whether it is possible to make use of nursing theories in care of older people, when the aim is to support them in the process of ageing.

AIM

To review 17 well-known nursing theories/models in order to delineate the views on ageing presented and discover whether there are descriptions of how nursing care of older people could be organized.

METHODS

Seventeen nursing theories/models originating over a 30-year period from the early 1960s to the early 1990s were chosen. A search of CINAHL was done and lists of reference from books were used to find original sources. For the review, a list of research questions were formulated and addressed to each theory.

RESULTS

Results showed that most nursing theorists see human ageing from a developmental perspective, but do not discuss what ageing implies. In only a few theories are some important aspects of nursing care of older people discussed, but no concrete instructions are given on how to apply these to nursing care.

CONCLUSION

There is a need to develop a nursing care model that - more than other contemporary theories - takes into consideration human ageing.

Practice wisdom

A participatory process approach in research and scholarship is proposed in the context of the postmodern movement and a disciplinary emphasis on practice. Two sequential studies are presented to illustrate praxis in nursing in which health is expanding consciousness. A framework of personal practice was developed from the first study and reconceptualized in the second as a process of modeling practice involving partnership, dialogue, pattern recognition, and health as dialectic. This praxis illustrates the merging of theory, practice and research as practice wisdom. Health and caring can be seen as the same process.

Ideological implications of paradigm discourse

Whilst the notions of paradigm and paradigm shift have become popularized in nursing's scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivation underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.

Sailing beyond: nursing theory and the person

This article explores nursing's conceptualization of the person in terms of holism and uniqueness. These concepts raise concerns from postmodernist and feminist perspectives in terms of the unitary self, essentialism, culturalism, agency, and subjectivity. The use of holism and uniqueness in nursing theory appeals to the generic person, disregards interactions among the individual's race, class, and sex, and, thus, leaves larger institutional and societal issues unacknowledged, unexplored, and unchallenged. Nursing theories are needed that have social justice as their goal.

Expanding self-awareness through exploration of meaningful experience

In a phenomenological investigation of nurses' meaningful experiences with patients, the author continued investigation of caregiver/patient interaction reported in two previous studies of confirmation and exclusion. Exploration of meaningful experience is presented as an avenue for greater self-awareness for the caregiver. Findings include description of study participants' lived meaningful experiences and the essential structures of experiencing meaningfulness. The lived meaningful experiences were characterized by intense emotion, implicit experiencing, and relating. The essential structures of experiencing meaningfulness were found to be a temporal process of reflecting and articulating the discovery of self and the function of meaningful experience as a template for both future and past experiences. Expanded self-understanding through exploration of meaningful experience is discussed for its significance in nursing practice and education.