Reading nursing history

Reading nursing history
This paper undertakes a reading of nursing history as a constituent discourse. The discursive power of history, with its active mining of the archives of the past to construct a narrative of contemporary force and power, is emphasized. The essay begins with the nineteenth-century and early twentieth-century professional histories that celebrated nursing's evolutionary achievements. It then moves to the sociologically influenced revisions of the 1960s, and the feminist and critical revisions of the 1980s and 1990s. We then turn to recent scholarship and examine the call for nursing history to participate in the theoretical construction of the discipline of nursing. The observation is made that, in the name of relevance, contemporary nursing history appears to be expected to contribute to the development of nursing knowledge, just as early histories contributed to the professionalization of nursing. The teleological assumptions of both nursing history and nursing theory are then argued to set the limits of nursing discourse, with detrimental effect on scholarship.     

Nursing resistance as ethical action: literature review

BACKGROUND: Much has been written about nursing as a predominantly female profession whose members display passivity, submission, obedience and powerlessness. Alternatively, some authors have presented evidence of nurses' capacity to exercise power, revealing the possible relationship between powerlessness and ethical compromise. Thus, empowerment strategies for nurses can yield ethical action. AIM: The aim of this paper is to use analysis of the literature to demonstrate how the actions and responses of nurses to ethical concerns are examples of nurses exercising power. METHOD: Empirical studies published in the nursing literature between 1990 and 2003 have been analysed to illustrate how nurses' actions of resistance can ensure that moral values are realized in practice. Foucauldian notions of power relations and feminist ethics provide the theoretical framework. CONCLUSIONS: Nurses were found to resist in situations where they experienced moral conflicts in relation to the actions of health professionals; however, instances were cited where they did not. Consequently, strategies for nursing education and management are proposed to increase nurses' understanding of the potential acts of resistance that they could employ in situations of moral conflict or concern.     

Nursing scholarship in Japan: Development, facilitators, and barriers

This qualitative study sought a contemporary view of the development, facilitators of, and barriers to nursing scholarship in Japan from the perspectives of the scholars. In-depth interviews were conducted with 13 scholars across Japan, which were digitally recorded, and the data were subjected to content analysis. Five themes emerged: a spirit of collectivism; a lack of nursing control; a lack of English ability; a high workload; and collaboration. The participants considered that culturally based consensus and communication behaviors, as well as the control and dominance by the medical profession, were hampering nursing scholarship. Furthermore, Japanese nurses were not in control of the profession in a period of unprecedented growth in university nursing education and a growing nursing shortage. A lack of English-speaking and English-writing abilities hindered collaboration with scholars internationally and the writing of international publications. Most of the participants felt unable to compare the extent and nature of Japanese scholarship with that of their Asian neighbors. The Japanese scholars need to grasp opportunities to learn English, collaborate with other nurses nationally and internationally, learn assertion and political skills to give them the confidence to take control of nursing education, and be more involved in research collaboration and international publications.     

Private thoughts in public spheres: issues in reflection and reflective practices in nursing

AIM: This paper aims to problematize the notions of reflection and reflective practice, particularly as they relate to private thoughts in public spheres and the constitution of personal and professional subjectivities. BACKGROUND/RATIONALE: Reflection and reflective practice, through the technologies of power and technologies of the self, permit the previously private thoughts of nurses to enter the public sphere where they are subject to surveillance, assessment, classification and control. Instead of raising serious concerns and debate about such practices, the plethora of literature, whilst using a bewildering array of ambiguous, diverse interpretations of reflection and reflective practice, has been united in claiming them as good for nurses and nursing. APPROACH: The paper draws on Foucauldian concepts of power-knowledge and discourse to interrogate radically the conceptualizations of reflection and reflective practice in contemporary nursing literature. CONCLUSIONS: The paper challenges the hegemonic discourse of reflection in nursing. It argues that new conceptualizations of reflection that acknowledge and value a diversity of perspectives, contexts and dimensions are needed.     

Through the looking glass: reflections on the authorship and content of current Australian nursing journals

Over the past three years, Australian nurses have witnessed a proliferation of locally published refereed nursing journals. This paper considers the refereed content published in four selected Australian nursing journals over a recent twelve month period. Material appearing in the Australian Journal of Advanced Nursing (AJAN), Contemporary Nurse, Nursing Inquiry and Collegian was categorized according to subject matter and authorship by gender and discipline. Findings indicate that articles pertaining to clinical practice, the practice of research, and professional nursing issues are well represented in the literature. These findings mark a change from earlier analyses of Australian nursing journals, which suggested that the epistemologies of other disciplines were over-represented in Australian nursing journals, and thus exerted a powerful influence over the development of nursing theory and scholarship. The increase in the number of refereed Australian nursing journals is indicative of the dynamic state of Australian nursing, in terms of confidence, scholarship and clinical practice development.     

A discursive exploration of the practices that shape and discipline nurses' responses to postoperative delirium

A discursive exploration of the practices that shape and discipline nurses' responses to postoperative delirium Although delirium is classified as a medical emergency, it is often not treated as such by health care providers. The aim of this study was to critically examine, through a poststructural, Foucauldian concept of discourse, the language practices and discourses that shape and discipline nurses' care of older adults with postoperative delirium (POD) with a purpose to question accepted nursing practice. The study was based on data collected from face-to-face, in-depth, personal interviews with six nurses who work on an acute postoperative patient care unit. Five analytic readings of the data identified two prominent discourses at work in nursing practice which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse - the biomedical/scientific discourse - served to direct, legitimize and govern all other discourses. The findings of this study have implications for nursing knowledge and practice, length of hospital stay and improved patient outcomes. This study builds on previous work and is the first study to conduct a discourse analysis illuminating nurses' responses to POD through comparison with other acute medical emergencies from a poststructural perspective.     

Re-thinking representations, re-writing nursing texts: possibilities through feminist and Foucauldian thought

FOCUS: Critical approaches are increasingly being used to inform theory and research within the discipline of nursing. In this paper we discuss the work of feminist writers, particularly those located within the postmodern, and Michel Foucault. Their work, although having significant points of difference, can be viewed as complementary and our engagement with these ideas has led us to re-think nursing knowledge. RATIONALE: Using ideas from Foucault and postmodern feminism foregrounds critical questions such as whose knowledge is visible in nursing literature, whose is suppressed, and the power relationships reflected in representations of knowledge. Our exploration of representations of knowledge has led us to review fundamental nursing texts that we consider to be important political and ideological artefacts in the enculturation of student nurses. The dominant position of medical knowledge in the texts reviewed continues to position this 'voice' as primary in nursing literature. DISCUSSION: Drawing on our current research on endometriosis to illustrate the potential inherent in rewriting such texts, we argue for a repositioning of knowledge related to the illness experience. Privileging the voices of people who are the focus of our clinical care reflects the reality of nurses' work; the embodied experience of the person is made visible rather than marginalized in the illness discourse.     

Discovering and affirming knowledge in nursing practice

This paper discusses how the use of care stories or stories derived from clinical nursing practice were used to elucidate the knowledge used in nursing practice. In addition, the processes used to elucidate this knowledge are described and consisted of reflective and critical reflective activity undertaken in both individual and group forms. In describing the processes used the concepts of reflection, critical reflection, narrative and story are discussed with reference to contemporary literature. It is the contention of the authors of this paper that nurses can, by verbalizing care stories with peers, identify knowledge that is either unique to nursing or highly valued by nurses. An additional value, that is concluded in this paper, is that nurses, by the verbalization of care stories, assist other nurses to see what they do, to hear what they do and also to value what they do. By using reflective conversation, as described by D.A. Schon, as a teaching-learning strategy the authors believe that this process may also enable the generalization of such knowledge and its transmission to peers as well as assisting students to record their knowledge and, in so doing, maintain it within the discipline.     

Starry night: using story to inform aesthetic knowing in women's health nursing

AIM OF THE PAPER: This paper describes the use of story as a vehicle to inform aesthetic knowing in nursing. Because health care demands that nurses know two distinct languages, the language of nursing science with its quantifiable outcomes as well as the experiential observations of health and illness, it is critical that nurses be fluent in each discourse. BACKGROUND: Nursing scholars have long voiced a commitment to two epistemological domains: scientifically derived knowledge (empirics) as well as the expressive, creative, intuitive application of knowledge (aesthetics). In recognition of the need for these interpretive paradigms for practice, nursing scholars have sought to identify the kinds of knowing which provide the nursing discipline with its unique perspective. DISCUSSION: Stories mould every human encounter and telling one's story in the context of a trusting relationship allows women and nurses to journey together to uncover and discover the meanings inherent in the story. Through this mutual process of unfolding the story, nurses engage the women in deep reflection and focus on what 'might be' so that possibilities for the future are illuminated. This is important in all nursing, but particularly in women's health nursing because the emergence of story suggests that contextual, phenomena-centred knowledge has found its voice in the nursing care of women as a way of knowing that focuses on personal experience and relies on methods in which woman-to-woman caring facilitates the disclosure of the human health-illness experience. CONCLUSIONS: Storytelling is a useful strategy to inform aesthetic knowing in nursing. Stories supply a foundation for nursing scholarship because truly to hear women's stories require nurses analyse information, formulate hypotheses, and seek to understand the causal relationships as expressed by women. Through this analysis and attention to detail, nurses are able to glimpse possibilities for the future, thus transforming the experience.     

The current status and future significance of nursing as a discipline

The nature of nursing and the need for knowledge distinct from medicine was first spoken of by Florence Nightingale in 1859. Her notions may be regarded as the earliest formations of nursing as a discipline. Since that time there has been substantial effort committed to the development of a distinct theory base for nursing. Increased interest in nursing's unique body of knowledge has been particularly evident in the last decade, as seen by the growth in research undertaken from a nursing perspective, and by the numbers of publications which focus on the nature of knowledge and theory in nursing. These efforts have served not only to advance the discipline of nursing but also to challenge all nurses to articulate for themselves the theoretical foundations of their own practice. The main thesis of this paper is that nursing is an evolving discipline. Aspects of its evolution will be discussed using the four characteristics of a discipline; domain, syntax, history, and output of knowledge.     

An analysis of nursing citations and disciplinary characteristics in 79 articles that represent excellence in nursing publication

Development of the knowledge base for a profession depends on research and scholarship that builds on the insights and work of scholars within the discipline and is disseminated through the literature. The purpose of this study was to examine a unique collection of 79 articles selected by editors as representative of their nursing journals. Articles were assessed for congruence with long‐standing values and conceptual definitions of nursing, and the extent to which they built on prior literature published in nursing. Articles were scored based on whether they reflected four characteristics of nursing as a discipline (holism, social context, goal of health, and consistency with common definitions of nursing); an abstract score on the extent to which the title, abstract, or keywords indicated a general focus on nursing; and a distinction score based on whether the article distinguished nurses or nursing from other providers. Fifty of the articles received an article score of 4, indicating all four disciplinary characteristics were present in the article's content. While the majority of the articles were congruent with fundamental nursing values and perspectives, only 28% of the sources cited were from nursing sources. The lack of citations to nursing literature, coupled with an assessment that reveals gaps in substantive content that builds on nursing knowledge, raises questions about the future of nursing perspectives in the literature.     

Ideological implications of paradigm discourse

Whilst the notions of paradigm and paradigm shift have become popularized in nursing's scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivation underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.     

本科护理毕业生循证知识、态度和实践现状及其影响因素分析

目的调查并分析本科护理毕业生知识、态度和实践的现状及影响因素。方法采用整群抽样法对我中心2017年7月入职培训来自18所学校的196名应届本科毕业护士进行问卷调查。问卷内容包括一般资料、循证知识、态度和实践量表(EBPQ)。结果新入职护士循证护理态度、实践和知识的现状总分(4.82±1.32)分,得分由高到低依次是:循证态度(5.69±1.01)分、循证实践(4.61±1.39)分、循证知识(4.60±0.99)分。本科循证护理教育开展率为21%;单因素分析显示:影响循证态度的因素为文献阅读频率和写作兴趣;影响循证实践的因素为文献阅读频率与写作能力;影响循证知识的因素为文献阅读频率、写作兴趣与能力、循证教育(P<0.05)。多因素回归分析显示:文献阅读频率对循证知识、态度、能力影响显著;写作兴趣对循证态度、知识影响显著;写作能力对循证实践影响显著(P<0.05)。结论本科护理毕业生循证态度积极,循证知识和实践有待进一步提高;护理本科生循证护理教育开展不足,需要进一步加强;本科护理教育应大力发展文献阅读和写作能力,以促进护生循证素质的提高。     

Continuing education in psychiatric nursing: a reflection on concepts

The concern with continuing education programs that prepare nurses to work in psychiatric nursing led us to conduct this study, the first one on the "development of psychiatric and mental health nursing personnel" research line. Its objective is to make a reflection on the concepts of continuing education, in-service and permanent, found in recent nursing education literature. To carry out the literature review of the concepts we reviewed the MEDLINE and LILACS data bases, theses and dissertations and a number of classical titles on the theme. After the analysis of the concepts and discussions with experts, we concluded that the continuing in-service education denomination is the one that presents more consonance with the authors and experts that were consulted, as well as the one that better meets the demands of knowledge in the area of psychiatric nursing towards the quality of assistance.     

Empowerment: reformulation of a non-Rogerian concept

The authors present a reformulation of empowerment based upon historical and current perspectives of empowerment and a synthesis of existing literature and Rogerian thought. Reformulation of non-Rogerian concepts familiar to nurses is proposed as a strategy to accelerate the mainstreaming of Rogerian thought into nursing practice and research. The reformulation of empowerment as a participatory process of well-being inherent among human beings may provide nurses with new insights for practice. This paper may also serve as a model for reformulating other non-Rogerian concepts and theories for wider dissemination across the discipline.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Power and partnership: a critical analysis of the surveillance discourses of child health nurses

AIMS: To explore surveillance discourses within New Zealand child health nursing and to identify whether surveillance practices have implications in this context for power relations. BACKGROUND: In New Zealand child health nurses are called Plunket nurses, who are employed by a voluntary organization, the Royal New Zealand Plunket Society (RNZPS). These nurses primarily work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices, which are generally carried out in homes and clinics in the context of an ongoing relationship between the Plunket nurse and the mother of a baby. However, suggestions in the literature that surveillance, wherever it is practised, has implications for power relations cast doubt on official claims that this nurse-mother relationship is mediated through a partnership model of care. METHODS: Five experienced and practising Plunket nurses were each interviewed twice. The texts generated by these semi-structured interviews were analysed using a Foucauldian approach to critical discourse analysis. RESULTS: In contrast with the conventional view of power as held and wielded by one party, this study revealed that, in the Plunket nursing context, power is exercised in various and unexpected ways. Although the relationship between the mother and the nurse cannot be said to operate as a partnership, it is constituted in the nurses' discourses as a dynamic relationship in which the mother is actively engaged on her own terms. The effect of this is that it is presented by the nurses as a precarious relationship that has significant implications for the success of their work.     

A pragmatic view of intuitive knowledge in nursing practice

Examining and exploring the intuitive knowledge--ergo intuition--of nurses is a critical undertaking for the practice of nursing. Traditionally, as nurses, we have been conditioned to value empirical knowledge above all other forms of knowledge. Intuition is, however, a rich source of nursing knowledge and, the authors would suggest, integral to the practice of nursing. Explicit recognition and embracing of intuition, as being a legitimate form of knowledge in the practice arena, must be intentionally nurtured. The focus of this paper is to explore intuitive knowledge within the context of nursing practice. It will also address various influences on our understanding of intuition as an essential form of nursing knowledge.