Johns Hopkins Address: Does Nursing Have a Future?

Purpose: To outline the importance of identifying where nursing is heading as a profession and explore the metaphors it uses to explain its role to society. Current images of nursing are confused. Nurses should articulateb clearly why nursing should be retained as a social force for improving health and meeting the needs of vulnerable people.
Scope: The historical development of nursing considering the metaphors used.
Conclusions: Because of contemporary pressures on nursing, the metaphors used are inconsistent and require interpretation. Nurses should find new metaphors and resolve comlex internal tensions. Unless nursing can articulate its primary function more cogently, it risks extinction.     

A Nursing Model For Addressing The Health Needs Of Homeless Families

Homelessness in the United States continues to be a major social problem directly affecting an estimated three million persons, of whom nearly 30 percent belong to families without permanent shelter. This paper reviews recent research concerning homeless families and the conditions in which they live and outlines the significant health and mental health problems that these families experience. Effective nursing interventions for homeless families using Peszneckers' Model of Poverty are proposed. Nurses must advocate for changes in the social and political conditions that bring about homelessness since the resources to meet the needs of these families are either nonexistent or woefully inadequate.     

Blurring the boundaries: technology and the nurse-patient relationship

Nurses, like the rest of the world's population are increasingly participating in online social media. Nurses must be mindful to avoid situations that could ultimately compromise past, present and future patient health and wellbeing, as well as their professional identities and reputations and that of the nursing profession. Unprofessional uses of social networking tools are common. This article aims to inform nurses of the public accessibility to professionally inappropriate online behaviour and activities. It asks nurses to carefully consider the risks posed by online social media with a focus on boundary crossing in an e-society. Forethought is required to ensure that private information stays private and that the nature of the professional relationship between nurse and patient continues to be respected.     

Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placements

RACINE L and PERRON A. Nursing Inquiry 2012; 19 : 190–201
Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placements The growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty‐first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as a means to fulfil nursing’s social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin’s notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels.     

Development of a professional qualification and associated training program in New Zealand

Employers need to understand the level and complexity of the work of occupational health nurses. Nurses need to demonstrate competencies and convince tertiary education bodies to provide post-basic education for them. The New Zealand Occupational Health Nurses Association published standards for occupational health nursing practice based on ILO and primary health care recommendations. The document includes self evaluation to determine the education needs of the occupational health nurses. This led to development of an education program which provides a career pathway with recognition of different levels. In New Zealand, occupational health nurses are well on the way to demonstrating that occupational health nursing services are accessible, acceptable, affordable, and achievable.     

Health disparities, social injustice, and the culture of nursing

BACKGROUND: Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities. OBJECTIVE: The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. METHODS: The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method. RESULTS: Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. DISCUSSION: For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities--racism, sexism, heterosexism, and other forms of discrimination--will then be made visible and open to challenge.     

Part 3: Defining the unique role of the specialist district nurse practitioner

The third of a series of articles concludes the unique role of the District Nurse. District Nurses are proud of their profession and seek to demonstrate their advanced skills through further case scenarios. As Government policy continues to expect health care providers to keep patients in the community who have complex health and social care needs, District nursing is the obvious profession that remainss constant in ever changing times.     

The management of loneliness in aged care residents: an important therapeutic target for gerontological nursing

Social engagement and meaningful relationships are critical determinants of the quality of life of older people. Human beings have an intrinsic need for social connections and an engagement with the social environment. Deficits in the quality of these social relationships lead to feelings of isolation and loneliness in older people. Loneliness can have serious physiological and health implications. It is well established that loneliness is a risk factor for poor physical and mental health, comparable in size to obesity, a sedentary lifestyle and possibly even smoking. The aim of this article is to present an argument for the management of loneliness in aged care residents as an important therapeutic target in gerontological nursing. To date little is known about the effectiveness of intervention strategies designed to alleviate loneliness in aged care residents. Nurses can address this deficit in our understanding by evaluating the impact of loneliness intervention strategies.     

Psychosocial rehabilitation

One example of a psychosocial rehabilitation model uses an intensive case management approach. This approach offers an interdisciplinary model that integrates pharmacotherapy, social skills training, and family involvement. This evidence-based plan of care is cost-effective and offers psychiatric nurses opportunities to facilitate symptom management, facilitate self-efficacy, and improve communication and social skills. Ultimately, nursing interventions promote a higher level of functioning and quality of life. Nurses in diverse practice settings must be willing to plan and implement innovative treatment models that provide seamless mental health care across the treatment continuum.     

Nursing in a changing society.

In this paper the technological, demographic, social and disease-pattern changes in British society are considered and their implications for the nursing and health services discussed. The influences of major nursing reports as well as the consequences of the growth of professionalism in nursing and the potential outcome of the spread of political consciousness among nurses are also highlighted. Nurses are admonished to come to terms with the 'real' diseases of today; those resulting from affluence and senescence. Although conceding that nurses have unique and professional roles, a plea is made for the importance of good team work in health care. The paper ends with the recognition that by building up the body of knowledge of nursing, not only will the planning of nursing care be enhanced but also the ability to change as the needs of society change.     

Advocacy in mental health nursing: an integrative review of the literature

The term 'advocacy' has taken on a meaning beyond its legal origins and is now of importance as a concept in health and social care. Within nursing, the role of advocate has been accepted as an important one, although there are arguments against nurses taking on such a role. The majority of papers on this topic relate to nursing generically rather than being specifically mental health oriented. Nurses need to be made aware of the legal framework within which they practice, in terms of duty of care within their role of nurse advocate, maintaining standards of advocacy acceptable to their professional body, accountability relating to action and omission of actions, guidance on guarding against stepping beyond the boundaries of their professional practice of advocacy, and to have adequate knowledge of the law. This paper offers a critique of nursing advocacy models, raising a number of mental health nursing issues and identifying some areas for further research.     

A wellness framework for pediatric nursing clinical practice

This article presents a proposed holistic Framework for Exploring Adolescent Wellness specific to the discipline of nursing. Conceptualized as a practical adolescent wellness assessment tool, the framework attends to the physical, spiritual, psychological and social dimensions of adolescent health. Through the discussion of a reconstructed case study the framework's application to nursing practice is illustrated. Nurses are distinctly positioned to promote adolescent wellness. This approach facilitates the exploration of the multiple influences on the health of adolescents, across a variety of clinical practice specialties and settings, by nurses of varying experiences.     

The health‐promoting school: what role for nursing?

Aim. To review the existing literature on health‐promoting schools and put forward recommendations for continuing progress. Background. The World Health Organisation's Ottawa Charter for Health Promotion in 1986 sought to create a framework for health promotion action that conveyed the notion of capacity building as it related to specific settings. It provided the catalyst from which the health‐promoting school movement emerged, against the backdrop of health professionals adapting to the changing needs and demands of clients and the evolving social context of the communities in which they live. Since then, the international health‐promoting school movement has been one of the most successful of the settings‐based projects and has expanded considerably over recent years. Method. An extensive review of available health‐promoting school‐related literature provides the basis for critical discussion and recommendations. Findings. Traditionally, the school nursing movement has provided the backbone of nursing‐related health promotion activity in the school setting. The literature, however, is generally critical of its contribution over the years – especially as its role is mainly confined to a ‘conventional’ health education function and has little to do with health‐promoting school projects. There are more and more calls now for the school nursing service to either re‐evaluate its function and processes or be devolved back into a broader primary health care practitioner role. Conclusion. Nurses should view the health‐promoting school movement as another opportunity to embrace evolving broad‐based health promotion concepts truly, as a means to forge and own their own health agenda and also as a means to move beyond a traditional reliance on a limited health education role. Schools also need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever‐widening community networks of health and social agencies. This requires the commitment of all healthcare professional groups. Nurses who practice in all settings, and not just school nurses, should be aiming to initiate and promote radical health promotion reform as set out in the health‐promoting school movement. Relevance to clinical practice. If health professionals wish to be at the forefront of current health‐promoting school strategies they must embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article. Building such group capacity, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasize the health promotion role of nursing. The health‐promoting school movement is truly an international concept and, as such, deserves a concerted nursing representation and resourcing well beyond its current commitment.     

Nursing care and collaborative practice

This article argues that the time is right for nurses in the UK to become the case managers in all healthcare settings. The re-launch of family health nursing, as a model for the organization and delivery of nursing care in the community, and the advent of the GP practice-based self-managed integrated nursing teams, offer the means by which to take up the opportunities presented by recent legislation and the national strategies for promoting partnership working and collaborative practice. Nurses could approach this by combining their current involvement with developing the single assessment process for older people with the overall development of interprofessional collaborative practice across all boundaries in health and social services. Despite the new opportunities, this will not be straightforward because of the still existing problems associated with the health and social care divide. In order to generate high quality care, it is imperative for nurses and their patients that the profession gains control and ownership of its own policy, remit and practice. Nursing care should be defined according to the patient's condition, so that their dependency level, diagnostic picture and potential for rehabilitation govern the eligibility criteria for health or social care and not the level of technicality in the task itself.     

Preparing nurses for a 21st century role in genomics-based health care

Advances in genomic research are changing the nature and focus of health care. All health professionals must be prepared with new knowledge and skill competencies to meet the social and scientific demands of clinical practice. Nurses can expect to take on new practice roles that involve family history assessments, screening, and case coordination for clients receiving genetic testing and gene-based therapies. The authors report on successful initiatives since 1995 resulting from efforts of national organizations to advance the diffusion of genetic knowledge and genomics in nursing education and practice. Recommendations to strengthen these developments, along with strategies for nursing leadership in carving a new role, that of Genomics Nurse Case Coordinator, are presented.     

National quality efforts: what continuing and staff development educators need to know

In 1994, the American Nurses Association initiated a series of activities currently referred to as Nursing's Quality Initiative. This first step toward public accountability was based on the premise that all nurses must become more knowledgeable about the measurement, improvement, and benchmarking of clinical costs, quality, and outcomes specific to nursing. The American Nurses Association has not been working alone to advance quality health care. Rather, it has taken an active role in several collaborative activities, including those of the National Quality Forum. The National Quality Forum has focused on a variety of issues, including nursing care performance measurement, an activity in which the American Nurses Association has been involved. It is up to professional nursing, the National Quality Forum, and all who have interest in the provision (or receipt) of quality health care to advance quality in a collaborative, coordinated way.     

Nursing curriculum through a social justice lens: An upstream approach

This article describes a one‐day seminar rooted in critical interactionism for nursing students in a diverse urban setting in the United States. The authors are registered nurses and members of Nurses for Social Justice (NSJ)—a loose network of nurses and nursing students committed to societal change. Informed by the history of NSJ and larger social justice movements, the authors intentionally incorporate their personal experiences and offer an example of how nursing education can improve health at the micro and macro levels. The seminar starts with introductions and creating a safe space for authentic engagement. Students are guided to connect with their own journey to nursing and the experiences that have shaped their identities, including being oppressed and privileged. The lack of diversity within the nursing workforce and various nursing roles along the continuum of care are discussed. Case‐based scenarios are presented where students explore leveraging their power and privilege to effectively partner with individuals and communities. In closing, lessons learned are shared through a group activity that uses the ecologic model. Recommendations are made to equip nursing students with tools to better understand their role in the broader context of health.     

Fighting back: promoting emancipatory nursing actions.

Poverty, education, and social problems are inextricably linked to health concerns and cannot be addressed in isolation from each other. Nurses are being challenged to care for clients who are socially, politically, and economically disadvantaged. The model of emancipatory nursing actions is derived from the work of Freire, Habermas, and Katz and presented as a practice model in guiding nurses to begin choosing actions that seek to help people fight back from the depths of their despair, rather than helping people cope and adapt to their oppression. Emancipatory interventions are provided to help nurses launch a new direction toward freeing their clients, rather than herding them through an uncaring and disjointed health and social service system.     

The role of district nurses in caring for people with mental health problems who live in rural settings

District Nurses in rural areas frequently fulfil, in some permutation, the functions of district nursing, health visiting, school nursing, and community midwifery. This complex role can bring them into contact with a wide range of mental health problems. The extent, nature and type of mental health problems, and their response to these problems, is not well documented in the literature. The findings of this qualitative study indicate that District Nurses do in fact have contact with a wide range of mental health problems. The role of District Nurses in caring for this client group is more substantial than has been previously recognized. It is suggested that this role be formally acknowledged and that systems put in place to optimize the effectiveness of District Nursing interventions.