Invisibility of the self: Reaching for the telos of nursing within a context of moral distress

Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for the telos of their practice, within a context of moral distress. A qualitative case study was carried out in a private hospital in Brazil. Observation and semi‐semistructured interviews were conducted with 13 nurse participants. With the aid of ATLAS.ti software, the data were analyzed by using thematic content analysis using virtue ethics to theorize the findings. These nurses experienced a loss of their nursing identity as they encountered an ambiguous telos and the domination of institutional values. In their reach for the telos of their practice, nurses found an environment permeated by ethical challenges, which not only created moral distress but also created professional invisibility, a phenomenon referred to as ‘invisibility of the self’.     

Analysis of the moral habitability of the nursing work environment

BACKGROUND: Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications. AIM: The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment. METHODS: A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral-social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits. FINDINGS: Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings; (3) moral suffering and (4) moral influence and resistance. The findings clearly indicate that participants perceived the work environment to be morally uninhabitable. The social and spatial positioning of nurses left them vulnerable to being overburdened by and unsure of their responsibilities. Nevertheless, nurses found meaningful ways to resist and to influence the moral environment. CONCLUSIONS: We recommend that nurses develop strong moral identities, make visible the inseparability of their proximity to patients and moral accountability, and further identify what forms of collective action are most effective in improving the moral habitability of their work environments.     

知识经济对护理工作的影响及对策

21世纪，知识经济的兴起给社会各行各业带来了深刻变化。针对知识经济对护理工作的影响，笔从护理模式，护理工作职能，护理管理，护理教育4个方面进行了探讨，并提出相应对策；（1）树立新型护理质量观92）加快护理信息网络建设93）建立以人为本的护理管理模式（4）加强学习，做好知识储备与更新，同时强调了只有大力开展护理科技开发与创新，自觉遵循知识经济规律，才能推动护理工作不断发展壮大。     

The role of tacit knowledge in the work context of nursing

AIMS OF THE STUDY: Previous research on the role of tacit knowledge is ambiguous. Some studies show the superiority of expertise, while other studies found experts would not be better than laymen. This paper aims at clarifying the contribution of tacit knowledge to expertise in the domain of nursing. BACKGROUND: Two important concepts for dealing with critical situations are outlined - tacit knowledge and experience-guided working. The framework of tacit knowledge and experience-guided working can contribute to an explanation of the ambiguous results. Tacit knowledge is acquired implicitly in the course of working and is therefore not subject to reflection. For this reason it can contain erroneous or problematic contents. METHODS: A method for the explication of tacit knowledge was developed and a laboratory study with 16 experienced nurses conducted. In the laboratory study the nurses had to deal with a critical nursing situation that was developed in co-operation with nursing experts. The explicit knowledge of the nurses was tested before the laboratory study. RESULTS: No systematic differences in explicit knowledge could be observed, i.e. differences in performance could not be attributed to this knowledge mode. Results from multidimensional scaling procedures illustrate differences in the tacit knowledge of nurses who successfully accomplished the critical situation and those who did not. CONCLUSIONS: The findings are in line with the assumption that experience-guided working is of the utmost importance for dealing with critical situations. Consequences of these results for nursing and person-related services in general are discussed and the aim of future research is outlined.     

Mapping social processes at work in nursing knowledge development

In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta‐analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially‐sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions – based on social processes of authority, credibility, and prestige – have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement.     

Caring about--caring for: moral obligations and work responsibilities in intensive care nursing

The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants' examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians' 'doings' and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.     

Duty,professionalisation and nursing knowledge

ABSTRACT

The history of human nursing demonstrates that the nature of nursing knowledge is closely tied to the development of the vocation and its subsequent redefinition as a profession (Johnson 1974 JOHNSON, D. E. (1974). Development of theory: a requisite for nursing as a primary health profession. Nursing Research. 23(5) pp. 372–377.[Crossref] , [Google Scholar]). This article discusses the context in which nursing knowledge has evolved and its intimate relationship with the nurse's duties and obligations. It concludes with a short discussion of possible next steps in the development of veterinary nursing practice.     

The development and piloting of electronic standardized measures on nursing work: combining engineering and nursing knowledge

bragadóttir h., gunnarsdóttir s. & ingason h.t. (2013) Journal of Nursing Management  21 , 679–689 The development and piloting of electronic standardized measures on nursing work: combining engineering and nursing knowledge Aims  This paper describes the development and piloting of electronic standardized measures on nursing work (e-SMNW) for rich data gathering on the work and work environment of registered nurses (RNs) and practical nurses (PNs). Background  Efficient and valid methods are needed to measure nursing work to enhance the optimal use of the nursing workforce for safe patient care. Methods  The study combined human factors engineering (HFE) and nursing knowledge to develop electronic standardized measures for observational studies on nursing work in acute care. Results  The work and work environment of RNs and PNs in acute care medical and surgical inpatient units was successfully measured using e-SMNW. With predetermined items of work activities and influencing factors in the work of nurses, and full use of computer technology, multi-layered rich standardized data were gathered, analysed and displayed. Conclusions  The combination of nursing knowledge, HFE and computer technology enables observational data collection for a rich picture of the complex work of nursing. Implications for nursing management  Information collected by standardized and multi-layered measures makes it easier to identify potential improvements, with regard to influencing factors and management of the work and work environment of nurses. Further use of computer technology in health services research is encouraged.     

Social acceleration,alienation, and resonance: Hartmut Rosa's writings applied to nursing

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge.     

Evidenced-based nursing: knowledge, performance and learning in nursing care

As part of the nursing process, nurses choose an academically secured intervention in response to a patient's problem, implement it and evaluate it. "Evidence based" describes a learning and working method which has the advantage of being applied in real, professional problem situations. Not only the learner but also the professional nurse can improve their competencies for professional acting. Following the problem- and motivation orientated approach of Roth (1983), the implicit learning steps of this method can be illustrated. The implementation of evidence-based nursing can raise high expectations. However, there are also critical aspects connected to it that need further exploration.     

Economism, efficiency, and the moral ecology of good nursing practice.

The free-market rhetoric dominating health-policy discussions today frames health-care goods and services as commodities that consumers will or will not buy at a given price. Health-care systems are being redesigned and hospitals restructured with a view to increased efficiency and productivity. Drawing on the experiences of clinical nurses in the United States, this paper shows how the application of economism to nursing may severely disrupt the ecology of good practice, leading to difficulties in meeting minimal standards of nursing care and severely constraining the acts of compassion called for by the human experiences of illness, loss, and death. Concerns about moral responsibility and conflicts between institutional and nursing goals are described. Increasing mistrust of health-care systems on the part of practitioners, patients, and families suggests that it is time to attend closely to the moral ecology of caring practices.     

Shared moral work of nurses and physicians

Physicians and nurses need to sustain their unique strengths and work in true collaboration, recognizing their interdependence and the complementarity of their knowledge, skills and perspectives, as well as their common moral commitments. In this article, challenges often faced by both nurses and physicians in working collaboratively are explored with a focus on the ways in which each profession's preparation for practice has differed over time, including shifts in knowledge development and codes of ethics guiding their practice. A call for envisioning their practice as shared moral work as well as practical strategies to begin that work are offered as a basis for reflection towards enhanced nurse-physician relationships.     

Unity of knowledge in the advancement of nursing knowledge

During the past 20 years, we have witnessed an explosion in nursing knowledge providing the discipline with diverse and multifaceted theoretical frameworks and paradigms. One knowledge theme that pervades the dialogue in the scholarly literature is that of multiple ways of knowing. With the acknowledgement that the fundamental nature of nursing knowledge is grounded in the understanding of human nature and its response to its environment, comes an imperative for a consilience of knowledge. The purpose of this article is to present such a unified worldview by articulating a vision of nursing knowledge, a meaning of unity of knowledge, and a challenge to the discipline to embrace inclusive rather than exclusive ways of knowing.     

隐性护理知识传递会实施后护士工作体验的质性研究

目的 了解实行隐性护理知识传递会后耳鼻喉科护士工作真实体验,为护士核心能力的提高提供依据.方法采用质性研究中的现象学研究法,以深入访谈的方式了解耳鼻喉科8名临床护士参加科内举行的隐性护理知识传递会后的工作真实体验.结果护士操作技能、护士分析和解决问题的能力、患者的满意度明显提高.结论隐性护理知识传递,对减轻护士压力、提高护理质量及患者满意度具有重要意义.     

移动护士工作站在临床护理工作中的应用

随着无线网络(WLAN)技术、掌上电脑(PDA)技术的不断成熟,移动医护工作站在医院的应用已势在必行[1].病房护士站系统是医院信息系统的重要组成部分,是为临床服务的最集中体现,是病人信息的基本来源之一.中国人民解放军第二五一医院以医院信息系统(HIS)为支撑平台,以掌上电脑为硬件平台,以先进的WLAN技术的无线局域网设备为网络平台,充分利用HIS的数据资源,全面实现了ＨＩＳ向病房的扩展和延伸,极大地推动了医院的信息化建设,向"无纸化、无胶片化和无线网络化"的目标迈进了一大步.     

On the moral nature of nursing practice

Until recent times many nursing authors have relied on rather narrow interpretations of selected aspects from the broader discourse of ethics and moral philosophy in their writing on ethics in nursing As a consequence, discourse in nursing ethics has been limited in its vision and far from comprehensive in its content This can be seen in the large number of texts and journals which discuss issues in nursing ethics Particularly in many of the nursing textbooks up to and including the 1960s, 1970s and, to a lesser extent, the early 1980s, ethics content is commonly framed in terms of the dilemmas of practice Moreover, overall there is a preoccupation with either deontological or teleological positions and the application of corresponding analytical frameworks consistent with the particular view taken In most texts the preferred view is deontological, with a predominating emphasis on principle and duty Recently in nursing ethics there has been a focus towards the deconstruction of the dominant views in ethics encompassed by the more traditional perspectives Consequently, as in other areas of applied and theoretical ethics, there has been a re-awakening of interest in the 'virtues', and in processes which encourage the articulation of ethical dimensions of practice in ways other than applying principles, rules and formulae to situations of clinical dilemma