Nursing as concrete philosophy,Part I: Risjord on nursing knowledge

This essay addresses the problem of the essentiality of nursing knowledge and what kind of theory, if any, is essential to nursing practice. The overarching aim of the essay was to argue for the thesis that nursing may be described as a kind of philosophical activity, and, consequently, that philosophy is the kind of “theory” that is essential to nursing practice and to the nursing discipline at large. The essay consists of two papers. The present paper, Part I, is a critical examination of Mark Risjord's discussion of the problem of the theory‐practice gap in his Nursing Knowledge: Practice, Science, Philosophy, from 2010. According to Risjord, the cause of the theory‐practice gap originates in an erroneous conception of science (logical positivism) which had a decisive influence upon the way nursing scholars appropriated theoretical frameworks for the nursing discipline. This philosophical influence is considered in effect to have generated the theory–practice gap. In order to bridge the gap, Risjord suggests, the nursing discipline needs to adopt a standpoint epistemology conjoined with a postpositivist conception of scientific theory. In this way, a legitimate brand of nursing science may be developed and the theory–practice gap overcome. I will argue that neither Risjord's diagnosis of the problem, nor his recommended cure, may succeed in rescuing the nursing discipline from the theory–practice gap. Rather, the real cause of the theory–practice gap, I will claim, derives from an erroneous conception of nursing (not of science), namely the conception of nursing as a kind of science (roughly speaking). On my view, to overcome the gap, the nursing discipline needs to make salient the inherently philosophical character of nursing. In the second paper (Part II), I will continue the discussion of nursing knowledge and delineate the thesis of nursing as a kind of concrete philosophy.     

护士执业环境对护理人为差错的影响研究

目的调查护士执业环境与护理人为差错的现状,并探讨护士执业环境对人为差错的影响。方法采用护士执业环境测评量表和护理人为差错量表对重庆市万州区所有医院的护士进行问卷普查。结果共调查医院77所,被调查护士3 442名。护士执业环境得分88.54±11.51;护理人为差错得分1.65±0.51;护士执业环境各维度及总体得分与护理人为差错各维度及总体得分均显著负相关（Pearson's r=-0.658～-0.286,P＜0.05）;多重线性回归分析显示,控制人口学变量后,执业环境的6个维度均是人为差错的重要影响因素（P＜0.05）。结论管理者应采取有效措施改善护士执业环境,尤其是“优质护理服务基础”“薪酬待遇和社会地位”“参与医院事务”,从而减少护理人为差错,保障患者安全。     

Locating the lived body in client–nurse interactions: Embodiment,intersubjectivity and intercorporeality

The practice of nursing involves ongoing interactions between nurses' and clients' lived bodies. Despite this, several scholars have suggested that the “lived body” (Merleau‐Ponty, 1962) has not been given its due place in nursing practice, education or research (Draper, J Adv Nurs, 70, 2014, 2235). With the advent of electronic health records and increased use of technology, face‐to‐face assessment and embodied understanding of clients' lived bodies may be on the decline. Furthermore, staffing levels may not afford the time nurses need to be as “present” with their clients in embodied ways. The failure to attend to the lived body may contribute to missed opportunities for care and decreased quality of life for both clients and healthcare practitioners. In this paper, we undertake an analysis of selected aspects of the work of Maurice Merleau‐Ponty. The aim is to advance understanding of the affordances this work may offer to enhancing client–nurse interactions within the practice of nursing. Merleau‐Ponty's notions of embodiment, intersubjectivity and intercorporeality as articulated in his seminal texts The Phenomenology of Perception (New York, NY: Routledge, 2012) and The Visible and the Invisible (Evanston, IL: Northwestern University Press, 1968) are examined. These three constructs are discussed as they relate to the lived body in client–nurse interactions in nursing practice and education. Finally, implications of how attention to “the lived body” could shape interactions and have the potential to foster increased quality of life of clients and nurses are considered.     

Exploring Nurses’ Involvement in Artificial Nutrition and Hydration at the End of Life: A Scoping Review

This review aimed to summarize existing nursing literature to provide an overview of the extent, range, and nature of nurses’ involvement in artificial nutrition and hydration (ANH) at the end of life and to map the key concepts underpinning nurses’ involvement in ANH. A scoping review was designed following the methodological framework guidelines of Arksey and O'Malley and the recommendations for advancing the methodology by Levac et al. An inductive qualitative content analysis was conducted according to the guidelines by Elo and Kyngäs. Thirty-nine articles were identified. Content analysis revealed 1 main category: “nurses’ role in the decision-making process,” with the 2 subcategories of “mediator” and “activator.” The category and subcategories are influenced by the following generic categories: “being,” “feeling,” and “knowing,” each of them constituted by 2 subcategories in their turn. Nurses perform the roles of activator and mediator. Their ability to establish good relationships and their attitudes enable the creation of teamwork and closeness to patients and family: relationships and attitudes are the subcategories of the “being” category. The category “feeling” represents the ways nurses experience the decision-making process, which can raise ethical and moral dilemmas and cause emotional responses. For these reasons, nurses have to create the right balance between personal-self and professional-self. The category “knowing” includes nurses’ clinical and ethical knowledge about ANH. It emerges that deep clinical and ethical knowledge of ANH is necessary to provide consistent, adequate care at end of life.     

国外军队医院护理管理启示与借鉴

本文在借鉴国外先进医院管理理念的基础上,以“病人满意、社会满意、政府满意、护士满意”为宗旨,牢固树立“姓军为兵、姓军为战”服务军民的理念,通过护理质量管理、品牌营造与学科建设,不断优化护理质量,改善服务模式,搭建学术平台,打造人才梯队,促进服务水平提升,塑造护理品牌。     

Authentic intention: Tempering the dehumanizing aspects of technology on behalf of good nursing care

The nursing profession has a responsibility to ensure that nursing goals and perspectives as these have developed over time remain the focus of its work. Explored in this paper is the potential problem for the nursing profession of recognizing both the promises and pitfalls of informational technologies so as to use them wisely in behalf of ethical patient care. We make a normative claim that maintaining a critical stance toward the use of informational technologies in practice and in influencing the thought patterns of the younger generations of nurses is a moral imperative of the discipline, because without this practice can become subverted from professional goals in various ways. We use a synthesized concept we call “intentional authenticity” derived from the writing of Heidegger and Feminist care ethics to provide a foundation for the development of nurses who understand the importance of the nurse‐patient relationship and how the unthoughtful use of informational and other technologies can militate against effective or good nursing care.     

Occupational therapy and culture: a literature review

Abstract

Background: Occupational therapy has culture as a relevant phenomenon of interest. Culture appears increasingly often in occupational therapy research, from diverse approaches and foci. As culture is difficult to define, and has political and ethical implications, an investigation into its usage is warranted. Aim: To identify and describe how culture as a broad phenomenon is expressed in OT research published between 2006 and 2011, regarding knowledge development in the discipline and its impact on practice. Methods: A qualitative study was carried out, using an integrative literature review. Thirty-nine studies in English were included. Results: From the analysis, two dimensions concerning expressions of culture emerged: “culture is alive” and “occupational therapy as a culture”. Aside from these dimensions, a group of forces that have an impact on these dimensions is described. Conclusions: In its understanding of expressions of culture, occupational therapy stands at a crossroads between traditional and critical approaches. A lack of critical insight into professional knowledge increases the risk that occupational therapy will remain satisfied with the current understanding of culture, based on the dominant knowledge. The discipline could fail to address the political, ethical, and theoretical issues required to reach the targeted diversity in its practice.     

The central question and the scope of nursing research

As nursing continues to develop as a professional discipline, it is important for nurses to have a central question to guide their research. Since the 1800s, nursing practice and research have covered a wide scope in cooperation with other disciplines. This wide area of nursing practice and research has led to the proposal that the central question be: How can the well‐being of a person, family, community, or population be improved? The proposed question must remain flexible and open to revision because nurses will continue to adapt to the changing needs of their patients and populations and to their complex and evolving work environments.     

临床教学中让护生担任护士角色的效果分析

目的探讨在临床教学中让护生担任护士角色的临床教学效果。方法将120名实习护生随机分为实验组60例,采用“非指导性教学法、合作性教学法的放手放眼事后检查”的教学方法。对照组60例,采用常规带教方法。通过问卷形式对两组教学方法的效果及对病人的影响进行比较分析。结果实验组教学效果明显优于对照组。护患关系、理论联系实际、应急、独立工作能力等方面与对照组比较,差异有显著的统计学意义(P<0.05)。结论临床教学过程中应打破常规的带教方法,让护生担任护士角色,充分发挥护生的实习潜能,有利于提高护生独立思考、分析、处理问题的工作能力。提高护理教学质量,有利于护理队伍人才的培养。     

六位一体护理学科建设体系构建

如何将学科建设与临床护理相结合,以科学研究成果推动护理学科发展,是值得探讨的课题。以医院学科建设理论为依据,审视医院护理学科发展情况,从护理信息化、护理人力资源管理、优质护理服务、护理质量管理、护理培训和护理科研等6个方面,构建了六位一体护理学科建设体系。实践后,该院护士离职率远低于《三级综合医院评审标准实施细则（2011年版）》要求,住院患者满意度提升,出院患者回访率提高,慢病管理病种数增加,慢病管理患者数上升,慢病患者复诊率提高,护理不良事件发生率下降。未来,仍需在护理人力配置、患者服务体系、护士职称晋升、患者风险预警等方面深化护理学科建设。     

Causal criteria and the problem of complex causation

Nancy Cartwright begins her recent book, Hunting Causes and Using Them, by noting that while a few years ago real causal claims were in dispute, nowadays “causality is back, and with a vengeance.” In the case of the social sciences, Keith Morrison writes that “Social science asks ‘why?’. Detecting causality or its corollary—prediction—is the jewel in the crown of social science research.” With respect to the health sciences, Judea Pearl writes that the “research questions that motivate most studies in the health sciences are causal in nature.” However, not all data used by people interested in making causal claims come from experiments that use random assignment to control and treatment groups. Indeed, much research in the social and health science depends on non-experimental, observational data. Thus, one of the most important problems in the social and health sciences concerns making warranted causal claims using non-experimental, observational data; viz., “Can observational data be used to make etiological inferences leading to warranted causal claims?” This paper examines one method of warranting causal claims that is especially widespread in epidemiology and the health sciences generally—the use of causal criteria. It is argued that cases of complex causation generally, and redundant causation—both causal overdetermination and causal preemption—specifically, undermine the use of such criteria to warrant causal claims.     

Reconciling conceptualizations of ethical conduct and person‐centred care of older people with cognitive impairment in acute care settings

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise , when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand , sovereign expressions of life and parrhêsia . We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research.     

A critical analysis of the failure of nurses to raise concerns about poor patient care

The occurrence of poor patient care is emerging as one of the most significant, challenging, and critical issues confronting contemporary nursing and those responsible for the provision of health care more generally. Indeed, as a consequence of the increased recognition of the manner in which nurses can be implicated in the occurrence of poor patient care, there has been sustained critical debate that seeks to understand how such healthcare failings can occur and, in particular, why nurses seemingly fail to intervene, raise concerns, and effectively respond to prevent the occurrence and continuation of such poor patient care. In seeking to contribute to this critical discussion, and in contrast to those “situational explanations” that maintain that the failure to raise concerns is a consequence of the contextual factors and challenging conditions to which nurses can be subject in the clinical setting, this paper will provide a resolutely philosophical analysis of that failure. In particular, it will draw upon the work of Jean‐Paul Sartre—the French philosopher generally regarded as one of the most influential thinkers of the twentieth century—in order to propose that his work can be productively recontextualized to provide a detailed, challenging, and provocative critical analysis of the occurrence and continuation of poor patient care and the role of individual nurse practitioners in such healthcare failings.     

How “age-friendly” are deprescribing interventions? A scoping review of deprescribing trials

Objective

To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—“Medication”, “Mentation”, “Mobility”, and “What Matters Most” to the person—can be used to guide assessment of age-friendliness of deprescribing trials.

Data Source

Published literature.

Study Design

Scoping review.

Data Extraction Methods

The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms.

Principal Findings

Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: “Medication” was considered in the intervention design of all trials; “Mentation” was considered in eight trials; “Mobility” (n = 2) and “What Matters Most” (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: “Medication” was the most commonly assessed outcome (n = 33), followed by “Mobility” (n = 13) and “Mentation” (n = 10) outcomes, with no study examining “What Matters Most” outcomes.

Conclusions

“Mentation” and “Mobility”, and “What Matters Most” have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.     

我院落实非在编护士聘后待遇的实践与体会

目的 推进非在编护士岗位同工同酬,探讨稳定护理队伍有效措施.方法 由人事部门和护理部牵头,发挥党团工会政治思想工作优势,统一认识,缩小临床科室非在编护士与在编护士各种福利待遇和发展机会上的差距,努力做到同工同酬.结果 非在编护士全部加入了工会;成为共青团重要力量;工资、保险和其他福利待遇得到了保障;有了正常技术职务晋升...     

Reconciling economic concepts and person‐centred care of the older person with cognitive impairment in the acute care setting

Person‐centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person‐centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person‐centred. In this article, we explore key concepts of neo‐liberal thought which forms an important back‐story to the articles. Economic concepts, “efficiency” and “freedom” are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo‐liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power.     

Patient Involvement: A New Source of Stress in Health Care Work?

Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers’ partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N = 488, response rate 67%). The sample was comprised of registered nurses (RNs, n = 303), licensed practical nurses (LPNs, n = 132), and physicians (MDs, n = 53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one’s clinical work. Regression analyses were used to examine factors associated with staff’s partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negative—“Hassles”—and positive—“Uplifts”—aspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.