Using phronesis instead of ‘research‐based practice’ as the guiding light for nursing practice

Abstract Phronesis, a popular Aristotelian concept that emphasizes deliberation and moral action, should replace the phrase ‘research‐based practice’ as the guiding light for nursing practice. Knowledge from research is still essential, of course, but is insufficient by itself for practice. In this paper, the author describes assumptions behind the apparent superiority of research‐based knowledge, and offers a critique of this position. One critique is that by automatically accepting the superiority of research‐based knowledge other types of knowledge (e.g. intuitive, ethical, personal) are devalued. A second critique is that undeliberated, indiscriminate use of research findings may lead to inappropriate nursing practice. Phronesis is then described, and its application to nursing. For example, phronesis requires that the context of the situation be considered very carefully before acting. Aristotle stated that the goal of personal phronesis is to reach eudaimonia, or genuine happiness or ‘human flourishing’. Infusing nursing practice with phronesis means that an anthropomorphized discipline's eudaimonia would be the eudaimonia of patients. That is, nursing practice would be guided by a desire for patients' genuine happiness or human flourishing. The final section of the paper offers rebuttals to potential criticisms.     

Putting Socrates back in Socratic method: Theory‐based debriefing in the nursing classroom

The term “Socratic method” is so pervasive in education across the disciplines that it has largely lost its meaning, and it has lost its roots in its originator—the historical Socrates. In this article we draw from the original source, Plato's ancient dialogues, to understand the theory and principles behind the questioning used in Socratic method. A deep understanding of Socratic method is particularly timely now as nursing leaders call for increased use of theory‐based debriefing across the nursing curriculum. Socratic questioning is ideally suited as a method for debriefing in nursing classrooms because of its ability to enhance critical thinking and self‐reflection of the learner and because of its basis in care for the learner through a learner‐centred design. We present an analysis of the Socratic method in Plato's works and provide an overview of the key Socratic principles and techniques. We illustrate these principles and techniques with examples of how Socratic teaching can be applied in the nursing classroom, and we address the challenges and rewards for nursing faculty implementing Socratic method. Learning about Socratic method directly from Plato's dialogues can provide a richer and more robust understanding of this key pedagogical technique and help nurse educators practice more intentional and informed Socratic questioning and debriefing.     

A Gadamerian approach to nursing: Merging philosophy with practice

Philosophy is commonly criticized for being too abstract and detached from practical spheres. Upon chronicling how philosophy has gained this reputation, the authors explore the philosophical fields of phenomenology and hermeneutics that have explicitly attempted to merge philosophy with everyday life contexts. In recent decades, phenomenology and hermeneutics have been applied to healthcare. In the realm of nursing, Patricia Benner's nursing theory is especially informed by phenomenology, which is briefly explored through her relationship with one of her mentors, the philosopher Hubert Dreyfus. The authors then turn their attention to Hans-Georg Gadamer's philosophy in an attempt to mine concepts relevant to the practice of nursing. Gadamer juxtaposed the human sciences from the natural sciences and thought that both needed different approaches: whereas natural sciences are guided by episteme, that is, universal knowledge, human sciences are guided by phronesis, that is, practical wisdom. Gadamer's philosophy is especially helpful in understanding how to cultivate phronesis in nursing wherein a nurse relies upon one's clinical experience to masterfully navigate each unique patient relationship. Nurses must serve as authorities in the realm of healthcare but also be open to the authority of their patients, who ultimately choose their course of treatment in our contemporary era of patient autonomy. Gadamer's philosophy can help us understand why phronesis requires not only practice but also reflection on that practice to be appropriately cultivated. The authors apply this to the realm of nursing in showing how both practice—clinically and via simulation—and reflection—through journaling or dialogue—are necessary for phronesis to emerge.     

Correlates of physical,psychological, and social frailty among formerly incarcerated,homeless women

Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N?=?130, M_age = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty.     

Comparing the academic performance of graduate‐ and undergraduate‐entry medical students

Medical Education 2010 44 : 197–204 Objective This study compared the academic performance of graduate‐ and undergraduate‐entry medical students completing the same pre‐clinical curriculum and assessment at a large metropolitan university. Arguments have been made for the relative merits of both graduate‐ and undergraduate‐entry medical programmes. However, data on the academic performance of graduate and undergraduate entrants are relatively scarce. Methods This retrospective study adopted a quasi‐experimental design to compare data from assessments of bioscience knowledge and clinical skills undertaken across 2 years for four cohorts of medical students (who commenced their studies between 2002 and 2005). Percentage final results for four bioscience knowledge subjects and four clinical skills assessments (based on objective structured clinical examination [OSCE] results) were compared for 240 graduates and 464 undergraduates using multivariate analysis of variance (manova ). Results Graduate‐entry students performed marginally better than undergraduate‐entry students on all four bioscience knowledge assessments (partial eta‐squared [) and also on early clinical skills assessments (. Conclusions Graduate‐entry students had a marginal academic performance advantage during the early years of this medical course. Most graduate‐entry students had a first degree in a science discipline; thus their advantage may be explained by prior bioscience knowledge. Their performance advantage in clinical skills is less easily attributed to prior learning. Instead, this result provides some evidence for a possible advantage related to age. The marginal differences in early academic and clinical performance probably suggest that both graduate and undergraduate entry should exist in parallel to preserve multiple points of entry to the medical profession.     

Student Response Systems and Learning: Perceptions of the Student

To assess student perception of learning and use of a student response system (SRS) as a teaching/learning strategy. Survey methods were used to explore student perceptions of learning and use of student response systems as a pedagogical strategy. Fifty-nine graduate students participated in the survey post completion of two graduate intervention courses. Overall, there was a positive response to the use of SRS's in the classroom. All of the students (100%) recommended the continued use of the clickers for various reasons. The primary benefit reported by students related to providing immediate feedback, the opportunity to manipulate and revisit the content, and the ability to check for understanding within a class session. Students recommended the continued use of the SRS in classes to support acquisition of content and exam preparation. The student reported technology difficulties as the only the negative to SRS use in the classroom. Instructor perception was that the addition of the SRS devices added a new way to interact with the students. Suggestions for incorporating the use of a SRS devices into classroom instruction are offered.     

Telling a different story: Historiography,ethics, and possibility for nursing

With this paper, I will interrogate some of the implications of nursing's dominant historiography, the history written by and about nursing, and its implications for nursing ethics as a praxis, invoking feminist philosopher Donna Haraway's mantra that ‘it matters what stories make worlds, what worlds make stories.’ First, I will describe what I have come to understand as the nursing imaginary, a shared consciousness constructed both by nurses from within and by those outside the discipline from without. This imaginary is fashioned in part by the histories nursing produces about the discipline, our historical ontology, which is demonstrative of our disciplinary values and the ethics we practice today. I assert that how we choose to constitute ourselves as a discipline is itself an ethical endeavour, bound up with how we choose to be and what we allow as knowledge in nursing. To animate this discussion, I will outline the received historiography of nursing and dwell in the possibilities of thinking about Kaiserswerth, the training school that prepared Nightingale for her exploits in Crimea and beyond. I will briefly consider the normative values that arise from this received history and consider the possibilities that these normative values foreclose upon. I then shift the frame and ask what might be possible if we centred Kaiserswerth's contested legacy as a training school for formerly incarcerated women, letting go of the sanitary and sanitised visions of nursing as Victorian angels in the hospital. Much energy over the past 250 years has been invested in the professionalisation and legitimation of nursing, predicated (at least in our shared imaginary) on the interventions of Florence Nightingale, but this is one possibility of many. I conclude with a speculative dream of the terrain opens up for nursing if we shed this politics and ethos of respectability and professionalism and instead embrace community, abolition and mutual aid as organising values for the discipline.     

Reconciling conceptualizations of ethical conduct and person‐centred care of older people with cognitive impairment in acute care settings

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise , when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand , sovereign expressions of life and parrhêsia . We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research.     

Nutrition education intervention improves vegetable-related attitude, self-efficacy, preference, and knowledge of fourth-grade students

BACKGROUND: Impact of a classroom‐based, standardized intervention to address limited vegetable consumption of fourth graders was assessed. METHODS: A 4‐lesson, vegetable‐focused intervention, revised from extant materials was repurposed for Pennsylvania fourth graders with lessons aligned with state academic standards. A reliability‐tested survey was modified, then examined for face and content validity and test‐retest reliability. Lessons and evaluation materials were modified through an iterative testing process with educator feedback. A nonequivalent control group design was stratified by local Supplemental Nutrition Assistance Program Education (SNAP‐Ed) partnering organizations with random assignment of participating elementary schools as control (N = 68) or intervention (N = 72) treatments. Independent t‐tests compared control and intervention group changes. A mixed effects model was created to account for classroom effects from the nested sampling method of selecting classrooms within SNAP‐Ed partnering organizations. General linear model univariate analyses of variance were conducted to assess intervention effects considering gender, and food preparation/cooking experience. RESULTS: During a 3‐ to 5‐week time frame, 57 intervention classrooms (N = 1047 students) and 51 control classrooms (N = 890) completed pre‐ and post‐testing. Intervention students improved in vegetable‐related attitude, self‐efficacy, preference, and knowledge scores (p < .001). For example, intervention vegetable preference increased 1.56 ± 5.80 points; control group mean increase was only 0.08 ± 4.82 points. Group differences in score changes were not affected by gender or interactions between gender and food preparation/cooking experience with family. CONCLUSIONS: A defined intervention delivered in a SNAP‐Ed setting can positively impact mediators associated with vegetable intake for fourth‐grade students.     

Nursing and music: Considerations of Nightingale’s environmental philosophy and phenomenology

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a holistic, caring‐healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music‐based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well‐being of this vulnerable group of older persons.     

Living a socio-cultural approach in nursing education

The paper describes a teaching experience linking an undergraduate course and Master's degree course strictu sensu. The aim is to reflect on the social-cultural approach in nursing teaching and the relationship between teacher and students in the classroom. The subject of the study were students and a teacher from the discipline Philosophical Anthropology (graduate course) and student of the discipline Methodology of nursing teaching (master's course). The methodology applied was varied. The master's student followed the discipline through a participant observation and taught eight hours of class. On the participant observation of classes Paulo Freire's concepts of relationship between teacher and student and teaching-learning were applied. The feedback from the subjects in relation to the experience was positive.     

Young Men's Reentry After Incarceration: A Developmental Paradox

We apply a life course perspective to study young men's transition to adulthood within the context of their return to family after a period of incarceration. Our phenomenological analysis was based on 9 in‐depth, semi‐structured interviews with formerly incarcerated men between the age of 18 and 24. Our findings revealed that reentry was a developmental paradox that embodied contradictions about employment, maturity, and dependence on family. A key developmental contradiction was that although employment was essential for young men's ability to become independent, it was out of reach for most of the study participants due to their criminal justice involvement. Furthermore, lived meanings around dependency on family as a result of incarceration ran counter to young men's self‐definitions of adult manhood. Recommendations are discussed to help resolve these contradictions and facilitate young offenders' ability to move forward in life.     

Occupational therapy students’ perceptions of occupational therapy

Background/aims: An understanding of students’ perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students’ perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Methods: Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose‐designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Results: Students’ responses were categorised as ‘what’ occupational therapists do; ‘how’ they do it; ‘why’ they do it; and ‘who’ they work with. In ‘what’ occupational therapists do students frequently described ‘helping’ people. Both undergraduate and graduate entry masters students used the term ‘rehabilitation’ to describe how occupational therapy is done, with graduate entry students occasionally responding with ‘through occupation’ and ‘modifying the environment’. Students perceived the ‘why’ of occupational therapy as getting back to ‘everyday activities’, with some students emphasising returning to ‘normal’ activities or life. Regarding the ‘who’ category, students also thought occupational therapists worked with people with an ‘injury’ or ‘disability’. Conclusions: Students entered their occupational therapy programmes with perceptions consistent with the general public’s views of occupational therapy. However, graduate entry students exposed to a pre‐reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.     

A community-based approach to the medical humanities

BACKGROUND: This paper discusses the rationale behind, and an approach to, the development of a graduate level interdisciplinary curriculum in literature and health care that incorporates community-based learning. Such an innovative approach emerges from the recognition that professional training in both health care and humanities programmes often does not model the kinds of collaborative relationships and professional values desired by contemporary health care students, providers and patients. METHOD: Recent trends in literary study and the medical humanities are described, along with the function (and benefits to students) of interdisciplinary classrooms and the role of community-based learning in higher education. The authors discuss their experiences teaching, and offer students' responses to medical humanities courses from which the concept for such a curriculum evolved. The paper offers advice on developing, evaluating and disseminating such a model curriculum for medical, nursing and graduate literature students. PROPOSAL: By linking health care with graduate English literature students, such a course would promote dialogue and understanding among health professionals, enhance student awareness of the effects of illness on patients, their caregivers and families, and encourage student activism and community service. A common set of literary works would provide a shared vocabulary and opportunities for ethical, critical and personal response. Working together in a community-based project, students from different programmes would learn to appreciate alternative professional and lay perspectives on common experiences.     

Assessment of health professional education across five Asian countries—a protocol

Background

There is an increasing consensus globally that the education of health professionals is failing to keep pace with scientific, social, and economic changes transforming the healthcare environment. This catalyzed a movement in reforming education of health professionals across Bangladesh, China, India, Thailand, and Vietnam who jointly volunteered to implement and conduct cooperative, comparative, and suitable health professional education assessments with respect to the nation’s socio-economic and cultural status, as well as domestic health service system.

Methods

The 5C network undertook a multi-country health professional educational study to provide its countries with evidence for HRH policymaking. Its scope was limited to the assessment of medical, nursing, and public health education at three levels within each country: national, institutional, and graduate level (including about to graduate students and alumni).

Results

This paper describes the general issues related to health professional education and the protocols used in a five-country assessment of medical, nursing, and public health education. A common protocol for the situation analysis survey was developed that included tools to undertake a national and institutional assessment, and graduate surveys among about-to-graduate and graduates for medical, nursing, and public health professions. Data collection was conducted through a mixture of literature reviews and qualitative research.

Conclusions

The national assessment would serve as a resource for countries to plan HRH-related future actions.