The meaning of support as narrated by family carers who care for a senior relative at home

The authors' aim in this study is to illuminate the meaning of support as narrated by family members who care for a senior relative at home. This study originates from a context of advanced in-home palliative care in Sweden. Twenty individuals who cared for a senior relative at home participated. Narrative interviews resulted in a text, which the authors analyzed in three recurring phases, naive understanding, structural analyses, and comprehensive understanding, using a phenomenological hermeneutical method. They formulated two themes from the analysis: Experiencing a togetherness with others in caring and Sensing togetherness with oneself in caring. The meaning of support was understood here as Sensing togetherness. In the comprehensive understanding, the authors further illuminate this meaning using literature on the concepts of friendship, inner strength, and manageability through the sense of coherence theory. They provide suggestions for relevance to practice and further research.     

Gadow's contribution to our philosophical interpretation of nursing

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We contend that Gadow, by making self‐direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing.     

Caregiver meaning: a study of caregivers of individuals with mental illness

The study discussed in this article examined caregiver meaning. Study participants were individuals paid and supported by the South Carolina Department of Mental Health Homeshare program to provide care in their home for an individual with severe mental illness. A structured questionnaire and interviews were used to develop categories and themes about caregiver meaning. Quantitative and qualitative analyses yielded three categories of caregiver meaning: other-directed-altruistic, self-directed-self-actualization, and existential-purpose in life. Caregivers most often referred to altruistic themes, with the most common one being "helping others." The next most common themes were "home and family" and "making a difference." Caregiving difficulties also were categorized. Social work implications are discussed.     

Self care as a condition for care to others in health practice

We need to take a critical look at our practices and the relationships we construct in our personal and professional life, with a view to leading a life guided by ethics. In this text, we discuss governability practices that are built in the relations between health and especially nursing professionals, with the health institutions, with the clients and with the nursing profession. We conclude that, for persons to deliver care and guide others, like nurses do in their practice, they first need to demonstrate that they can guide themselves, that they know the limits of their practice and can respect the other as someone different from themselves.     

Use of the computer as a tool for the implementation of the nursing process

This text article has as its objective to analyze the use of the computer as a tool in the work process of the nursing professional. There are many evidences that informatics has revolutionized work processes in different service structures such as health care, education and management. Therefore, informatics is conducting Nursing to a systematic and organized practice that has propitiated individualized care to the patient. The authors describe software that gives support to the planning of Nursing Assistance and make some considerations aiming at the development and modernization of the Brazilian Nursing practice.     

The experiences of close relatives living with a person with serious chronic illness

Living with serious chronic illness has a directly threatening effect on the life course of healthy relatives. The aim of this study was to elucidate the meaning of close relatives' experiences of living with a person with serious, chronic illness. Using a narrative approach, the authors interviewed 13 spouses and 1 daughter about the meaning of their experiences. They used a phenomenological hermeneutic method to interpret the interview text. The structural analysis revealed three major themes: A Shrinking Life, Forced to Take Responsibility, and Struggling to Keep Going. Close relatives in this study seemed to be living lives characterized by a reduced sense of individual freedom and an increased sense of responsibility for the care of the ill person. It means struggling to obtain the strength to manage their duty and an inner sense of community and of solidarity. The authors interpret the findings in the light of the works of philosophers who have described ethical demands and natural love between people.     

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person‐centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.     

A conversation on diverse perspectives of spirituality in nursing literature

Abstract  Spirituality has long been considered a dimension of holistic palliative care. However, conceptualizations of spirituality are in transition in the nursing literature. No longer rooted within religion, spirituality is increasingly being defined by the universal search for meaning, connectedness, energy, and transcendence. To be human is to be spiritual. Some have argued that the concept of spirituality in the nursing literature has become so generic that it is no longer meaningful. A conceptualization that attempts to be all-encompassing of what it means to live a human life has a tendency to render invisible the differences that make life meaningful. For palliative patients in particular, a generic approach may obscure and relativize the important values and beliefs that inform the critical questions that many patients grapple with at end of life. A different approach to conceptualizing spirituality can be achieved through the use of typologies. Rather than obscuring difference, categories are constructed to illuminate how spirituality is understood within a diverse society and how those understandings might influence patient–provider relationships. What follows in this article is a dialogue illustrating one typology of spirituality constructed from a review of selected nursing literature. The hypothetical narrator and three participants, representing the positions of theism, monism, and humanism, discuss their understandings of spirituality and religion, and how those understandings influence the intersections between nursing ontology, epistemology, and spiritual care.     

Certified nurse assistants making meaning of direct care

Using qualitative data from 87 focus groups with certified nurse assistants (CNAs) in 16 nursing homes in Massachusetts, we explore ways that CNAs make meaning of their work despite devaluations, such as lack of respect from management and residents, and the physical and emotional demands of such low-status work. CNAs' meaning making represents an effort to assert a positive identity rather than accept the stigmatization associated with their work. Assertions of the value help CNAs reconstitute their identities. Assertions of meaning, which depend upon providing good care to residents regardless of financial reward or management respect and support, make CNAs vulnerable to exploitation.     

Applications of performance ethnography in nursing

In this article, the authors explore the origins of and theory behind performance ethnography and demonstrate how it can be used effectively in nursing research, education, and practice. They have included a performance text created by one of the authors based on semistructured, qualitative interviews with parents of children with genetic conditions. The text highlights the lived experiences of the parents, allowing the "audience" to appreciate more fully the complexities of parenting children with genetic conditions. The authors also discuss specific ways in which nurses can use performance ethnography in their professional practice, including several examples. Performance ethnography can be a creative method for nurses to communicate with patients and families, research audiences, colleagues, and students. Clinicians, researchers, educators, and students can learn to use performance ethnography to achieve the goal of a clear understanding of human needs and conditions for improved quality of care.     

循证护理在预防气管切开术并发症中的作用

目的：探讨循证护理方法在气管切开护理中的应用效果以及发生并发症时的护理措施。方法：对气管切开患者护理过程中出现的护理问题进行汇总、筛选,用计算机网络检索有关文献,对证据的真实性、可靠性、实用性做出评判和选择,并与常规护理组比较,得出有效的护理方法。结果：本研究中循证护理组出现并发症4例,常规护理组16例。循证护理组无并发症率为90．9％,常规护理组为63．6％,两组比较差异有统计学意义（x2=4．695,P〈0．05）。结论：在临床护理工作中应用循证护理方法不仅能有效预防气管切开术并发症的发生,还可以培养护士的评判性思维能力,提高护士工作效率。     

Nursing work in primary health care -- family health care

This article is part of an integrated research project called The Organization of Primary Health Care (a perspective for nursing practice). Its objective is to investigate the perception of nursing personnel concerning their practice in family-centered primary health care. This article presents a case study focuses on nursing personnel workers from the Family Health Program (PSF), in the city of Batatais. Data collection was done through semi-structured interviews with those professionals. Thematic analysis of the data was realized in which initial categorization was done with the help of the Ethnograph software. The topics identified in the workers' narratives were: comprehensiveness, health care, bonding and active case-frading. These themes suggested that the work in family-centered care is difficult, therefore it leads to a more comprehensive health care practice in which decision-making is shared with clientele.     

Evidence for practice, epistemology, and critical reflection

Abstract  Evidence-based practice (EBP) has become a critical concept for ethical, accountable professional nursing practice. However, critical analysis of the concept suggests that EBP overemphasizes the value of scientific evidence while underplaying the role of clinical judgement and individual nursing expertise. This paper explores the empiricist position that valid evidence is the basis for all knowledge claims. We argue against the positivist idea that science should be regarded as the only credible means for generating evidence on which to base knowledge claims. We propose that the process of critically reflecting on evidence is a fundamental feature of empirical epistemology. We suggest that critical reflection on evidence derived from science, arts and humanities and, in particular, nursing practice experience can provide a sound basis for knowledge claims. While we do not attempt to define what counts as evidence, it is argued that there is much to be gained by making the processes of critical reflection explicit, and that it can make a valid contribution to expert nursing practice, without recourse to irreducible concepts such as intuition.     

实施优质护理服务在护理管理中的实践与作用

目的：探讨实施优质护理服务活动的实践方法与效果。方法：在全院范围宣传开展“优质护理服务”的意义,先确定4个科室为“优质护理服务示范病区”,然后在全院范围内开展优质护理服务活动,采取的措施包括实施护士责任制包干;提高护理人力资源的合理利用;推行亲情护理服务;不断完善护士激励机制。结果：提高了护理人员的整体素质、护理工作质量及患者满意度。结论：开展优质护理服务,能达到令患者、医院、社会、政府都满意的效果。     

Gender representations and morality in the nursing profession

This text is part of a dialogue between the authorserlating to two research projects: one on "The professional ambiguities, work conditions and the citizenship of nurses--a comparative study in the Federal District and S?o Paulo" and the other on "The impact of work conditions on the nurses in the Hospital S?o Paulo as to sexual and reproductive life". Nursing occupies a singular place in the health professions. Is is differentiated by numeric importance as well as by a professional practice which is almost exclusively feminine. Culturally, to care is attributed as a woman's task (nurse, mother teacher, social worker, etc.); to treat is a man's task (doctor, father, provider, etc.) The dichotomy between caring and treating denies other conflicts, relations of power, and of hierarchies established in the professional practice of nursing. These conflicts may be associated with: a) the founding myth of the origin of nursing, generator of a morality and a competence which condition htis professional practice; b) feminity, mothering, the administration of intimacy and body care, that is, the social representations of nursing with respect to gender; c) the androcentric character of power relations and those of sexuality which subsume the professional space of nursing.     

The relationship of the aims of the theory of Peplau with the care of the diabetic patient

In the face of the contextual amplitude of nursing activity, its theories need to be mediatated so to we be able to access the real meaning of the ideas elicited by theorists, and thus making possible to the nurses, consider and incorporate them into practice professional. In this article, we described the nursing theory developed by Hildegard Peplau still looking for to establish a connection of this theory with the way of caring of diabetic patient. The building of this study was worth of reflexion and it provided not just knowledge of theoretical ideas but mainly the urgency to use it (or to use another theory) in the environment of our daily practice of diabetic patient care.