Exploring a hermeneutic perspective of nursing through revisiting nursing health history

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse–client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau‐Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation to narrative, orientation to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals.     

Time(lessness): Buddhist perspectives and end-of-life

Abstract  The perception of time shifts as patients enter hospice care. As a complex, socially determined construct, time plays a significant role in end-of-life care. Drawing on Buddhist and Western perspectives, conceptualizations of linear and cyclical time are discussed alongside notions of time as interplay of embodied experience and concept. Buddhist understandings of self as patterns of relating and the theory of 'dependent origination' are introduced. Implications for understanding death, dying and end-of-life care within these differing perspectives are considered. These explorations contribute to the growing dialogue in nursing between Buddhist and Western traditions.     

Locating a geography of nursing: space, place and the progress of geographical thought

Although traditionally, nursing research has paid little attention to geographical approaches, recent years have witnessed some initial research interest in the dynamic between nursing, space and place. Such research potentially represents the foundations of what may be termed a ‘geography of nursing’. Although, to date, some novel and valuable perspectives have been gained into the spatial features of nursing, no consideration has been given to the theoretical development of, and basis for, a geography of nursing. Furthermore, no consideration has been given to philosophical heritage; the treatment of space and place in human geography and the insights that this may provide for the new field of research. In this context, this paper provides an historical review of geographical research and traces the evolution of how space and place have been conceptualized and operationalized by it. The paper outlines the emergence of a health geography subdiscipline and its own changing and diverse perspectives. In the final section, the central themes of the current geography of nursing are considered and, reflecting back on the theoretical concerns of contemporary human geography, the paper outlines some philosophies and theories on which future geography of nursing could be based. From a disciplinary perspective, one potential role of the geography of nursing is argued to be the maintenance of the relationship between health geography and mainstream health service and medical concerns, but in a place‐sensitive, patient‐sensitive and qualitative form.     

Emotional knowing in nursing practice: In the encounter between life and death

Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses'' emotional knowing at this encounter is crucial. Consequently, this study''s purpose was to analyse and describe nurses'' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses'' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses'' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses'' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.     

A nursing manifesto: an emancipatory call for knowledge development,conscience, and praxis

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience‐ness and intention seen in the framework of the Nursing Manifesto.     

A case for the ‘middle ground’: exploring the tensions of postmodern thought in nursing

Abstract Diverse beliefs about the nature and essence of scientific truth are pervasive in the nursing literature. Most recently, rejection of a more traditional and objective truth has resulted in a shift toward an emphasis on the acceptance of multiple and subjective truths. Some nursing scholars have discarded the idea that objective truth exists at all, but instead have argued that subjective truth is the only knowable truth and therefore the one that ought to govern nursing's disciplinary inquiry. Yet, there has been relatively little critical debate or dialogue about the implications of adopting subjective and multiple truths as a maxim to govern the discipline. In this paper we examine what it might mean to adopt subjective forms of truth as the only knowable truths for nursing, and to accept the possibility of multiple co‐existing realities. We understand the implications of such a philosophical stance for the epistemological basis of a practice science to be considerable, therefore we consider what it might mean for a practice‐based discipline such as nursing to remain ambiguous on the question of truth, and examine the implications of failing to achieve consensus on what constitutes a truth claim. On the basis of this examination, we urge a cautious approach to the extremes of either position and argue for a more thoughtful and rigorous dialogue about ‘truth’ and knowledge in nursing practice, education, and research.     

Narrative ethics in nursing for persons with intellectual disabilities1

Abstract Both in the Netherlands and in Britain, practices of ‘life story work’ have emerged in nursing for persons with intellectual disabilities. The narrative approach to care and support may at the same time be considered as an attempt to compensate for the ‘disabled authorship’ of many persons with intellectual disabilities and as a sign of controversy with standard practices of diagnosis and treatment that tend to neglect the personal identities of both clients and care givers, their particular historical and relational contexts and their spiritual needs. This paper argues that narrative ethics not only offers an appropriate moral framework for practices of life story work, but that these practices are a narrative ethics in action. Starting with an account of the concept of ‘life story work’ as it has been introduced in nursing practices in the field of intellectual disability, the paper explains its relationship with key characteristics of narrative ethics. The teleological dimension in narrative ethics and in practices of life story work sparks off a dialectic process of understanding of the client and self‐understanding of the care giver. It also invites a respect for life in its openness toward the future and presupposes an openness toward other possible versions of the life narrative. The phenomenological and hermeneutic‐interpretative methodologies in narrative ethics aim at a ‘sudden moment of intimacy’ in relationships of nurses and clients. The ‘epiphany’ of this essential moment of recognition, insight and engagement cannot, however, be brought about by methodology.     

Re-thinking nursing science through the understanding of Buddhism

Western thought has dominated scientific development for a long time, and nursing has not escaped the influence of such ideology. Nurse scholars, in an attempt to fit the dominant scientific ideology, typically have had to struggle with non‐empirical elements of nursing. This orientation in science, however, may have contributed inadvertently to a form of scientific ethnocentrism in the culture of inquiry in nursing as in other fields. The result has been a narrow view of science and knowledge and failure to recognize the potential significance of Eastern philosophy in nursing knowledge development. Recently, intensive cultural exchanges between the East and the West have contributed to Western scientists becoming aware of the limits of Western linear thinking and concomitant efforts to explore the mysteries of Eastern philosophy. In this article, we explore Buddhism as one example of such philosophies that have great potential to enrich nursing as it continues to strive for definition and identity.     

Nursing art as a practical art: the necessary relationship between nursing art and nursing ethics

In the last decade, nurse scholars have focused extensively on the nature of nursing and its relationship to art and science. This emphasis has also been accompanied by an increasing literature on nursing ethics. In spite of this growing interest, the relationship of nursing art and nursing ethics has been left unclear. This paper proposes that nursing must be considered as a practical art because this conception explicates the relationship of nursing art and nursing ethics. It is based on the thesis that nursing art is subordinated to nursing ethics and as such is a moral art. Different conceptions of nursing art (craft and fine art) will be explored to show their limits. This will be followed by the conception of nursing art as a practical art.     

A Review of Research on Buddhism and Health: 1980–2003

Electronic searches of social science and biomedical literature identified 44 empirical studies that specifically investigate Buddhism, meditation, and health. The number of studies increased over time, especially in medical and other health-related fields. The studies were found to differ by geographical region with regard to the emphasis on spiritual, psychological, or physical outcomes. Results from this study are explored with respect to historical trends as well as current variations in scholarship and religious practice between the regions.     

Towards a philosophic theory of nursing

Abstract Recently, Edwards and Liaschenko questioned the validity of an argument put forward by Dr Søren Holm and Joseph Dunne concerning the impossibility of a theory of nursing. Taking into consideration the premises of the argument, I describe how Maritain's conception of philosophy allows for the possibility of a theory of nursing conceived as a philosophy of nursing art that is both practical and propositional in nature. As well, I identify how the philosophy of nursing art guides nursing art in developing and applying other kinds of artistic practical nursing knowledge: artistic nursing rules and artistic prudential nursing judgements. Finally, the relationship of ethical knowledge to artistic practical nursing knowledge is set down.     

循证护理:护理发展的趋势

本文对循证护理的有关概念、循证护理教学、循证护理实践以及循证护理与整体护理、护理科研和循证医学的关系进行了阐述，并提出循证护理是护理发展趋势的展望。     

Spirituality and nursing: a reductionist approach

Abstract  The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing 'spirituality' have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I adopt a different premise, rejecting unsupported claims, and surveying the 'spirituality' terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non-naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example.     

Midnight reckonings: on a question of knowledge and nursing

Abstract The paper contrasts understandings of knowledge grounded in Enlightenment norms with the departures from those norms taken by some strands of feminism and hermeneutics, as well as the contributions made by the writing of Michel Foucault. A reading of Foucault's writings on knowledge, power and the discursive constitution of self and world is offered as a potentially useful frame within which to raise questions about nursing, nurses and knowledge.     

Nursing knowledge: A middle ground exploration

The discipline of nursing has long maintained that is has a unique contribution to make within the health care arena. This assertion of uniqueness lies in great part in the discipline's claim to a distinct body of knowledge. Nursing knowledge is characterized by diverse and multiple forms of knowing and underpins the work of all nurses, regardless of field of practice. Unfortunately, it has been challenging for the discipline to take full ownership of its epistemological diversity, largely due to factors such as competing worldviews, and ideological and binary positioning. A philosophical middle ground stance is proposed as a way for the discipline to contemplate, discuss and develop nursing knowledge; a middle space that provides the freedom to consider competing worldviews while still allowing for the discipline to fully express itself in all of its epistemological diversity. In being able to enact its multiple forms of knowledge in a creative and open space that is open to different ideas and worldviews, not only can nursing take full ownership of its practice and its unique knowledge, it can also demonstrate how best to navigate an increasingly polarized world. In a world that is increasingly fixated on binary solutions and dualistic points of view, it is time for nursing to celebrate its epistemological diversity.     

Differentiated practice and specialization in community nursing: a descriptive study in the Netherlands

Nursing roles are described with respect to two principles on the basis of an inventory study carried out in the Netherlands: differentiated practice and specialization. A total of 58 agencies for community nursing participated in this study (response = 84%). In each of these agencies an expert was asked to answer questions by telephone. The results show that a distinction is made between two levels of nurses working in the community: community nurses and community nurse auxiliaries. This distinction is based on the complexity of care, the range of responsibilities and a division between curative and preventive care (adult care vs. mother and child care). Assessment and diagnosis is reserved for nurses at the first level. Second level nurses are responsible for the other components of the nursing process. This study also showed that first level nurses regularly perform tasks that do not require a first level of expertise. It has become obvious with regard to specialization that the generalist work for first level nurses is diminishing: they have to choose either (curative) adult care or (preventive) mother and child care. First and second level nurses also have the opportunity of specializing in one or more patient categories. The aim of these “areas of special expertise” is to improve professionalism and patient care in community nursing. Based on the results of this study the use of measures to guarantee that the mix of staff meets the demand of care is recommended. In line with this, special measures have to be taken to upgrade the tasks of community nurses. In this respect the use of areas of special expertise and activities relating to coordination of care seem to be appropriate measures.     

Befriending the family: an exploration of a nurse-client relationship

This paper explores the relationship between one group of nurses (specialist paediatric oncology nurses, or ‘SPONs’) and the families for whom they care. It draws upon a recent research review of their role in linking hospital and home care for children with cancer, and it argues that whereas this relationship often contains elements of friendship, it is not friendship in the conventional sense of the term, but is perhaps better characterized as a relationship of befriending. Befriending leads to the diminution of formal professional-client barriers and, in some cases, to a close and reciprocal relationship between SPONs and their clients. Befriending facilitates partnerships in care between SPONs and families, but also increases the demands of emotional labour for SPONs. Finally, some questions are raised about the appropriateness of the role of befriending in the nurse-client relationship.