The family resemblance metaphor: some unfinished business of interpretive inquiry

Nurses' attitudes towards sexual relationships between patients in high security psychiatric hospitals in England: an exploratory qualitative study

BACKGROUND

The issue of relationships between patients in long-term care settings can present nurses with numerous challenges. However, addressing this element of patient care is recognised as an important element of nursing in this sphere of practice. What nurses think about patient sexual relationships and the difficulties of incorporating these into care is closely linked to the care they provide. However, the issue of patients sexual relationships within high security psychiatric hospitals is a relatively poorly researched area of clinical practice.

AIM

To explore the attitudes towards patients' sexual relationships held by nurses working in high security psychiatric hospitals in England.

METHODS AND PARTICIPANTS

A qualitative methodology was employed with data collected from 10 in-depth interviews with nurses working within secure psychiatric hospitals in England. Interview data were subjected to thematic analysis.

RESULTS

Practitioners reject permissive policy in relation to patients' sexual relationships on account of perceived perpetuation of abuse and exploitation. Practices and attitudes are dominated by personal (lay) values that seek to restrict patient experience and undermine professional mores whilst also seeming to uphold a professional duty of care.

CONCLUSION

Lay understandings are constructed as moral rights and priorities that are of higher order concern than professional values or the rights of the individual. This constitutes a clash of values and the minimisation of professional mores within the clinical context raises questions about the role of professional teaching, knowledge and policy in relation to professional socialisation.

Producing the magnum opus: a metaphor for nephrology nursing expertise acquisition

AIM

This paper elucidates the nature of metaphor and the conditions necessary to its use as an analytic device in qualitative research, and describes how the use of metaphor assisted in the analytic processes of a grounded theory study of nephrology nursing expertise.

BACKGROUND

The use of metaphor is pervasive in everyday thought, language and action. It is an important means for the comprehension and management of everyday life, and makes challenging or problematic concepts easier to explain. Metaphors are also pervasive in quantitative and qualitative research for the same reason. In both everyday life and in research, their use may be implicit or explicit.

METHODS

The study using grounded theory methodology took place in one renal unit in New South Wales, Australia between 1999 and 2000 and included six non-expert and 11 expert nurses. It involved simultaneous data collection and analysis using participant observation, semi-structured interviews and review of nursing documentation.

FINDINGS

A three stage skills-acquisitive process was identified in which an orchestral metaphor was used to explain the relationships between stages and to satisfactorily capture the data coded within each stage.

CONCLUSION

Metaphors create images, clarify and add depth to meanings and, if used appropriately and explicitly in qualitative research, can capture data at highly conceptual levels. Metaphors also assist in explaining the relationship between findings in a clear and coherent manner.

The I-C-A-C framework: uncovering patients' experiences

The use of metaphors to enhance nursing knowledge and intervention has not been thoroughly addressed in a Chinese context. Use of metaphors helps people transform feelings from the inexpressible to the expressible, to revise their view of their own strengths from unaware to aware, and to expand a one-dimensional view to a multifaceted one. Based on the therapeutic essence of metaphors, this article proposes the I-C-A-C framework on the use of metaphors, with a case example given to illustrate how nurses can help uncover patients' illness experiences. The I-C-A-C framework has four strategies: I - Inviting the patients to create and share their metaphors; C - Creating many meanings for the metaphors; A - Analysing the metaphors; amd C - Connecting the patients' metaphors to their personal context. Limitations and implications of the framework for nursing practice are suggested.

Developing a provisional standard for clinical supervision in nursing and health visiting: the methodological trail

The authors outline the process that led to the development of a provisional professional standard for clinical supervision, focusing on design, data collection, and analysis methods. The work was undertaken in an ethos of new paradigm/fifth-generation approaches and used the "manifold of subjective knowing" to gain a holistic understanding of supervisors' experience as represented by experiential, presentational, propositional, and practical knowing. They show how they arrived at the indicators of the standard: Professional Support, Learning, and Accountability. Each of these indicators consists of further elements related to Time, Environment, Relationship (Professional Support), Focus, Knowledge, Interventions (Learning), Organizational Support, Recording, and Competency (Accountability). Findings confirm that clinical supervision practice is complex, and the authors describe proportionally complex methods of analysis.