On different types of dignity in nursing care: a critique of Nordenfelt

Abstract  Dignity appears to be an important concept in nursing philosophy and more widely in health care policy and provision. Recent events in the UK have generated much interest in the subject. However, there appears to be some confusion about the precise meaning and application of the concept. An influential contribution to the debate has come from Nordenfelt, who, as part of a European project investigating dignity and the care of older people, has proposed a four-part typology of dignity. In this article, we will explore some of the background to the dignity debate in UK nursing and health care, give a brief overview of Nordenfelt's position, offer some criticisms of his work and propose some modifications to his view.     

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.     

A response to Michael Clinton's On Bender's orientation to models: Towards a philosophical debate on covering laws,theory, emergence and mechanisms in nursing science

My purpose in this short response to Clinton's interesting article On Bender's orientation to models: Towards a philosophical debate on covering laws, theory, emergence and mechanisms in nursing science, which is published in this issue, is not to provide any counterargument to Clinton's interpretation of my own argument; readers are welcome to interrogate both articles at their leisure and make their own conclusions. What I will do instead is provide a brief critical assessment of my own (il)logic re bringing in the notion of mechanism as conceived by Machamer, Darden and Craver into an argument for models versus theories as a carrier of nursing knowledge.     

医院护理信息化建设实践

紧随医院信息化建设步伐,紧扣护理专业特点,以2个护理信息平台（人力资源管理信息平台和护理质量管理信息平台）和5个护理信息化子系统（排班系统、人力资源管理系统、重症监护系统、床旁PDA系统和麻醉手术监护系统）践行护理信息化建设,成效佳。     

The multifaceted structure of nursing: an Aristotelian analysis1

A careful reading of Aristotle's Nicomachean Ethics focusing on his treatment of politics reveals a multifaceted discipline with political science, legislation, practice and ethics. These aspects of the discipline bear clear resemblance to the multiple conceptions of nursing. The potential that nursing is a multifaceted discipline, with nursing science as just one facet challenges the author's own conception of nursing as a practical science. Aristotle's discussion would seem to argue that nursing science is nursing, but nursing is more. Nursing is also ethical practice, or art, and legislative for health. The multifaceted discipline of politics is united by the end, the common good, a just community that makes human happiness possible. Reasoning in this way, nursing is unified by its end, health of individuals and communities. Since nursing is not unique in having health as its end, this discussion ends with the question of where its uniqueness lies, i.e. within the activities or the personal presence of its practitioners. This discussion also contains some of the contemporary ethical and legislative challenges with which nursing is confronted.     

Compassion and professional care: exploring the domain

Compassion unites people during times of suffering and distress. Unfortunately, compassion cannot take away suffering. Why then, is compassion important for people who suffer? Nurses work in a domain where human suffering is evidently present. In order to give meaning to compassion in the domain of professional care, it is necessary to describe what compassion is. The purpose of this paper is to explore questions and contradictions in the debate on compassion related to nursing care. The paper reviews classical philosophers as well as contemporary scientists' main arguments on compassion. First, I will examine the relationship between compassion and suffering. Second, how does one recognize serious suffering? This issue raises questions about the role of imagination and the need for identification. Third, literature describes compassion as an emotion. Some philosophers consider emotions uncontrollable feelings; others see a clear rational dimension in emotions. In order to determine what compassion is, it is necessary to weigh these contradictional arguments. Fourth, I will discuss motives for compassion. Is compassion an act of altruism or egoism? In this debate Nietzsche and Schopenhauer are well‐known opponents. Today, analysis of their arguments leads to some surprising conclusions. Fifth, there is the issue of fault and compassion. Can we only feel compassionate when people who suffer are not to blame for their own suffering? Such a condition faces professional caretakers with a dilemma which needs a thorough analysis if compassion is to be of use in the field of professional care. Finally, I will explore the moral meaning of compassion. Compassion, described as a concept with cognitive as well as affective dimensions, also has volitional and behavioural aspects. These aspects specifically are of importance to nursing care and further research of compassion in the nursing domain.     

谈整体护理与人文护理

为了探讨加强整体护理与人文护理有机结合对临床护理的影响,本文阐述了整体护理的基本内涵。提出应树立新的医学观念,全面认识医学与社会;培植道德情感,规范道德行为;培养人文科学能力等整体护理与人文护理相结合的新理念。重点介绍了整体护理与人文护理有机的结合使护理工作实现了三个转变、六个到位,全面提升了护理人员素质,规范了护理行为,提高了护理质量。     

Towards understanding the unpresentable in nursing: some nursing philosophical considerations

Abstract  While nursing practice embodies certain observable and sometimes habitual actions, much inheres in these actions that is not immediately discernible. Taking on Lyotard's exegesis of the unpresentable , I undertake an analysis of the unpresentable as it occurs in nursing practices. The unpresentable is a place of alterity often excluded from dominant discourses. Yet this very alterity is what practising nurses face day after day. Drawing from two nursing situations, one from a hermeneutic phenomenological study and the other from the literature, I elucidate the unpresentable from a nursing point of view. Evoking Lyotard as well as selected philosophers from the continental philosophical tradition, I also question whether nursing in its present discourse is capable of responding to the unpresentable in nursing situations. Through the philosophical stance of presentation and representation, I delineate the urgent need to bring the otherness of the unpresentable into our nursing discourse. Nurses in practice confront a wide array of human differences and diversities and come to the realization that no framework alone can ever really have primacy over the multiform presentations of human suffering that so strikingly evoke alterity.     

浙江省护理人力资源配置公平性研究

目的 对浙江省护理人力资源配置公平性进行分析,为卫生行政部门加强护理人力资源的管理及合理配置提供借鉴.方法 采用洛伦兹曲线（Lorenz Curve）与基尼系数（Gini Coefficient）来评价浙江省护理人力资源配置公平性. 结果 2011年浙江省各地护理人力资源按人口、面积分布的洛伦兹曲线均分布在绝对公平线附近;按人口分布的基尼系数为0.16,按面积分布的基尼系数为0.28.结论 浙江省护理人力资源配置总体上公平,但布局欠合理,其人口公平性优于地理公平性.     

Generic and specialist nursing roles in the community: an investigation of professional and lay views

In the UK, a number of policy documents have sought to outline and clarify the role of the community nurse in the past 10 years. Furthermore, the increasing specialisation of community nursing has been the topic of much debate in the UK and Ireland. The present study aimed to investigate the perceptions of community nurses, general practitioners (GPs), members of the public, and senior strategists and policy-makers in relation to specialist and generalist nursing roles within community nursing in Northern Ireland and the Republic of Ireland. Focus groups were undertaken with community nurses (n = 38), GPs (n = 14) and public representatives (n = 8). This was followed by a two-stage Delphi investigation using self-report questionnaires with the same samples. In addition, data were collected from 34 senior policy-makers using a semi-structured interview schedule. The results uncovered a mix of views. While there was much negativity about specialisation, the participants felt that the move away from generalism was unavoidable. There was concern that specialisation, whilst welcome in some areas, would lead to role conflict, role overlap and role confusion. Findings from this study have the potential to inform the specialisation-generalism debate within and outside the UK and Ireland. Recommendations are suggested for future policy and practice.     

“优质护理服务示范工程”活动中整体护理模式的实践与探索

目的实施全方位的整体护理,提供患者满意服务。方法领导重视,责任落实;加强培训,优化护理团队;实行责任制大包干,让病人受益;严格执行护理核心制度,保证护理安全;加强人性化管理,提高护士执行力;护士分层级管理,合理使用护理人力资源。结果有效提高了护士综合素质和护理质量,促进了病人的康复,减少了医患纠纷,和谐了护患关系,患者的满意度大幅提升。结论实施全方位的整体护理,实现护理管理在临床工作模式、护理管理方式、绩效考核方法、薪酬分配和激励机制方面的新突破,使护理工作更加贴近病人、贴近临床、贴近社会,增强医院的综合竞争力。     

优质护理服务示范工程的实施现状与分析

目的:调查了解江苏、上海两地优质护理示范工程实施的情况。方法:采取随机抽样法调查15家城市医院的268名患者,自行设计问卷展开调查。结果:床护比≥1∶0.4的医院占42.7%;71.6%的患者知道医院有优质护理服务;48.9%的护士能够介绍优质护理服务内容、项目及收费标准;53.0%的患者认为有必要开展基础护理;99.6%的患者对护士的技术满意;41.8%的患者能接受无陪护护理。结论:优质护理服务尚有提升的空间,应该在人力资源和硬件配备等方面继续努力,护理人员应加强与患者交流和沟通,提高护理质量。     

On Bender's orientation to models: Towards a philosophical debate on covering laws,theory, emergence and mechanisms in nursing science

Nursing scholars continuously refine nursing knowledge and the philosophical foundations of nursing practice. They advance nursing knowledge by creating new knowledge and weighing the relevance of developments in cognate sciences. Nurse philosophers go further by providing epistemological and ontological arguments for explanations of nursing phenomena. In this article, I engage with Bender's arguments about why mechanisms should have more primacy as carriers of nursing knowledge. Despite the careful scholarship involved, Bender's arguments need to be more convincing. Accordingly, this article encourages debate about Bender's arguments for reorientating nursing science to mechanisms. I begin by suggesting that the claim that the theory-practice divide can be overcome by reorientating to mechanisms is acceptable only if we accept Bender's depiction of the challenge. Then I question the ontology Bender relies on to justify reorientating nursing science. After that, I argue that mechanisms in models that parallel analytical sociology undermine the kind of nursing science Bender advocates. I illustrate my arguments with a social mechanism thought experiment. Then I explain why Bender's arguments cannot escape the received view of science or inform emancipatory nursing action without theory. Finally, I mention some caveats and implications for nursing science.     

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.     

Development policies of health and nursing human resources

The sanitary movement brought about, in the educational setting, demands for health training focused on primary care, considering the inconsistency between professional practice and population health needs. This is a documental research with the objective to identify human resources development policies in National and Health Human Resources Conferences, in the period from 1986 to 2005. Results show that the debate concerning nursing education is presented in the following categories: legal landmarks in nursing education; curricular dimension of health education; perspectives of teaching-learning methods; and health human resources training. This course of debate shows the current path that different education instances should trail.     

A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation

A coordinated emergency management response to disaster management in nursing homes is desperately needed globally.During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents.The responsibility for the management of nursing homes during the pandemic was multifaceted, and responsibilities lay at the national, jurisdictional, and regional levels. Success in managing COVID-19 in nursing homes required all these levels to be aligned and supportive, ideally through management by an emergency response leadership team. However, globally there is a paucity of effective management strategies.This article uses the example of the COVID-19 pandemic to propose a risk stratification system to ensure timely and appropriate allocation of resources to nursing homes during disaster preparation and management. Nursing homes should be risk-stratified according to 4 domains: risk of intrusion, capability for outbreak containment, failure in organizational capability, and failure in the availability of community and health care supports. Risk stratification should also consider factors such as current levels of community transmission, if applicable, and geographic location of nursing homes and services.Early identification of nursing homes at risk for infectious disease, or disasters, and targeted allocation of resources might help reduce the number of outbreaks, lower the mortality, and preserve community supports such as acute hospital services. The next step is to debate this concept to validate the selected variables and then develop and pilot test a risk stratification tool for use.     

Can nursing epistemology embrace p‐values?

The use of correlational probability values (p‐values) as a means of evaluating evidence in nursing and health care has largely been accepted uncritically. There are reasons to be concerned about an uncritical adherence to the use of significance testing, which has been located in the natural science paradigm. p‐values have served in hypothesis and statistical testing, such as in randomized controlled trials and meta‐analyses to support what has been portrayed as the highest levels of evidence in the framework of evidence‐based practice. Nursing has been minimally involved in the rich debate about the controversies of treating significance testing as evidentiary in the health and social sciences. In this paper, we join the dialogue by examining how and why this statistical mechanism has become entrenched as the gold standard for determining what constitutes legitimate scientific knowledge in the postpositivistic paradigm. We argue that nursing needs to critically reflect on the limitations associated with this tool of the evidence‐based movement, given the complexities and contextual factors that are inherent to nursing epistemology. Such reflection will inform our thinking about what constitutes substantive knowledge for the nursing discipline.     

浅谈医疗护理费核算方法

护理费是与护理消耗相对应的费用,为补偿医疗护理过程中物化劳动和活劳动的消耗而向护理对象收取的。如何合理制定等级护理收费标准,使日常护理支出得到合理的补偿,是本文研究探索的内容。     

工作分析在护理中的应用现状

工作分析既是实用理论,又是进行人力资源管理的手段与技术。文章就工作分析在护理人力管理方面、护理工作设计以及护理人员绩效管理的应用作一综述,并指出应用过程中出现的误区如范围较单一和局限、实施的技术和方法不完全、运用不深入等,为工作分析能科学地运用到护理工作中提供参考。     

人性化护理服务的对策

人性化护理服务的核心是以人为本,注重人文关怀,尊重患者的生命价值、人格尊严和个人隐私,为患者提供充满亲情和人性的服务。理念的滞后、环境和制度的限制,使人性化护理服务质量徘徊。医院管理者应处处站在患者的角度考虑问题,营造人性化护理服务环境,通过倡导人性化服务理念,更好地满足不同患者的各种需求,提高护理人员的素质,提升服务品质,增强医院竞争力,真正体现护理服务的内涵和使命。