Ideas of caring in nursing practice

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring.     

Education of the nurse for caring: reflections of professional practice

It is a reflective study that aimed at discussing the education of the nurse concerning the care in a perspective of change of the professional practice. The curricular guidelines for the profession are based Guidelines and Basis for National Edcucation which have aims to educate capable nurses to transform the practical reality of the Brazilian nursing. However, we realize that only the implementation of such guidelines does not make possible the education of critical, reflexive and transforming professionals regarding the real world.     

Reflection and moral maturity in a nurse's caring practice: a critical perspective

The likelihood of nurse reflection is examined from the theoretical perspectives of Habermas' Theory of Communicative Action and Moral Action and Sumner's Moral Construct of Caring in Nursing as Communicative Action, through a critical social theory lens. The argument is made that until the nurse reaches the developmental level of post‐conventional moral maturity and/or Benner's Stage 5: expert, he or she is not capable of being inwardly directed reflective on self. The three developmental levels of moral maturity and Benner's stages are presented with discussion on whether or not there can be self‐reflection because of an innate vulnerability that leads to self‐protective behaviours. It is only when the confidence from mastery of practice has been achieved can the nurse be comfortable with reflection that enables him or her to become enlightened, emancipated, and empowered. The influences and constraints of the knowledge power between nurse and patient are acknowledged. The power hierarchy of the institution is recognized as constraining.     

The affective domain: behaviors important in entry-level practice

Affective behaviors, those associated with attitudes, beliefs, and values, were identified by a Delphi panel of dietetic experts. Statements converged through four rounds into a set of behaviors categorized into five components: human, technical, conceptual, personal, and professional. One group of registered dietitians rated each of these statements from most to least important within each component. Another group rated each statement using the scale 1 = absolutely essential to 4 = not of concern. Mean rankings within each of the five components tended to have a small range. Mean ratings of the statements indicated respondents considered all of the behaviors to be essential or at least important. For an additional analysis, ratings of statements were subjected to principal components analysis. Inspection of the varimax-rotated factor matrix revealed that all but 1 of the 41 behavior statements could be grouped in an additional way to yield six internally consistent scales: initiative/flexibility, professional commitment, interpersonal, personal responsibility, leadership, and personal commitment. Additional research should be done to determine the practicality of utilizing these behavior statements to evaluate the performance of dietitians both at the entry level and at more advanced levels.     

Re-engineering healthcare pipelnes: why trajectory selection is as important as process selection in enabling effective transfer of best practice

PURPOSE: To demonstrate that effective re-engineering of healthcare pipelines requires selecting both the "best" process (how we shall do it in the future) and the best trajectory for change (how we get from here to there). DESIGN/METHODOLOGY/APPROACH: Exploitation of Braess' Paradox to identify strategic factors necessary to enable change in the re-engineering of NHS healthcare pipelines. FINDINGS: Route to maximising the chance of achieving effective change is displayed via a Johari Window. Each cell is then related to no change (despite significant investment); failure; or successful implementation. RESEARCH LIMITATIONS/IMPLICATIONS: The demonstrator pipeline is an NHS cataract repair supply chain. However, via the "Power of Analogy" concept the NHS scenario is readily related to a substantial number of industrial case studies. PRACTICAL IMPLICATIONS: The need to understand both process and trajectory is the key to effective re-engineering of pipelines. All "actors" in re-engineering programmes should acquire this knowledge and benefit from the new way of doing things. ORIGINALITY/VALUE: Formalises the strategic route to enabling healthcare delivery "best practice".     

The importance of caring and attachment in direct practice with adolescents

Caring and attachment are discussed as the foundation for healthy change in troubled adolescents. Examples of caring and attachment-forming interactions and environmental characteristics are cited along with the positive outcomes that result from them. Adolescents are viewed as requiring nurturing, rather than fixing.     

Harsh humour: a therapeutic discourse

Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)–patient interactions and CNS pre‐ and postinteraction audio diaries provided the baseline data corpus. Follow‐up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non‐laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90‐minute follow‐up interview and 10 hours of field note observations. The negative case – a CNS working with female drug users’ sexual and reproductive health needs – contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient persona was evident in the baseline data corpus but the negative case worked with ‘bad’ patients. Accordingly, a specific type of humour – harsh humour – was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients – disenfranchised or otherwise – in healthcare interactions.     

Clinical sympathy: the important role of affectivity in clinical practice

Medicine, Health Care and Philosophy - Bioethics has begun to see the revaluation of affects in medical practice, but not all of them, and not necessarily in the sense of affects as we know them....     

Nursing autonomy plays an important role in nurses' attitudes toward caring for dying patients

The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (beta = .19, P = .001), death avoidance domain of the DAI (beta = -.14, P = 0.03), life purpose domain of the DAI (beta = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (beta = -.17, P = .02), patients' rights domain of the PNQ (beta =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.     

Courtesy in caring. The patient as customer

If you were paying $500 a night for a hotel room,. would you be happy if you were told you would be sharing it with a stranger? While such a question cannot be literally asked about a hospital experience, metaphorically it can be--and is--asked every time a patient enters a hospital. The idea of patient-as-consumer is not longer just another trendy concept but an integral part of the way many hospitals do business, and it's the hospital manager's responsibility to ensure the customer's satisfaction.     

Patient safety incidents in general practice: important needles in many haystacks

Results of a Dutch quantitative chart review study in general practice (within and outside normal hours) revealed relatively low numbers of incidents with mostly no harmful consequences for patients. This commentary elaborates on the validity of these results and their importance for day-to-day general practice.