Re-thinking the law, and challenging its traditional role in nursing's affairs: a strategy for professional reform.

Nurses world wide have regarded the law as a powerful tool of professional reform, and have historically looked to the law (its system and processes) to enhance and advance their professional goals. Nevertheless, the nursing profession still has not achieved its ultimate goals. To this day, nurses lack legitimated status as autonomous professionals, and are still burdened with enormous responsibility without the authority to match it. Given that the law is such a powerful tool of professional reform, the question must be asked at this point of nursing history: Why has the nursing profession not received the legal remedies it has sought in its quest to gain legitimated freedom from the subordinate and oppressed position it has historically occupied? In this paper, an attempt will be made to answer this question.     

Men in nursing: making the right choice

Why do men choose nursing as an occupation? What are the perceived barriers for men working in a predominately female-oriented profession? To answer these questions, the authors conducted a study in 2005, using a self-report survey as the data collecting tool. The 250 male registered nurses in Newfoundland and Labrador were the target population. The most common reasons for entering nursing cited by the respondents (N = 62) were career opportunities, job security and salary. The most commonly perceived barriers were sexual stereotypes, lack of recruitment strategies, female-oriented profession and lack of exposure to male role models in the media. The respondents stressed that recruitment strategies should focus on the factors that are important to them: job security, career opportunities and salary. The findings from this research may help with future recruitment strategies designed to attract more men into the nursing profession.     

Development of nursing science in Germany

This essay investigates the following two questions: Why did it take so long to become apparent that nursing has an important role in our society? What influenced the growing importance of nursing? Since this essay was part of a habilitation process, it begins with a review of the first German habilitation in nursing in 1895. In retrospect, this document reveals ideas of nursing that are important and still valid today, even though it was written by a physician. However, nursing as a profession practised by nurses or nuns was hidden in the invisible corners of health care and developed as a marginal category. For religious reasons nurses, as women, were encouraged to obey and not think for themselves. Only during the last few decades did nursing acquire a new meaning due to structural changes in morbidity and population, as well as a belated new sense of self-confidence in a profession still predominantly female. Within these new demands, nursing science also gained in significance. Its first substantial ideas came from North America. The difficulties in developing the nursing science lie in the nature of nursing, which often seems to be near omnipotence.     

Health promotion: the emerging frontier in nursing

Health promotion is gaining recognition as a health care strategy The major premise of this paper is that the nature of health promotion is emerging Rising into view, health promotion offers many challenges and opportunities to all health care professionals Many of the influences that health promotion will have on nursing have not yet been fully explored What is health promotion? What concepts are inherent in health promotion? Are there models of health promotion that are specific to nursing7 What will be nursing's role in health promotion? What changes are required by the nursing profession to enable nurses to emerge within this new frontier? These are central questions for nurses as health promotion professionals to ponder, and attempts are made in this paper to answer these questions     

Psoriasis: the burden of disease and treatment

We've all met them: the patient with chronic disease that simply will not help themselves. Why don't they listen to us? Why, when it's clear they understand the principles, do they seem to do everything in their power to make life difficult for themselves-and, in turn, for us? Of course, as enlightened nurses we take the trouble to understand the individual, and learn that their failure to follow a treatment programme is connected to their feelings about their disease and their body. If they ignore the answer they are also ignoring the problem and, in some way, they are taking control of their situation, making choices and asserting themselves.     

Nursing education and definition of the professional nurse role. Expectations and knowledge of the nurse role

The aim of nursing education is a development of the nursing profession. One way to promote development is to clarify the professional role. The role definition for nursing is mostly transmitted through tacit knowledge. We consider that the professional development of the nursing profession in Sweden requires a clear and well-defined nurse role. Stated goals of professional programmes for nursing do not include the entire body of tacit knowledge. The overall development requires recognition of a professional status together with a clear and well-defined role. We have found a significant change in the distribution of role-conceptions which occurred after the nurses had experienced their first year as registered nurses, and which did not occur during the educational process. This indicates that the conceptions of the need for a more clearly defined nursing role are assimilated during work experience. This confirms the necessity and importance of role modelling, role repetition and interactions with a professional group as part of the educational process.     

Hidden hemolysis.

The exact cause of this case of hemolysis has not been definitively determined, although evidence has pointed to a possible defect in the dialysis blood lines, which remains the only plausible etiology. However, we must always keep patient safety at the forefront so that the cause can be identified. The majority of our dialysis nursing staff has had extensive hemodialysis experience with the current equipment. None of us had ever experienced hemolysis before. When the etiology remained elusive, we kept struggling with the thought of "Why after all these years?" We must never lose sight of the fact that day in and day out we perform thousands of technologically complex procedures that have many potential complications. Since this incident, we have heard of other similar cases past and present. We reached out to a company that assists with medical investigations to determine if this was being experienced in other facilities. Since then, other facilities have contacted us with very similar stories. Why are we seeing more of this now? Do higher hemoglobins in our patients play a role in this? Are proper quality controls followed by manufacturers? There are many questions that need to be answered and research to be done. Lastly, as medical professionals, we must network and share the information we have been able to gather. This is about patient safety, not blame.     

The audio-visual revolution: do we really need it?

In the United Kingdom, the audio-visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound. This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio-visual equipment. But its purchase and use relies on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency. In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: ‘Why should we use this aid?’, ‘How effective is it?’, ‘And, at what?’. Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear.     

Intrepid: Second nursing cycle. First step, first desire in European Spain

When we started to write this article for ROL the first question which confronted us was first step? Why? The beginning of second cycle studies in 1998 did not correspond to any European desire, but rather consolidated a real desire which Spanish Nursing had: attain the highest possible academic title through growth inside the nursing discipline itself, having as an objective to place nursing in equal conditions as the majority of titles in the Spanish university system. This meant it was necessary to carry out research and investigation inside one's own scientific field, develop future professionals, administrate under equal conditions, and specifically consolidate a way deserving of one who bears responsibility over health care.     

Finding the leader within: thoughts on leadership in nursing

Leadership is an important topic in nursing. We recognize the importance of leaders who represent us well to those outside of the profession, yet many nurses do not view themselves as "leaders." This is unfortunate, because real leadership is less about a title or institutionally granted power, and more about how we "show up" in the many situations that make up our days. The image of the nursing profession is formed in the many day-to-day interactions between nurses and patients, families, the public, physicians, and administrators. Nurses who can find their inner leader and use it in their practice, at whatever level of the organization they contribute, will find that they are able to positively impact patient care and outcomes. This paper describes a framework for finding your inner leader that is based upon 5 "skill-cepts" (skills derived from leadership concepts), which we have found essential to leading.     

Evidence-based nursing: a change dynamic in a managed care system

The emerging evidence‐based decision‐making phenomenon represents a new opportunity for nursing professionals. This opportunity arises because managed care brings about a new motivation to incorporate existing evidence and research skill into the health care delivery process. In order to participate fully in managed care systems nursing research must be uncompromising in its focus on the characteristics of the client group, the processes of intervention and the outcomes of intervention. It is argued that evidence‐based nursing, as a process, needs to consider three questions. How do we know what practice needs to be changed? How do we enable this change in practice? and how do we ensure that change brings about no further harm? The greatest danger in the process of identification and prioritizing by a group is the bias that can occur because of conscious and unconscious habits associated with power relationships within groups. Nominal Group and Delphi techniques are suggested to alleviate this. Action research is proposed as a method of dealing with, the critical issue of risk management.     

A model for nursing and nursology

Wilson (1972) believes that disciplines are forms of thought that have a characteristic approach to appropriate questions related to the subject. An attempt has been made to interpret nursing accordingly. The ‘subject’ of nursing is the patient. Because there are periods in life when a person cannot yet or can no longer perform one or more of the activities of daily living, each person could be said to have a dependent/independent continuum for each activity along which he can move in either direction according to circumstance. Appropriate questions concerning each patient or client would be: Where is he on each continuum? Why is he at that point? Where could or should he be? How can he be helped to move along any continuum? How can any movement be evaluated or measured? Use of the model could help to produce research-minded nurses; could give value and prestige to helping patients with their activities of daily living; might help the profession to portray its relevant image; could reduce discrepancy between theory and practice, a common complaint made by today's vocal students; could help the profession to make overt its characteristic approach to its subject and thus help nursing to develop as a discipline.     

Attitudes towards nursing research among trained nurses

If nursing research is to have an impact on the nursing profession by influencing our thoughts and practice, it must be appreciated by those who work at the bedside and by those who have a direct influence on that work. The favourable attitudes of trained nurses are all-important for creating the right climate in the research field. Why has a gap appeared between research findings and their implementation into nursing practice? Should we question the need for research into nursing? It looks as though we may have to, with the various cuts threatening its future. Perhaps we should be expending more energy in the post-registration education of nurses — fostering good reading habits and making research findings more digestible and more appealing to those for whom they are really intended.In a small research project some of these problems were investigated. A questionnaire and short, structured interviews were used to explore some of the attitudes of trained nurses in hospital towards nursing research and to gain some impressions about how we can ‘bridge that gap’ between research and its implementation for the patient's benefit.     

Nursing: empowerment and the problem of power

The concept of empowerment is one which is often invoked in discussions over the nature of nursing practice in a range of health and welfare services A short excursion through the Cumulative Index to Nursing and Allied Health Literature reveals that over the last 10 years 378 papers are identified which list empowerment as one of the topics discussed In 1993, the number is 55 These papers cover a diverse range of health related issues health promotion and HFV, breast feeding, mental health, management and leadership, change, training and education, feminism and women's issues, sexual abuse and violence, advocacy and working with immigrants, professionalism, and nursing theory However, few of these papers discuss the relationship between empowerment and the notion of power itself This gives rise to particular problems for nursing practice, for without a clear conceptualization of what is meant by power it is difficult to convincingly argue that one form of practice is more or less empowering than another Alternatively, this dilemma may be stated in the following question how do we work to empower others when we have no clear notion of what power is? This paper demonstrates that the concept of power demands a very specific consideration In order to illustrate this it briefly identifies problems within two models of power which are drawn upon in nursing It also demonstrates the way in which the work of Michel Foucault can be drawn upon to inform nursing in the analysis of the relationship between power and health     

Foucault and nursing: a history of the present

While a commitment to the development of nursing theory has been a significant force in nursing scholarship, particularly in the US, the authors have noted a recent trend among nurses in different countries to develop Foucauldian interpretations of nursing. The objective of this paper is to identify those publications by nurses that employ a Foucauldian perspective and to provide a useful summative review of these works to date, which illustrate the potential contribution of a Foucauldian reading of nursing. The authors have reviewed 27 publications written by nurses which present a Foucauldian analysis. These publications were issued between 1987 and 1998 in English, Portuguese and German. The most frequent concepts treated in the literature reviewed are power/knowledge, surveillance, discourse, discipline, resistance, docile bodies, clinical gaze, and panopticon. The literature reviewed illustrates that Foucault's concepts can have a profound impact on the way we conceive of nursing as a discipline and as a profession. Nursing care becomes a political event, nursing knowledge contributes to the dissemination of regimes of truth, and nurses, rather than being powerless, are perceived as professionals who exercise power over life in society. A Foucauldian reading of nursing enables nurses to move into a broader interdisciplinary and critical scholarship.     

The Challenge of Accountability in Nursing

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professionals, and the increasingly critical role of nursing in the healthcare system.     

Withdrawal of treatment in the intensive care unit: the ethical and legal issues

Many articles have been written and studies conducted into why our patients' pain is not being managed more effectively. The myths and fears still persist, yet the solution is known. Why, then, can't our profession help those we care most about--our clients? Intensive care units (ICUs) have, over the last 30 years, become places of life-saving miracles, and as such, moral dilemmas have also been created. As early as 1976, applications have been made to courts for the withdrawal of life-sustaining treatment (Wallace, 1995). The decision to withdraw treatment is one faced by health professionals every day in the ICU, and there are many legal and ethical issues to consider. The emotional, and other, stakes are also high in this area for patient, family and care team. This paper discusses ethical and legal issues highlighting the principles, doctrines, legislation and precedents especially important in the making of the decisions to withdraw treatment. An ethical framework grid is suggested to assist with the decision-making process.     

When TikTok Is Not Enough: Engaging Nurses at All Levels in the Advocacy Process

Nurses took to social media at the height of the pandemic. They leveraged the popular app TikTok to share their experiences with the pandemic, educate the public, combat misinformation, and used it as a tool to advocate for the nursing profession. Although many nurses leveraged this platform to educate, others used it as a platform to challenge the system and highlighted the great divide within the nursing profession. With 4.2 million nurses in the United States, it is estimated less than 10% are members of professional organizations. These professional organizations are the primary groups advocating on behalf of the profession. How are we developing legislative agenda’s that meet the need of the profession if less than 10% of nurses are engaging and speaking up? There are multiple ways nurse leaders can engage frontline staff in the advocacy process. Levels of engagement can range from within the organization to local, state, national, and global efforts. The opportunities to engage are endless. We are 4 million strong, yet we struggle to have an aligned collective voice. Our divide begins with unions versus non-unions, mandated staffing ratios versus other staffing models, associate degree versus bachelor’s degree, and so on. How do we ever expect to be heard if we are not aligning our voices and coming to consensus on what is best for the profession as a whole? Social media is not getting us in front of the right people. As leaders, we must role model what advocacy looks like and provide avenues for our nurses to engage in this process.     

Being a nurse today

This article was presented as a conference in Soria as part of the celebration of International Nursing Day 2000. The topic of this conference was the contribution Florence Nightingale made to the definition of the real essence of the nursing profession, and its evolution over the course of the century. The author included a discussion of these topics: What do nurses want? What do business managers want? What does society want and need? Finally, the author concluded that nursing is a lively profession which has tremendous desires to improve itself.     

Redefinition of professional roles: if we re-started again from patients?

Redefining professional roles: should we re-start from patients? The redefinition of nursing competences is a need determined by the progressive changes of the health system and health professions. If on one side the definition of what nurses can or cannot do helps to render more visible the nursing profession, on the other also the WHO agrees that a rigid definition is not realistic. The constantly evolution of technologies and systems reshapes the boundaries between health professions. The actual debate is strikingly centered on professions (what each profession gains or looses, increase or loss of responsibility or power) and only rarely from patients' needs.