Critical pathways: A critical analysis

This paper explores critical pathways in relation to nursing knowledge and practice. Critical pathways, as part of managed care, have evolved from contemporary economic and management influences on health care. Critical analysis of actual texts of critical pathways and relevant published literature reveals how certain knowledge bases and interests are afforded primacy, or legitimated in the way critical pathways are developed and used within clinical practice. It is argued that even though the discourses of medicine continue as a dominant influence on health care, the direction and evaluation of such care is increasingly governed by economic and administrative discourses. The paper concludes with questions intended to stimulate ongoing debate, discussion and critique about the form and function of critical pathways in clinical nursing practice.     

Ways of knowing: realism,non‐realism,nominalism and a typology revisited with a counter perspective for nursing science

In this paper, we reconsider the context of Barbara Carper's alternative ways of knowing, a prominent discourse in modern nursing theory in North America. We explore this relative to the concepts of realism, non‐realism and nominalism, and investigate the philosophical divisions behind the original typology, particularly in relationship to modern scientific enquiry. We examine forms of knowledge relative to realist and nominalist positions and make an argument ad absurdum against relativistic interpretations of knowledge using the example of Borge's Chinese Emporium of Benevolent Knowledge. We propose a contentious postpositivist practical classification for nursing knowledge that demonstrates and supports the idea that knowledge has both individual and subjective components. This classification supports the practical application of nursing knowledge within the paradigm of realist postpositivist science.     

Workplace aggression: beginning a dialogue

The June 2005 Clinical Journal of Oncology Nursing editorial titled "Communication: Whose Problem Is It?" (Griffin-Sobel, 2005) was written to begin a dialogue about a phenomenon frequently experienced yet rarely discussed: workplace aggression, also known as disruptive behavior. Prompted by a groundbreaking study published in the American Journal of Nursing by Rosenstein and O'Daniel (2005), the editorial challenged oncology nurses to begin to fix problems of communication. After reflecting on both of the articles and considering my own experience as a nurse manager, clinician, and scholar, I decided to explore the topic as it relates to nurse-to-nurse workplace aggression. The following is a summary of interviews with nurse managers, nurse practitioners, and nurse scientists about root causes and effective strategies to manage these sometimes complicated situations. This article is meant to continue the dialogue about the very sensitive issue. Confidentiality has been maintained, and I welcome your comments.     

Reconciling nursing's art and science dualism: Toward a processual logic of nursing

There is an enduring debate in nursing regarding the art–science dualism, involving an articulation of two distinct ‘kinds’ of disciplinary knowledge: objective/scientific and subjective/artistic. Nursing identifies both as necessary, yet unbridgeable, which creates problems in constructing a coherent disciplinary knowledge base. We describe how this problem arises based on an ontological assumption of two different kinds of ‘stuff’ in the world: that with essential determinate properties and that without essential properties. We experiment with a solution by ontologically understanding the world as made from a single kind: That the most irreducible element of the world is process, in that reality is a continuous construction whereby subject and object are products, not independent constituents, of reality. Process philosophy overcomes nursing's ontological bifurcation and enables nursing's art–science dualism to be re‐conceptualized as a cohesive logic of skilled reality production. An unavoidable implication of a process turn in nursing philosophy is that the disciplinary goal no longer becomes a privileged ‘body of knowledge’ that authorizes, which has always been a defining challenge in nursing. Rather, and more productively perhaps, the aim is for greater sophistication and plurality in its ongoing commitment to attuning to reality in ways that shape disciplinary attainment.     

A normative analysis of nursing knowledge

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension.     

A new paradigm for nursing: the potential of realism

Realism has been the dominant approach in the philosophy of science for the last 20 years. Realist philosophy has also been widely employed across a range of social sciences. Unfortunately, these powerful intellectual currents have not reached the shores of nursing which appears trapped in a time-warped debate about 'qualitative' (constructivist) and 'quantitative' (positivist) approaches. This paper argues that both positivism and constructionism are seriously flawed as philosophies of social and natural science. This is in marked contrast with realism which is a philosophy of both the natural and social sciences. I therefore propose that realism should be adopted as a radically different new paradigm for a unified biopsychosocial nursing.     

The idea of nursing science

This paper addresses the question of whether or not nursing can legitimately be considered as a science. It is proposed that an adequate answer to this question requires consideration of recent developments in philosophy of science (as urged by Paley). It is shown that such developments call into question the 'rational image' of science. However, a defence of the legitimacy of the scientific enterprise has been attempted by Laudan, an advocate of the 'historical turn'. Two conditions necessary for the applicability of this 'turn' are identified. It is shown that although they apply relatively unproblematically to science, they do not readily apply to nursing. Hence the conclusion is drawn that claims for the integrity of nursing science stand in need of much further development.     

Re‐conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice

Jacqueline Fawcett's nursing metaparadigm—the domains of person, health, environment, and nursing—remains popular in nursing curricula, despite having been repeatedly challenged as a logical philosophy of nursing. Fawcett appropriated the word “metaparadigm” (indirectly) from Margaret Masterman and Thomas Kuhn as a devise that allowed her to organize then‐current areas of nursing interest into a philosophical “hierarchy of knowledge,” and thereby claim nursing inquiry and practice as rigorously “scientific.” Scholars have consistently rejected the logic of Fawcett's metaparadigm, but have not yet proposed a substantially agreed‐upon alternative. Through an analysis of articles introducing and critiquing Fawcett's metaparadigm, I argue for a re‐conceptualized metaparadigm that articulates nursing's ontology. What exists for the nursing discipline are not already‐demarcated metaparadigm domains, but rather interdependent, dynamic relations that constitute people, including nurses, in their health/environment circumstance. The nursing discipline aims to skillfully access this dynamic relationality as the basis for action and reflection to produce both positive health trajectories and knowledge that facilitates future action and reflection. Further inquiry into the onto‐epistemology of nursing will produce a more robust understanding of nursing practice, science, and philosophy, and clarify its unique contribution to health and healthcare.     

Educational silos in nursing education: a critical review of practical nurse education in Canada

Changes to practical nurse education (with expanded scopes of practice) align with the increasing need for nurses and assistive personnel in global acute care contexts. A case in point is this critical exploration of Canadian practical nursing literature, undertaken to reveal predominating discourses and relationships to nursing disciplinary knowledge. The objectives of this poststructural critical review were to identify dominant discourses in practical nurse education literature and to analyze these discourses to uncover underlying beliefs, constructed truths, assumptions, ambiguities and sources of knowledge within the discursive landscape. Predominant themes in the discourses surrounding practical nurse education included conversations about the nurse shortage, expanded roles, collaboration, evidence‐based practice, role confusion, cost/efficiency, the history of practical nurse education and employer interests. The complex relationships between practical nursing and the disciplinary landscape of nursing are revealed in the analysis of discourses related to the purpose(s) of practical nurse education, curricula/educational programming, relationships between RN and PN education and the role of nursing knowledge. Power dynamics related to employer needs and interests, as well as educational silos and the nature of women's work, are also revealed within the intersection of various discourses.     

The nature of philosophy of science, theory and knowledge relating to nursing and professionalism

It appears that nursing has devoted an extravagant amount of concentration to the subject of professionalism and professionalization. Consequently, it has created and persists to create some proportion of controversy amid nursing authors, particularly in the Western World at the present time. According to Silva, philosophy, knowledge and theory are intrinsically linked. These notions are important to consider independently and to clarify their relationships, if nursing's knowledge base is to be built on a strong foundation. Perhaps then, if nursing wishes to continue on the trail of professionalization, nurses need to return to and reconsider its foundations and accomplishments. The aim of this discussion paper is to explore the nature of the philosophy of science, knowledge and theory and their interrelationships, with particular reference to professionalization by considering where nursing has come from and consequently the way forward to ascertaining professional status.     

Hospitality: a call for dialogue

As we rush around attending to the essentials of our lives (family, friends, clients, employers), what is left?Nursing Forum invites readers to engage in thought and activity that may awaken an untouched place. We hope these writings will kindle your personal involvement in something that was previously avoided–because of bias, fear, or uneasiness–in order to stretch your mind and spirit.     

Natural science and nursing science: where do the horizons fuse?

The natural sciences have an influential effect on society, contemporary world-views, and other scientific disciplines. A brief history of the major advances in the natural sciences and the associated philosophies provides a platform for scholarly discourse regarding the subsequent influence on nursing epistemology. The concepts of knowledge and understanding are differentiated and a cautionary word is expressed not to cast aside the natural sciences and their corollary philosophies as nursing embarks upon its epistemological journey into the 21st century. Aesthetics is presented as a possible fusion of horizons of nursing and natural science.     

428篇危重病护理论文分析

目的:分析近年我国危重病护理领域护理研究的现况,存在的问题。方法:手工查阅2000～2005年发表于国内4种护理核心期刊的428篇危重病护理论文,就论文研究内容、研究方法等进行分析。结果:目前国内危重病护理研究论文数量呈逐年增长趋势,以经验性论文为主,占60%;机械通气与气道管理为研究的热点问题;实验性研究论文增长较快;需要在科学性和有效性方面进一步提高。结论:危重病护理研究水平有待进一步提高,应发挥学科优势,促进危重病护理研究的发展。     

Nursing practice draws upon several different ways of knowing

? This paper explores the proposition that nursing practice draws upon several different ways of knowing. ? It highlights difficulties often faced by practising nurses in defining what they do and hence what it is that constitutes nursing practice. ? Following formal definition and analysis of sources of literature regarding nursing knowledge, issues such as the origins of knowledge and the sources of nursing knowledge are addressed. ? The types of knowledge required to enhance nursing practice are discussed, focusing upon future opportunities and innovations in the generation of knowledge for nursing. ? Finally, recommendations are made regarding the way forward for nurses endeavouring to communicate the complexities of nursing practice.     

加强危重病人规范化管理的做法与效果

目的探索加强危重病人规范化管理,促进护理质量持续改进的方法。方法健全病房的组织管理;制定明确的护理目标和质量标准;完善各种制度与职责;推行访视制度与等级护理公示制度;加强护患沟通,实施护理缺陷补救。结果规范化管理前后,护理质量的各项指标差异具有统计学意义(P<0.05);病人满意度由原来的92.00%上升到97.67%,差异具有统计学意义(P<0.01)。结论通过对危重病人加强规范化管理,护士的行为得到了逐步规范,有效地提高了护理质量,减少了护理差错与护理纠纷的发生,提高了病人的满意度。