Nursing research refrained by the inescapable reality of practice: a personal encounter

This paper describes how an innocent venture outside the confines of academia to update my nursing skills completely changed the focus of my research. I was deeply involved in the theoretical development of my thesis, which I thought was a feminist exploration of the meaning of health for mid-life women. I was immersed in feminist theory and was exploring the work of the French Feminists. I had written comprehensive draft chapters about nursing, women's bodies and science. While I was absorbed in my theoretical exploration I decided to venture back into practice to improve my nursing skills. I am still unsure why I chose to do this; however, in hindsight, my theoretical exploration was inexorably pushing me in that direction. While my conscious thinking was focused on my stated topic, my subconscious (my intuition) turned me towards another. Being confronted with the reality of nursing practice through working with staff nurses in a gynaecological ward caused a major disjunction in every aspect of my research: the topic, my methodology and the setting, and the experience challenged my feelings about nurses and nursing. This inevitably led to a dramatic and fundamental change in my research.     

From the tower into the trenches: a nurse educator's reflections on the knowledge of experience

I have been in the tower for a long time. I have been teaching nursing for more than 20 years, and only now, after spending 6 months in the trenches as a staff nurse, have I begun to realize how far removed I had become from the real world of nursing. In this article, I will first discuss the experiences that motivated me to take a leave of absence from my teaching position in Canada for a staff nurse position in an acute care hospital in Florida. Then I will share my early reflections about what I learned as a staff nurse in Florida and how I interpreted this experience in the context of my own teaching practice and in the context of nursing education.     

The marriage of nursing and law: Combining two helping professions

When I am asked what I do for a living, I reply that I am both a practicing nurse and a practicing attorney. The next question is usually, “How can you do both?” I reply, “I was a nurse first, then I went to law school 18 years later. By virtue of my nursing background, I am what would be called a nurturing attorney.” I then am asked, “Isn't that an oxymoron?”In my application to law school, I was asked to make a personal statement about my reasons for wanting to be accepted into the program. I told the professors that I wanted to learn all about the law so I could take that information back to my colleagues in health care and teach them how to avoid litigation. I was accepted, and I have not known a dull moment since!     

THE JUDGMENT PROCESS IN NURSING

I am committed to the diversity of nursing arising from its basic unity, that is, tender loving care. I am convinced that this domain is the unique province of nursing and that this is where nursing must focus its efforts. Unlike those who have reduced the concept to a trite, and therefore meaningless form, I am committed to its understanding as a complex entity, encompassing nursing's perceptive, cognitive and active domains. Accordingly, I have concentrated my inquiries and practice toward this understanding. My future work will be to continue my interest in the cognitive domain of nursing, especially with empirically testing my theory of judgment. In addition, I plan to investigate Polyanyi's concepts of tacit knowing and personal knowledge to determine their implications for nursing. The end result of these interests and studies cannot be predicted. I expect, however, my growth will continue to be informed by nursing's diversity, and that my creativity will be stimulated further.     

Combatting sexual harassment

According to one recent nursing survey, more than half of the female respondents said they'd been sexually harassed in the past. In light of such numbers, nurses must ask themselves: What can I do to minimize the chances that such harassment will affect me or my colleagues?     

The influence of the human becoming theory on teaching-learning stories in Hangzhou, China

As a nurse educator, human becoming theory was used to enhance my understanding of my experience with students in Hangzhou, China. I describe my initial tension in living simultaneously the uncertainty and the certainty when I was faced with a strange but yet familiar teaching situation. The tension has however enabled me to cross from a traditional teaching approach to a human becoming teaching-learning paradigm where the students were given opportunities to share their practice encounters with patients and families by narrating their lived experiences in a clinical reasoning course. As their meanings of nursing surfaced, the students began to learn about who they were, who they are becoming, and who they want to be as nurses, teachers, and human beings.     

The nurse practitioner in industry.

To summarize my feelings of my original goals and how I presently feel about an Industrial Nurse Practitioner: What it has made me is a better nurse, definitely more valuable to my employer, and I am serving my patient/employees at a more skilled level. I have much greater job satisfaction in my expanded role. Progress is slow and painful, and in representing the new expanded role of nursing, I am still involved in the routine everyday problems. Success is not always realized at the time it is most needed or wanted and there have been days when the load seemed almost too heavy to bear; however, I have experienced some of the triumphs of when a goal is realized, and it is knowledge of this that makes it all worthwhile.     

Caring for Alex: a clinical inquiry

In my final semester as a third year Bachelor of Nursing student, I undertook my practicum placement in an Intensive Care Unit (ICU). During this time I cared for Alex, a 10 year old boy with Cerebral Palsy, who presented to the ICU unit in with acute respiratory failure. This paper takes the form of a clinical inquiry in which I describe my experience of caring for Alex, his illness journey and his parents' experience of having a critically ill child. I describe Alex's presentation and treatment within the hospital, the focussing on nursing and medical interventions and my evolving therapeutic relationship with Alex's parents. Because Alex cannot communicate verbally, I obtained consent to write this inquiry paper from Alex's parents, Michael and Emma, who were also happy to discuss their experience as Alex's parents. This clinical inquiry is person-focussed and in its original form was the final piece of assessment for my nursing degree.     

Exemplar

As I gain more experience as a practitioner, I find I am increasingly able to articulate my personal philosophy of nursing. I have learned that, as a professional nurse, my personal values and philosophies of nursing do affect the nature of the care I deliver and the quality of relationships I form within my daily practice. Becoming involved in an incident like the following has enabled me to develop an understanding of complex interpersonal and interprofessional situations. Unspoken grief, the devastating death of a child and the behaviour that surrounds such an event are part of what makes my experience with Kate and her parents so important to me. By reflecting on this incident, I have developed a new insight and have found new meanings from my experience. This has further allowed me to uncover and explore the implications this might have in my future practice.     

Balancing life—in heels and a suit

“We need to hear the voice of nurse leaders talk about balance,” said my esteemed colleague. I agreed and set to task by reviewing the literature, exploring definitions, and reflecting on my past experiences. To write an article on balance between personal life and professional life appeared to be something I could accomplish with minimal to moderate effort. After all, I am the chief nursing officer (CNO) of a large major academic organization. My family life is busy with a husband and 2 children, one of those a preteen and the other in those glorious teenage years. I manage to do my fair share of carpooling, attend required school events, and even coach softball in the summer. Included on my weekly to-do list are exercise, church, and household chores.     

Nursing Diagnosis in Perspective: Response to a Critique

As noted above, I have attempted to respond to Shamansky and Yanni's critique of nursing diagnosis. This has included an identification of some critical assumptions that underlie their work, the contexting of their arguments in the history of scientific discovery, and a listing of various misconceptions and distortions concerning nursing diagnosis.
I have concluded that the authors' basic premise was a desire to eliminate rather than ameliorate nursing diagnosis. The authors had an unstated preconception of a preferred model of conceptualizing nursing, which they did not directly state as their preconception. They systematically listed real inadequacies of nursing diagnosis efforts as an argument for abandonment. They reflected limited understanding of or information about the nursing diagnosis literature. They tended occasionally to overstate their case.
I believe that my dissatisfactions with nursing diagnosis efforts are more informed, more complex, and more numerous than theirs including such quandaries as taxonomic principles and research units of analysis. However, my responses to these problems are proactive rather than reactive, committed to amelioration rather than elimination. While I feel that the authors have provided a salutory service in delineating their concerns, I look forward to other critical reviews that might provide the intuitive insights to address the next steps in the evolutionary development of nursing diagnosis.     

The use of debate in teaching nursing ethics

Using debate as an approach to teaching and as a learning activity could be one strategy for teaching students about ethical issues in nursing practice. In this article, I will reflect on class debates carried out among second-year nursing undergraduate students as a method of teaching nursing ethics in Brunei Darussalam. Additionally, I will deliberate on the setup of the debate topic and implementation of the debate as a whole. While feedback from the course evaluation has consistently been very positive, and students have expressed satisfaction with this active learning experience, I would like to highlight some of my hopes and concerns for the future use of debate in the teaching of nursing ethics.     

Generating evidence for best nursing practice: Getting your grooves

Grooves are developmental pathways along the journey to discover new directions in our ever-evolving nursing careers. This is my story of how I got my grooves in wound and foot care and the various pathways taken toward the attainment of groovy--the generation of evidence for best practice nursing. I started to work on my first groove in 1984 after I became a gerontological clinical nurse specialist. Much to my delight, that groove has taken various twists and turns, ups and downs, with an occasional rut here and there. The journey has been most pleasurable and rewarding!     

Statement on nursing: a personal perspective.

Contemporary nursing is based on a conglomerate of theoretical nursing models. These models each incorporate four central concepts: person, health, environment, and nursing. By defining these concepts, nurses develop an individual framework from which they base their nursing practice. As an aspiring nurse practitioner in the gastroenterology field, I have retrospectively assessed my personal definitions of person, health, environment, and nursing. From these definitions, I am able to incorporate specific theoretical frameworks into my personal belief system, thus formulating a basis for my nursing practice. This foundation is comprised of the influence of nursing theorists Jean Watson, Sister Callista Roy, Kolcaba, Florence Nightingale, and Ida J. Orlando; the Perioperative Patient-Focused Model; Watson's Theory of Human Caring; theories regarding transpersonal human caring and healing; and feminist theories. Therefore, this article describes self-examination of nursing care by defining central nursing concepts, acknowledging the influence of nursing theorists and theories, and developing a personal framework from which I base my nursing practice.     

Death in the age of technology: one memorable hospice visit

There have been many moments in my 11 years in nursing that I have felt were worthy to share. Having worked in the neonatal intensive care unit, then in pediatrics, and now in palliative care and hospice, there have been a multitude of experiences that have warmed my being and affirmed my choice of profession. I wanted to communicate 1 of my most recent experiences that occurred with a hospice patient and his family on the day of his death.     

The problem with prevention: the case of spina bifida.

In this paper, I present a viewpoint about prevention and spina bifida that is not usually expressed within the occupational therapy literature. Using an autoethnographic account, I convey my experiences as a person with impairments from spina bifida in order to problematize current preventive efforts undertaken to eradicate this birth defect. This self-reflexive account connects my personal experiences to historical and medical views about spina bifida. The messages inherent in preventive efforts are discussed from a disability rights perspective. Occupational therapists are challenged to examine their attitudes toward disability, act as advocates in their practice, and, in a more informed manner, support or contest policy initiatives.     

Liaison nursing.

In reviewing my efforts to clarify the role of the nurse clinician as a psychiatric consultant in a hospital setting, I came away with many impressions. Inherent in my search was a desire to experiment with various means of providing nursing service and much of my time was spent examining the collaborative aspects of the nursing role that would add greater depth to patient care. This involved role experimentation and allowed me the opportunity to develop my role within the context of the guidelines of community organization and consultation in a hospital setting. Although much of the time I found that the liaison role has been aimed at the supportive level, I have also discovered that as I developed security in the role wherein I could function in new and more independent ways--the parameters of the role expanded. Whereas initially I envisioned working only with nursing staff, I have found myself collaborating with many disciplines and many levels of care givers and I have also been able to function collaboratively with other psychiatric liaison team members. Thus, at this time I see the liaison nurse functioning basically as a coordinator, who, at any time, may assume one or more of the following roles: 1) Integrator; 2) Provider of direct services; 3) Educator and consultant; 4) Change agent.     

The Fulbright Journey: Reflections on a Challenging and Rewarding Experience in Saudi Arabia by a Nursing Professor

The Fulbright Program offers opportunities for faculty and students from the United States to participate in cultural exchanges for up to one year. Faculty have the opportunity to teach and conduct research with their colleagues in participating countries worldwide. My six month nursing faculty Fulbright Award at Umm Al-Qura University's School of Nursing in Saudi Arabia provided me with many opportunities for professional development. Upon arrival, the nursing school was in the midst of an accreditation process and requested my engagement in these activities. As a result, I had the opportunity to work collaboratively with far more faculty and administrators than originally anticipated. This set the foundation for productive teaching workshops and ongoing research exploring women's awareness about breast cancer within the cultural context of a conservative society. In this paper, I reflect on my journey and highlight important considerations for selecting a country and setting an agenda for teaching and research. Nursing faculty interested in global health are encouraged to become Fulbright Scholars and promote collaboration of nursing professionals and academicians worldwide.     

The bigger the crisis,the bigger the opportunity!

Every time I pick up the newspaper, a scientific or nursing journal, or more recently, an issue of Time, I find data, complete with startling facts and figures, that pierce my very soul, about the tragedies occurring in our nation's hospitals caused by the restructuring movement attempting to make health care a “bottom line” business. And 1 know all too well, as do most of you, how undetermined and tentative we are about the future for nurses.