Emancipatory physiotherapy practice

In physiotherapy, as with many other health-care practices, therapeutic interventions, based on scientific knowledge, may be at odds with patient experiences. Patients may understand what they need to do to improve their health condition, but feel that these requirements may be emotionally, socially, or culturally incompatible with their lifestyles, social behavior, or personal choices. To work in the best interest of their patients, physiotherapists need to engage with the tensions that exist between scientific reason and social reality to offer a meaningful and relevant service for their patients. The challenge for physiotherapists is to arrive at decisions and interventions together with their patients that enhance, for example, mobility, social function, and well-being. To achieve this, physiotherapists need to rethink their professional role and translate their technical knowledge and goals into the patient's 'lifeworld', and patients--for their part--need to engage with physiotherapy professional knowledge. Often, the most commonly used strategy for facilitating this reciprocal engagement is open dialogue between patients and therapists. Habermas, a prominent contemporary philosopher and critical theorist, has developed a communicative theory that may support physiotherapists in their efforts to arrive at more sustainable and shared decisions with their patients. In this paper, I examine what constitutes physiotherapists' practice knowledge and how Habermas's theory of knowledge, interest, and communication strengthens shared decision-making and can be used as a vehicle toward emancipatory practice. Drawing on data generated in an action research project, I examine how Habermas's ideas can be applied in emancipatory physiotherapy practice. The paper concludes that emancipatory practice is meaningful because it creates opportunities for reflection, evaluation, and choice for future physiotherapy practice.     

Hmong American Women Living With Diabetes

Purpose: To understand how to better care for Hmong women with diabetes using nursing theory praxis.
Design: Qualitative phenomenologic design, specifically community-based collaborative action research based on Margaret Newman's theory of health as expanding consciousness (HEC).
Methods: Five Hmong women with Type 2 diabetes and HgbA1c levels over 7.0 were recruited from a community-health clinic. Audiotaped in-home interviews were conducted and data were analyzed to identify common patterns and then developed into a play by the research team with the help of a female Hmong playwright. Community dialogue about the findings generated meaningful actions for health.
Conclusions: This study indicates the value of nursing praxis rooted in the theory of health as expanding consciousness and the importance of engaging communities to identify meaningful patterns of health and needed actions.
Clinical Relevance: Evidence-based practice is lacking in the care of Hmong women with diabetes. Community-based collaborative action research rooted in the HEC perspective is a new way to envision models of care.     

Emancipatory physiotherapy practice

In physiotherapy, as with many other health-care practices, therapeutic interventions, based on scientific knowledge, may be at odds with patient experiences. Patients may understand what they need to do to improve their health condition, but feel that these requirements may be emotionally, socially, or culturally incompatible with their lifestyles, social behavior, or personal choices. To work in the best interest of their patients, physiotherapists need to engage with the tensions that exist between scientific reason and social reality to offer a meaningful and relevant service for their patients. The challenge for physiotherapists is to arrive at decisions and interventions together with their patients that enhance, for example, mobility, social function, and well-being. To achieve this, physiotherapists need to rethink their professional role and translate their technical knowledge and goals into the patient's ‘lifeworld’, and patients – for their part – need to engage with physiotherapy professional knowledge. Often, the most commonly used strategy for facilitating this reciprocal engagement is open dialogue between patients and therapists. Habermas, a prominent contemporary philosopher and critical theorist, has developed a communicative theory that may support physiotherapists in their efforts to arrive at more sustainable and shared decisions with their patients. In this paper, I examine what constitutes physiotherapists' practice knowledge and how Habermas's theory of knowledge, interest, and communication strengthens shared decision-making and can be used as a vehicle toward emancipatory practice. Drawing on data generated in an action research project, I examine how Habermas's ideas can be applied in emancipatory physiotherapy practice. The paper concludes that emancipatory practice is meaningful because it creates opportunities for reflection, evaluation, and choice for future physiotherapy practice.     

Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing

Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis‐oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western‐based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning.     

Understanding the workplace culture of a special care nursery

Aim. This paper presents findings from the first phase of a research study focusing on implementation and evaluation of emancipatory practice development strategies. Background. Understanding the culture of practice is essential to undertaking effective developments in practice. Culture is a dominant feature of discussions about modernizing health care, yet few studies have been undertaken that systematically evaluate the development of effective practice cultures. Method. The study intervention is that of emancipatory practice development with an integrated evaluation approach based on Realistic Evaluation. The aim of Realistic Evaluation is to evaluate relationships between Context (setting), Mechanism (process characteristics) and Outcome (arising from the context‐mechanism configuration). This first phase of the study focuses on uncovering the context (in particular the culture) of the Special Care Nursery in order to evaluate the emancipatory practice development processes and outcomes. Data collection methods included survey, participant observation and interview. Cognitive mapping, constant comparative method and coding were used to analyse the data. Findings. Four key categories were identified: Teamwork, Learning in Practice, Inevitability of Change and Family‐Centred Care and collectively these formed a central category of Core Values and Beliefs. A number of themes were identified in each category, and reflected tensions that existed between differing values and beliefs within the culture of the unit. Conclusion. Understanding values and beliefs is an important part of understanding a workplace culture. Whilst survey methods are capable of outlining espoused workplace characteristics, observation of staff interactions and perceptions gives an understanding of culture as a living entity manifested through interpersonal relationships. Attempts at changing workplace cultures should start from the clarification of values held among staff in that culture.     

‘Outside the Original Remit’: Co‐production in UK mental health research,lessons from the field

The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process.     

Admiral nursing competency project: practice development and action research

Aims and background. Admiral Nurses are specialist dementia care nurses working in the community with carers of those who have a dementia. The aim of the competency project (2000–2003) was threefold. Firstly to work collaboratively with these specialist nurses to facilitate the development a competency framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's Higher Level Practice standard. Design and methods. The two complementary approaches of emancipatory action research and systematic practice development were adopted. Methods were taken from action research and systematic practice development approaches with an emphasis on promoting and enabling enlightenment, critical reflection, ownership and creating the best conditions for long‐term commitment to the competency framework. Results. The main outcome from this project was the development of a specialist nursing competency framework. The Admiral Nurses’ Competency Framework is made up of a set of eight core competencies with three levels of competency statements, loosely structured around the Higher Level Practice standard, and guidance documentation to illustrate how work‐based evidence can be generated to demonstrate competence. There were also process‐derived outcomes associated with combining systematic practice development with emancipatory action research that had an impact on the culture. The main outcomes here were that practitioners engaged in and experienced learning about how to research their own practice and the consequences of doing this. They also learnt about specialist nursing practice more widely than Admiral Nursing. Finally, there was some increase in awareness about the culture within their teams and organizations. The final competency framework reflects the needs of the service, is owned by the majority of practitioners and project commissioners and this has had a positive impact on implementation. Conclusion. In this paper, we report on combining systematic practice development with action research to achieve immediate project aims. In addition we show how a project of this nature can contribute to developing skills in practitioners necessary for cultural changes in practice and contributes to wider issues of modernization within nursing and health care. Relevance to clinical practice. This competency framework will enable Admiral Nurses to demonstrate their level of specialist practice, as individuals and collectively as a service and it also promotes the principles of nurses as life long learners. This may have relevance to other groups of specialist nurses. The project has widespread relevance for two reasons. Firstly, it shows that nurses can be involved in designing and testing a competency framework as collaborators. Secondly, that to achieve this within the spirit of approaches, such as systematic practice development and action research, can be testing for all collaborators even were there is a shared or espoused aim.     

Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health‐care systems

There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health‐care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health‐care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health‐care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self‐preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self‐preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well‐being.     

Teaching feminist group process within a nursing curriculum

Nurse educators are challenged to develop emancipatory teaching approaches that will create opportunities for students to develop their own praxis. In particular, the authors faced the challenge of teaching feminist group process within a curriculum based on phenomenology, feminism, and critical social theory. In this article, we discuss the challenges and rewards of teaching nursing and other students about feminist process through the creation of experiential learning opportunities. In addition, we highlight recommendations based on our own praxis.     

Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward

Aims and objectives. The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process. Background. One of the challenges of nursing today is to meet the health‐care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided. Design. This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence‐base for an evolving model of care. Methods. The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self‐care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients. Results. The participatory action research process resulted in improved heath‐care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient‐centred care relationship based on Orem's self‐care model. Conclusions. This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting. Relevance to clinical practice. This study is significant because of its evidence‐base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the ‘grass roots’ level. Therefore, being involved in the decision‐making process provided an incentive to actively implement change.     

Beyond the 'tick and flick': facilitating best practice falls prevention through an action research approach

Aims and objectives. To examine residential aged care facility staff views on using falls risk assessment tools and the implications for developing falls prevention practices in the context of an action research project. Background. Falls risk assessments play an important role in care planning by identifying and monitoring aged care facility residents most at risk of falls. Yet while such assessments are recommended in falls prevention best practice guidelines, there is little published research that examines staff procedures and views related to conducting falls risk assessments. Design. Falls risk assessments were undertaken in the context of an action research project. Method. Twelve staff members from two residential aged care facilities (RACFs) in Tasmania formed a single Falls Action Research Group, which met 22 times over a year, providing the study’s qualitative data. During this time, key group members assessed 178 residents using a new falls risk assessment tool (FROP‐Resi). Results. According to group members, facilities evolved from a ‘tick‐and‐flick’ approach to falls risk assessment to a more individualised, face‐to‐face assessment process. Group members perceived the process to be more meaningful and enjoyable for staff involved in the assessment process resulting in higher quality of assessments and leading to improved levels of falls awareness among staff, residents and family caregivers. Conclusions. An action research process is useful for facilitating a new approach to falls risk assessments, engaging aged care facility staff with falls prevention and prompting improvements in falls prevention practices. Relevance to clinical practice. RACFs need to provide opportunities for staff to meet regularly to discuss practice, identify issues and take action. By doing so, staff can engage meaningfully with best practice activities such as optimising falls risk assessment processes.     

How can we maximize nursing students’ learning about research evidence and utilization in undergraduate,preregistration programmes? A discussion paper

Aim. This article presents a discussion on how to maximize nursing students’ learning about research for evidence‐based practice in undergraduate, preregistration programmes. Background. Evidence‐based practice may use information from many sources, including research. Research utilization concerns the translation of research findings into practice. Thus, while evidence‐base practice may not be solely research‐based and hence more than research utilization, research remains an important ingredient in ensuring quality and cost‐effective care and an academic requirement for nursing students undertaking a science degree‐level qualification. Nevertheless, how educators can best support research‐related learning and application remains uncertain and requires discussion. Data sources. MEDLINE, CINAHL, Social Science Citation Index, British Nursing Index, and Intute were searched for papers published 1980–2011 using the following search terms: research, research utilization, evidence‐based practice, learning, teaching, education, training, nursing, health, and social care. Discussion. Nursing students need to be able to value the relevance, authority, and utility of nursing research for patient care through embedding research learning in both academic and practice‐based settings. Students can be supported in learning how to access, understand, and appraise the authority of research through weaving these skills into enquiry‐based learning. Furthermore, encouraging students to undertake research‐based practice change projects can support research utilization and development skills. Conclusion. Research should be fully embedded throughout nursing curricula beyond the confines of ‘research classes’, integrating learning in academic and practice‐based settings. Although this requires synergistic and integrated support of student learning by nurse educators, managers, clinical practitioners, researchers and policymakers; nurse educators have a pivotal role.     

An emancipatory study of contemporary nursing practice

Changes in health care facilities have created the necessity for individual nurses to change, eg, change jobs, pursue additional education, become independent entrepreneurs. There is a shortage of nurses that places stress on those who remain to care for an increasing number of persons with too few resources. The purposes of this study were to explore nurses' perceptions of the circumstances of their work lives and to describe the processes by which they can create change in these circumstances. The methodology was an emancipatory design combining tenets of critical inquiry and feminist research. The method used was a dialectical process of reflection and action (praxis). Three diverse groups of nurses met weekly over 6-10 weeks. Using the group process method, each group reflected on, discussed, and analyzed the phenomenon of practicing nursing today. The outcome of an emancipatory study is reflected in the power of the process. The group interaction increased awareness, promoted reflection on the status quo, and energized the groups to derive possible solutions to changing that status quo. It is not the solutions themselves that are as relevant as is the obvious cogency of the process to achieve individual and group emancipation. Six codifications reflected the themes that emerged and 5 processes for exploring untested feasibilities for change were identified. The participants perceived themselves more as subjects in their history than objects to be manipulated, capable of transforming a rather dismal situation of nursing practice into one that was critical, creative, and freer from constraints. The implication of this study is that nurses are encouraged to adopt and adapt this process of group interaction because of its demonstrated credibility to empower and validate the role that nurses have to derive and implement solutions to change their unsatisfactory status quo.     

Social transformation and social isolation of older adults: Digital technologies,nursing, healthcare

BackgroundThe incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue.AimThe purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies.MethodsTo do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation.FindingsTwo dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth.DiscussionTo benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population.ConclusionOlder adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation.     

There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize ‘risk’ and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses’ practices and confidence in risk assessment and safety planning. A self‐completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self‐harm, substance abuse, and violence being most frequently assessed. Risk from others and ‘iatrogenic’ risk were less frequently considered. Overall, there was limited evidence of recovery‐oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk‐taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk‐assessment and safety‐planning process. Gaps in knowledge about risk‐assessment and safety‐planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.     

Using action research in nursing practice with older people: democratizing knowledge

Aim. This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. Background. Action research has gained popularity in nursing and healthcare research, offering a way of developing practice‐based knowledge, which can assist in changing practice and democratizing inquiry. Methods. There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. Conclusion. While the principles of action research appear to offer much towards the development of a practice‐rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. Relevance to clinical practice. If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.     

Cultural conflict: the impact of western feminism(s) on nurses caring for women of non-English speaking background

Much research has been conducted for understanding the health needs of people of different cultural backgrounds and the problems they experience in seeking health care. In Australia, despite such research, it is argued that there remains an exclusionary health care culture that continues to affect equity and access for people of non-English speaking background. There was a need for research in which health professionals examined their own Anglo-Australian culture and its impact on other ethnic communities. Such concerns provided the impetus for a feminist praxis study to engage nurses in understanding and improving care for migrant women. This study was conducted with 26 nurses in a paediatric hospital in Melbourne, Australia. Five collaborative research groups were formed, each consisting of four to six nurses who were co-researchers. Together, the nurses and researchers explored the health care experiences of migrant women, using a variety of quantitative and qualitative data collection strategies. This paper explores a major finding of the study, which was the impact of liberal feminist approaches on the practices of Australian nurses who cared for women of different ethnicity and race. The study found that the efforts of liberal feminist nurses to "treat all people the same" meant that women from different cultural backgrounds did not always receive equity in care. Through the feminist praxis process the nurses were able to explore contradictions in their practice and focus on equity in care to meet the specific gendered and racially constructed needs of women of different cultural backgrounds. A number of strategies were adopted that included regular use of female health interpreters and provision of privacy for migrant women when caring for their children.