Jamesian pragmatism: a framework for working towards unified diversity in nursing knowledge development

Nursing is frequently described as practical or pragmatic and there are many parallels between nursing and pragmatism, the school of thought. Pragmatism is often glancingly referenced by nursing authors, but few have conducted in‐depth discussions about its applicability to nursing; and few have identified it as a significant theoretical basis for nursing research. William James's pragmatism has not been discussed substantially in the nursing context, despite obvious complementarities. James's theme of pluralism fits with nursing's diversity and plurality; his emphasis on social conscience in our actions matches nursing's fundamental purpose of improving the lives of others; his continuous testing of pluralistic truths in critically reflective practice pairs well with nursing's focus on developing best‐available, holistic evidence; and his conceptualization of truth as being born in practice and becoming an instrument in practice is entirely compatible with nursing's theory–practice identity. The oft‐discussed theory–practice gap is seen to hinder the development of nursing knowledge. If nursing is to find its identity in knowledge development and potentiate the knowledge developed, it is imperative to identify and address that which is impeding progress. By way of the pragmatic tenets of William James, I will argue that a significant part of the theory–practice gap lies in how nursing knowledge development is operationalized, creating a false dichotomy between practice and research. I will also argue that the research–practice schism has been widened by continued philosophical and methodological infighting in the research community. I will describe how Jamesian pragmatism can be ‘what works’ for rebuilding relationships and supporting an engaged plurality within nursing research and bring research and practice together into a collaborative and iterative process of developing nursing knowledge.     

Reflection-on-practice: enhancing student learning

The writing of a reflective diary is viewed as an effective tool for promoting reflection and learning in students, and for self-assessment and evaluation of a clinical learning experience This work is a study of 30 undergraduate nurses and then- use of reflective diaries during a period of community health care practice The theoretical basis of the study is based on Schon's work on reflection-in-action The research tool, developed for the study of nursing practice by Powell, is based on Mezirow's levels of reflectivity The findings are that, in the sample used, students do reflect on their practice according to Mezirow's levels of reflectivity, but that the highest number of reflections occur at the lower levels of reflectivity (94% of the total number of scores) However, although only 6% of the total number of scores were found at the higher levels of reflectivity, some 22 of the sample of 30 students did attain conceptual and theoretical reflectivity, the highest levels of reflectivity     

A Randomized Clinical Trial to Assess the Impact on an Emergency Response System on Anxiety and Health Care Use among Older Emergency Patients after a Fall

Objectives: Personal emergency response systems (PERSs) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department (ED) to home. This study measured the impact of a PERS on anxiety, fear of falling, and subsequent health care use among older ED patients.
Methods: This study was a randomized controlled trial comparing PERS use with standard ED discharge planning in subjects 70 years of age or older discharged home after a fall. Outcome assessors were blinded to the study objectives. Anxiety and fear of falling were measured at baseline and 30 days using the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and modified Falls Efficacy Scale (mFES). Return to the ED, hospitalization, and length of stay were recorded after 30 and 60 days.
Results: Eighty-six subjects were randomized and completed follow up (43 per group). There was no important difference in mean reduction in anxiety (mean change treatment − control, +0.35; 95% confidence interval [CI] =−1.5 to 0.76; p = 0.55) or fear of falling (mean change, +4.5; 95% CI =−6.7 to 15.7; p = 0.70). Return visits to the ED occurred in eight of 43 patients in both the control and treatment groups (risk difference, 0.0%; 95% CI =−16% to 16%). Hospitalization occurred in six of 43 in the control group versus three of 43 in the treatment group (risk difference treatment − control =−7.0%; 95% CI =−19.8% to 5.9%).
Conclusions: In contrast to previous studies, there was no evidence that a PERS reduced anxiety, fear of falling, or return to the ED among older persons discharged from the ED.     

Patient satisfaction with care in the emergency department

This paper looks at the patient satisfaction levels with care in an emergency department (ED) setting. Specific aspects of nursing care, information given to patients, auxiliary personnel and ED environment are examined in the light of the current literature on the subject. Recommendations for practice are provided to assist the nurse and administrator in updating their accountability to the ED patient.     

The Betty Neuman Systems Model applied to practice: a client with multiple sclerosis

The importance of nursing theories and models for the growth and development of the profession of nursing is widely acknowledged. The variety of nursing phenomena and situations demands some flexibility in the choice of specific conceptualizations to be used. This paper demonstrates the goodness of fit of the Betty Neuman Systems Model to the care of clients with multiple sclerosis. An adapted assessment tool, based on Neuman's tool, but more useful in the acute care medical setting, is used to gather data related to a woman with recently diagnosed multiple sclerosis. A nursing care plan illustrating the use of Neuman's model is generated, implemented and evaluated. The Neuman Model is demonstrated to be useful and effective in the implementation of the nursing process in this case.     

The psycho‐social dimension of pain and health‐related quality of life in the oldest old

Background: Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health‐related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce. Aims: The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho‐social) and health‐related quality of life as well as to compare sex and age groups in people aged 80 years and over. Methods: In this cross‐sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho‐social dimension of pain was measured using the Multidimensional Pain Inventory–Swedish language version (MPI‐S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health‐related quality of life was measured using the Short Form Health Survey‐12 (SF‐12). Results: Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI‐S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80–85 years had higher pain severity than those aged ≥86. Participants with a lower health‐related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life. Conclusions: Older people with prolonged pain suffered from a low health‐related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people’s physical, mental and social health.     

Depression: Risikofaktor für den Typ-2-Diabetes?

Diabetes and depression are both common diseases each having a significant impact on the individuals affected, as well as on the health care system. The combination of diabetes and depression leads to disproportionally high mortality and co-morbidity. Only recently, data on the association between diabetes and depression have been available from longitudinal studies. It could be shown that people suffering from depression have a distinctly higher risk of contracting diabetes, whereas the inverse risk is less pronounced. However, people suffering from diabetic complications are at higher risk. Conclusion: Type 2 diabetes and depression are associated. Patients with depression as well as patients with diabetes should be monitored for indications of the other disease.