An inquiry into the concept of infancy care based on the perspective of Islam

All schools of thought believe that infancy is crucial to the formation and development of the human character. Nevertheless, a search of literature revealed the lack of a clear definition of the concept of ‘infancy care based on an Islamic perspective’ in nursing texts. As the lack of a clear definition of a concept conveys the inapplicability of that concept to its relevant field and community, this study was conducted to explore and determine the characteristic features of the concept of infancy care based on the perspective of Islam. Walker and Avant's (Strategies for theory construction in nursing. Prentice Hall, Boston, 2011) literary concept synthesis as the manner of concept development approach was conducted. Islamic documents were surveyed without any time limitation. Findings involved the extraction of six main concepts, including God as the Merciful Nurturer, mother as the symbol of the Creativity and Divinity of God, infant as a person with dignity and potential for excellence, parents as the nurture way paver, basic principles of nurturing, and holistic lifelong health promotion. The theoretical definition of each concept was presented. From the perspective of Islam, infant care is the nurturing of a human who has been conceived with dignity, certain rights, identity, and the capacity for development and excellence.     

The integrality of situated caring in nursing and the environment

Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry.     

Concerns relating to the application of frameworks to promote person‐centredness in nursing with older people

There is an increasing need to develop a multi‐dimensional discussion and critique around the concept of ‘person‐centred’ in the context of the delivery of nursing care for older people. As the context of nursing being considered here, it is primarily nurses who should be leading with this discourse, although drawing on a broad range of ideas from outside of nursing. The person‐centred movement, commonly believed to originate in the care of those with dementia in the UK, is growing, especially in the UK and Australia, with signs of it moving across parts of Western Europe and North America. Person‐centredness has a big emotional appeal to many nurses working with older people, perhaps because it ‘has the right feel’ for them and nurses believe it ‘feels right’ for older people. It has grabbed the attention of many practising nurses in the UK in a way that humanistic nursing theory and the various associated nursing models from previous decades, seemed to have missed. This paper contributes to the discussion by suggesting that there are conceptual frameworks that nurses can draw on to help them understand and enhance their practice. However, it is suggested that these frameworks are either in their infancy or incomplete and they still need to convince nurses of their utility for day to day practice. It is also pointed out that the underpinning concept of ‘personhood’ has not yet been fully clarified by nursing.     

A unitary participatory vision of nursing knowledge

This article responds to the calls by Margaret Newman for clarifying and expanding the nature of nursing knowledge. The unitary worldview proposed by Newman and the participatory worldview of action research are explicated, highlighting their respective major elements. A synthesis of unitary and participatory worldviews, grounded in a union of the elements of each, is proposed as a vision for the development of nursing knowledge. The unitary, participatory vision described offers the potential for inclusiveness and transcendence of previous perspectives of nursing knowledge.     

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re‐centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value‐laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.     

Two-Eyed Seeing as a strategic dichotomy for decolonial nursing knowledge development and practice

The profession of nursing has recognized the need for contextual and relational frameworks to inform knowledge development. Two-Eyed Seeing is a framework developed by Mi'kmaw Elders to respectfully engage with Indigenous and non-Indigenous knowledges. Some scholars and practitioners, however, are concerned that Two-Eyed Seeing re-instantiates dichotomized notions regarding Western and Indigenous knowledges. As dichotomies and binaries are often viewed as polarizing devices for nursing knowledge development, this paper explores the local worldviews in which Two-Eyed Seeing emerged, proposing that the onto-epistemological and axiological ‘roots’ of the framework are antithetical to divisiveness, paradoxically asserting space for the dichotomy to stand. Two-Eyed Seeing, if understood as a relational, decolonial praxis, could fundamentally change the way nursing scholarship and practice operate by facilitating space for diverse knowledges, ways of being, doing and relating. In this paper, considerations for nursing scholarship and practice, as well as recommendations to support the uptake of Two-Eyed Seeing are explored. The authors assert that conceptual divisiveness, dichotomization and exclusion can be mitigated if nursing is informed by contextual knowledge, seeks to enact accountable partnerships with Indigenous knowledge holders, and holds the Mi'kmaq worldview upon which the concept developed in positive regard.     

A philosophical analysis of caring in nursing

The concept of caring is fundamental to our understanding of human nature. A philosophical examination of the concept in a particular context by analytical and phenomenological methods, may help to characterize the responsibilities and potentialities of caring. The concept of caring as applied to nursing has both an activities and an attitudes aspect. The latter is complex in particular, involving cognitive, moral and emotional factors. Attention, perception and recognition of fundamental moral values such as respect for persons are discussed, prior to an attempt to elucidate the emotional components of caring further. Whilst it is evident that liking or affection for a patient may be contingently present in nursing care, perhaps compassion and gratitude may also be generated by the nurse-patient relationship, where certain benefits of understanding can also accrue to the nurse. The development of such relationships implies a long-term caring context, severely at odds with many institutional and economic pressures today.     

A concept analysis of personal knowledge: application to nursing education

A concept analysis of personal knowledge is completed using the Walker and Avant method The analysis is based on Polanyi's concept of personal knowledge with a working definition being extrapolated from his writings combined with Belenky and colleagues' concept of constructed knowledge The goal is to construct a definition of personal knowledge which recognizes the multifaceted processing used by humans in the endeavour to perceive new patterns, and which is free from discrimination based on age, sex, culture, discipline, world view or learning style Knowledge is defined as pattern recognition which may be probabilistically rather than exactly predictive Personal knowledge is defined as recognition of a new pattern through processing by the human being The processing may consist of any combination of human and environmental interaction, 'rational intuiting', appraisal, active comprehension and personal judgement, all in a setting of departure from the current conceptual framework The pattern may be new to the person or to humanity Personal knowledge is denoted by perception of the person The antecedents, attributes and consequences are taken from the literature The empirical referents are hypothesized from a review of the nursing, social work and education literature After defining personal knowledge and differentiating it from other phenomena, it is integrated into nursing education An educator accepting personal knowledge as an expectation for students approaches the teaching/learning situation by planning to create an atmosphere in which individual growth and illumination can occur Therein personal knowledge is integrated into nursing education using the most barrier-free theoretical frameworks in the areas of learning, curriculum and instruction     

The converging paradigms of holism and complexity: An exploration of naturopathic clinical case management using complexity science principles

Rationale

Traditional whole systems of medicine, such as naturopathy, are founded upon holism; a philosophical paradigm consistent with contemporary complexity science. Naturopathic case management is predicated upon the understanding of an intimately interconnected internal physiological and external context of the human organism—potentially indicating a worldview aligned with a complexity perspective. In this study we investigate naturopathic clinical reasoning using a complexity lens with the aim of ascertaining the extent of correspondence between the two.

Method

Mind maps depicting case presentations were sought from Australian degree qualified naturopaths. A network mapping was undertaken, which was then analysed in accordance with a complexity science framework using exploratory data analysis and network analysis processes and tools.

Results

Naturopathic case schematics, in the form of mind maps (n = 70), were collected, network mapped, and analysed. A total of 739 unique elements and 2724 links were identified across the network. Integral elements across the network were: stress, fatigue, general anxiety, systemic inflammation, gut dysbiosis, and diet. A modularity algorithm detected 11 communities, the primary ones of these representing the nervous system and mood; the gastrointestinal tract, liver, and nutrition; immune function and the immune system; and diet and nutrients.

Conclusions

Naturopathic case management is holistic and based on a perspective of an integrated physiology and external context of the human organism. The traditional concept of holism, when subjected to a complexity lens, leads to the emergence of a contemporary holistic paradigm cognisant of the human organism being a complex system. The application of complexity science to investigate naturopathic case management as employed in this study, demonstrates that it is possible to investigate traditional philosophies and principles in a scientific and critical manner. A complexity science research approach may offer a suitable scientific paradigm to develop our understanding of traditional whole systems of medicine.     

Diversity and becoming: implications of human existence as coexistence

Better ways of understanding and working with human diversity are needed in the healthcare and human service disciplines. Nursing, as the discipline that cares for whole persons throughout their lives and meets people where they are, is ideally suited to provide leadership to this effort. In this column, the author explores human diversity by explicating human existence as coexistence, with implications for nursing. The author locates his worldview within the human becoming school of thought. Human diversity and human existence as coexistence are explored within this context, with implications for nursing as a discipline identified. Ideas that are crucial in the explication of human existence as coexistence are difference, imagination, creativity, and wholeness.     

A concept analysis of holistic nursing care in paediatric nursing

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care.     

Concept analysis: the importance of differentiating the ontological focus

AIM: The aim of this paper is to clarify the philosophical underpinnings of concepts and concept analysis and the implications of their use through the lens of particular ontological perspectives. BACKGROUND: Information on the philosophical foundations of concepts from an ontological and epistemological perspective is not readily identifiable in the international literature. Although some authors have made reference to the ontological perspectives of specific concept analysis processes, none have addressed the implications of the realist or relativist perspective in relation either to the analysis process or the implications of a particular ontological perspective on the meaning and utility of a specific concept. METHOD: We describe the evolution of concept analysis and influence of ontological paradigms on specific analysis methods. Using an historical review of concept development within nursing thought, we decode the language of concepts and processes of concept analysis, outline the importance of the ontological foundation of concept development, and describe the impact of concept use. DISCUSSION: The nursing literature is dominated by concepts created from a realist perspective. Although recent nurse-authors have introduced evidence-based data to facilitate the development of a number of concepts, they have held fast to the perception that the 'best', most adequate or mature concepts transcend context. CONCLUSION: The theoretical shift from context-bound empirical analysis of concepts belies the complexity of nurses' work. Concepts are unapologetically context-bound. A concept that transcends context (based on realist ontology) will remain the same even when the context of praxis changes limiting its utility.     

What characterises nursing care? A hermeneutical philosophical inquiry

The aim of this study was to identify some common characteristics associated with nursing care based on the historical text by the nursing pioneer, Rikke Nissen, and the modern philosophy of care, principally that of Kari M. Martinsen. The hermeneutic approach has been inspired by Gadamer's thinking. His philosophy influenced interpretation and reflection on the content of historical and modern text. Typical basic characteristics associated with nursing care can be grouped into three mutually reinforcing areas: (i) the notion of excellence in nursing care, (ii) the relationship between nursing care and moral values, and (iii) caring as an interpretational exercise. The most significant core element was the strong relationship between care and professional judgement (or clinical judgement), and the requirement of analytic cognition on different levels of abstraction in context with the patient. In the early days of nursing, care was a concept deeply rooted in Christian philosophy. Within modern nursing philosophy, care is conceptualized in a number of ways, depending on philosophical stance and world view. What seems absolutely necessary is to differentiate between the concept of care on the superordinate level and each individual philosopher's unique perspective on care. As a superordinate term, nursing care encompasses the patient's fundamental needs, as well as the patient's values and experience. Nursing care is characterized by the holistic view and the moral inherent in excellent nursing. Excluding the patient as a unique human being, should be regarded as noncaring and amoral practice. Whether nursing care represents a specific domain of knowledge is still an unanswered question, and something which has consequences for the application of a caring philosophy in nursing practice and the state of caring knowledge in nursing.     

The global context of nursing: a human becoming perspective

When one considers global health issues from the natural science worldview, it is with a belief that no one person can have any significant influence, hence, a sense of powerlessness and disconnection. In this column, though, the authors assert that when one's perspective is the human science paradigm, and particularly, the human becoming theory, one person can and does make a difference in global health. The authors discuss the human becoming perspective using the metaparadigm concepts of human, health, and environment, and also, nursing practice guided by the theory. Informed by this perspective, they then explore political implications for global nursing and health.     

Intentionality: applications within selected theories of nursing

Intentionality is an important concept for nurses to study for professional and theoretical reasons. Lewis states that intentionality is best studied within an active, rather than reactive, worldview. This article is a level-by-level outline of Lewis' five-level model for the study of intentionality. These levels are: necessity, interactive necessity, action intent, divergent intent, and conscious intent. Newman's tri-part categorization of nursing theory paradigms (particularate-deterministic, interactive-integrative, and unitary-transformative) proves to be a useful framework to compare the Lewis model of intentionality with nursing theory. Examples from nursing theory development, such as the Roy adaptation model, chronotherapeutics, Rogers' theory of unitary human being, health as expanding consciousness, and therapeutic touch, are used to support all five levels of intentionality in providing guidance for practice and research by nurse theorists.     

Principle-based concept analysis: recognition in the context of nurse–patient interactions

Title.  Principle-based concept analysis: recognition in the context of nurse–patient interactions.
Aim.  This paper is a report of a principle-based concept analysis of recognition in the context of nurse–patient interactions.
Background.  Recognition is a concept employed in practice and research. Since nursing is patient-centred and care is problem-driven, the specificity and accuracy of recognition may have an impact on how nurses label patient phenomena, interventions initiated and patient outcomes.
Data sources.  The data set included 98 English language articles published from 1997 to 2008 and retrieved through Medline and CINAHL searches.
Methods.  Principle-based concept analysis was used to examine the state of the science according to major perspectives of the philosophy of science. Conceptual components were integrated into a theoretical definition and the process of recognition was conceptually modelled.
Findings.  The scientific literature dealing with recognition in the context of nurse–patient interactions relies on implied meaning. Recognition is a process marked by an awareness of evidence coupled with the formulation of a conceptual label summarizing the identified pattern of patient phenomena. Contextual features of the nurse, patient and organization are relevant during nurse–patient interactions, resulting in pivotal points in nursing care. These pivotal points are the moments of recognition when the nurse consciously applies a summary label to interpreted evidence. Outcomes of recognition include a choice to act or not to act, each option carrying significant outcomes for nurses, patients, and at times, organizations.
Conclusion.  A working definition was produced that will serve as a foundation for future concept-driven research to advance the concept toward greater precision and usefulness in nursing science.     

La percepción del paciente crítico sobre los cuidados enfermeros: una aproximación al concepto de satisfacción

IntroductionLevel of satisfaction is a key indicator of quality of care. There are many tools that measure satisfaction with nursing care, however they do not respond to the reality of the critical care patient or to our context.ObjectivesTo define and to identify the dimensions of the satisfaction of patients admitted to the intensive care unit of a tertiary hospital with nursing cares and to define and identify the dimensions of the concept of satisfaction from their point of view.Material and methodsA qualitative research study was conducted according to the Grounded Theory Method in three Intensive Care Units with 34 individual boxes, with theoretical sampling. Nineteen patients remained after data saturation sampling. Data collection was obtained through recorded in-depth interviews and field logbook. Contents analysis was made according to the Grounded Theory. Guba and Lincoln rigor's criteria were followed. There was a favorable report from the Hospital's Ethics Committee and informed consent was obtained from the patients.ResultsFour categories were found: The definition and dimensions of the satisfaction concept, expectations and life experiences. The participants included the following dimensions in their satisfaction definition: professional competences, human, technical and continuous cares. The combination of these elements produces feelings of security, calmness, being monitored, feeling like a person, perceiving a close relationship and trustfulness with the nurse who performs the individualized cares.ConclusionsThe definition and dimensions of satisfaction concept from the patient's point of view show the important aspects of the person and also clarify their dimensions, allowing the construction of tools more in line with the context and real perception.     

Maintaining dignity in vulnerability: A qualitative study of the residents’ perspective on dignity in nursing homes

BackgroundOlder people, living in nursing homes, are exposed to diverse situations, which may be associated with loss of dignity. To help them maintain their dignity, it is important to explore, how dignity is preserved in such context. Views of dignity and factors influencing dignity have been studied from both the residents’ and the care providers’ perspective. However, most of these studies pertain to experiences in the dying or the illness context. Knowledge is scarce about how older people experience their dignity within their everyday lives in nursing homes.AimTo illuminate the meaning of maintaining dignity from the perspective of older people living in nursing homes.MethodThis qualitative study is based on individual interviews. Twenty-eight nursing home residents were included from six nursing homes in Scandinavia. A phenomenological-hermeneutic approach, inspired by Ricoeur was used to understand the meaning of the narrated text.ResultsThe meaning of maintaining dignity was constituted in a sense of vulnerability to the self, and elucidated in three major interrelated themes: Being involved as a human being, being involved as the person one is and strives to become, and being involved as an integrated member of the society.ConclusionThe results reveal that maintaining dignity in nursing homes from the perspective of the residents can be explained as a kind of ongoing identity process based on opportunities to be involved, and confirmed in interaction with significant others.