Understanding healing: a conceptual analysis

The practice of the healing arts has been a part of human history since ancient times Despite the development of related scholarly concepts in nursing such as caring, healing remains an enigma Using conceptual analysis a clear definition of healing within a Rogerian/Newmaman framework is explicated Case development assists in the understanding of healing as a concept, and questions arising from this definition provide focus for further scholarly work A result of this process of concept analysis was the development of a definition of healing which is clear and which fits the theoretical underpinnings of the unitary-transformative paradigm Healing, as a core variable of interest in the study of health, provides important parameters for study The definition of healing which arose from the concept analysis is Healing is an experiential, energy-requiring process in which space is created through a caring relationship in a process of expanding consciousness and results in a sense of wholeness, integration, balance and transformation and which can never be fully known     

Instead of reconceptualizing the nursing process let's re-name it

The discipline of nursing embraces the unitary-transformative paradigm and its theories that focus on nursing with attention to the language of humanbecoming, holism, relationship, authentic presence, caring, ethical interaction, complexity, pattern, energy, and recognition. In hospital nursing practice the medical paradigm is more prevalent and focuses on regulatory compliance, the standardization of technical language of the electronic health record, and the implementation of evidence-based practice initiatives for patient safety and quality improvement. Nursing and nursing theories are considered a moral enterprise; they involve seeking the good or caring for patients, others, and complex systems. With the continued influence of the medical paradigm, the questions for nursing are: what kind of good does nursing want to promote, and what unique contribution to patient care do nurses provide through their language, theories, and practice? A new mnemonic of Recognizing, Connecting, Partnering, and Reflecting is proposed.     

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.     

Embedded, engaged, evolving: a consortium of nurse researchers and clinicians

This article describes the journey of an innovative partnership among nurse researchers and nurse clinicians. The Chronic Illness Consortium (CIC) is an academic-service partnership between a university and its neighbors in a region without an academic medical center. It began with a small group of nurse researchers seeking a strategy to maximize research output and knowledge development and has evolved over 6 years into a forum that bridges scholars and clinicians, specialists and generalists, current and former students. The CIC engages in the scholarship of discovery, integration, application, and teaching,(1) and seeks to radically reform the way nursing and health care in general is delivered to people living with chronic illness. Finally, it is evolving as both knowledge development and practice address the demands of an increasingly large and complex patient population. As with any journey, many opportunities and lessons were learned. More importantly, there are implications for nursing knowledge development and application. Each of these areas is addressed.     

Recontextualizing learning in nursing education: taking an ontological turn

An ontological focus has been embedded within nursing education since its inception. There has been a strong emphasis on teaching students to become safe, competent nurses by translating knowledge into clinical action. But how would nursing education shift if we were to more intentionally orient the educative process ontologically and explicitly put epistemology at the service of ontology? We consider this question of an ontological turn in nursing education by examining what is commonly referred to in nursing curricula as interpersonal communication. With the goal of providing learning opportunities that can support students to develop confident and competent practice within the shifting, complex terrain of contemporary health care milieus, we explore the possibility of shifting the relationship between epistemology and ontology, and purposefully orienting the educative process in such a way that emphasizes and illuminates the manner in which nursing knowledge and action intersect with subjectivity and context.     

The nature of psychiatric nursing: the intersection of paradigm, evolution, and history

Psychiatric nursing, while vibrant and applicable once, is predicated on an approach to care and an understanding of mental illness that reflects an older time. Psychiatric nursing is in the precarious position of having an aging paradigm of practice, rooted in older knowledge and beliefs and recalcitrant to new knowledge and new realities of clinical practice. This article highlights paradigmatic assumptions and identifies the two dominant knowledge structures that struggle to coexist within that paradigm. Practical consequences of practicing psychiatric nursing with an aging paradigm are reviewed and a beginning point for the development of a new paradigm is presented.     

Participatory dreaming: a unitary appreciative inquiry into healing with women abused as children

Unitary appreciative inquiry was used to explore healing in the lives of 11 women abused as children using a model of participatory dreaming. Aesthetics, imagery, and journaling were used in a participatory design aimed at the appreciation of healing in the lives of the participants as it related to the abuse. Using Cowling's theory of unitary healing, research and practice were combined within a unitary-transformative framework. Participatory dreaming was useful in illuminating the life patterning in the lives of the women and promoted the development of new knowledge and skills that led to change and transformation, both individually and collectively.     

Implementing health promoting nursing: the integration of interpersonal skills and health promotion

Health promoting nursing practice is seen as the way forward for the nursing profession. This paper outlines the meaning of health promotion and distinguishes between a traditional and new paradigm approach. The research examining the extent to which a new paradigm approach is practised demonstrates that, to date, nurses predominantly adopt the traditional approach to health promotion. It is argued that the integration of interpersonal skills and health promotion within nursing curricula is crucial in enabling the transfer of theoretical concepts into practice. The ways in which this integration has been approached within one college of nursing are described. The difficulties encountered in attempting this integration and accomplishing a philosophical shift from a traditional to a new paradigm approach to health promotion are discussed and critiqued. Specifically conflicts that occur at an interpersonal, organizational and societal level are identified and proposed as explanations for the slow implementation of health promoting nursing.     

Nursing theory and practice: connecting the dots

The authors propose connecting the dots among theory, practice, and research by adopting an expanded conceptual-theoretical-empirical structure of nursing knowledge and matrix process to guide the placement of nursing knowledge in a contextual whole. An overview of the theoretical journey of nursing knowledge development is contrasted with the journey from practice resulting in a theory-practice disconnect. Both approaches are united to present an integrated view of the dimensions of the knowledge development of nursing as a professional discipline.     

Developing best practice in critical care nursing: knowledge,evidence and practice

Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as 'high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight. This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called 'soft' end of science. Thus, the 'Catch 22' situation is that the evidence base for nursing practice is considered to be weak. Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate. The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation. It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change.     

Sustaining Magnet: keeping the forces alive

This article describes one health system's journey toward sustained redesignation of Magnet status for its flagship hospital, Inova Fairfax Hospital. The 14 forces of magnetism are described, with examples of how those forces are being met in a culture of shared governance and participation in decision making about clinical practice. The fundamental shift in thinking from Magnet designation as a project to Magnet as a way of organizing nursing services is underscored.     

Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar

Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

Genetics and nursing: the interface in education, research, and practice

Genetics is affecting all of health care, including nursing. The way in which nurses think about planning health care must be seen now through a "genetic eye" or lens, and nurses must learn to "think genetically." While efforts to integrate genetics into nursing began in earnest in the early 1980s, this effort did not accelerate until the mid-1990s. Before nursing can fully incorporate genetic knowledge into education and practice in a meaningful way, the ways in which genetics will influence health care must be understood. The basic knowledge, skills, and attitudes needed by health professionals are discussed as well as their integration into education and practice. Opportunities for nursing research in genetics are presented as are possible directions. Recommendations for facilitating the integration of genetics into nursing education, practice, and research are also presented.     

Preparing the nursing workforce for the next era: Re-classifying and reframing enrolled nursing knowledge

Health systems are being transformed and redesigned in Australia to better respond to changing health needs, technological advances, and new capabilities needed for safe and quality care. A capable and responsive nursing workforce, at both enrolled and registered nurse levels, is one of the mechanisms required for achieving effective health care reform.This paper situates a critical discussion of enrolled nurse education within a symbiotic relationship model to consider how nursing knowledge can enhance workforce performance and contribute to improved function of health systems. Discussion focusses on classification, or what constitutes nursing knowledge, and how that knowledge can be presented, or framed, in nursing education.It is contended that different nurse education systems in Australia mean the construction of professional enrolled nurse knowledge differs in form and structure from registered nurse professional knowledge. While different courses are needed for enrolled and registered nurses to reflect their different scope of nursing practice, it is important enrolled nurse education classified and frames nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.     

The focus of the discipline of nursing.

The focus of nursing as a discipline has not been clearly defined but is emergent in the centrality of the concepts of caring and health. The authors propose a focus for nursing as a professional discipline in the form of a statement that identifies a domain of inquiry that reflects the social relevance and nature of its service. Several perspectives from which the focus can be studied are described. The authors assert that a unitary-transformative perspective is essential for the full explication of nursing knowledge.     

Paving the way: Stepping stones to evidence-based nursing

Wallace MC, Shorten A, Russell KG. International Journal of Nursing Practice 1997; 3: 147–152
Paving the way: Stepping stones to evidence-based nursing
Evidence-based practice is an emerging paradigm in health care. This paper outlines the main features of this paradigm and its potential value to nursing. Evidence-based practice is based on a conceptual framework that examines the extent of evidence available in support of particular clinical practices. The Quality of Evidence Ratings adapted by the National Health and Medical Research Council (NHMRC) from the United States Preventive Services Task Force are discussed, and the strengths and weaknesses of different categories of evidence are highlighted. Potential barriers to implementation of research into practice are identified. The authors suggest that legal, ethical, economic and humane imperatives oblige nursing to develop evidence-based practice as one of several viable contributions to nursing knowledge. Suggestions for analysing current research and for the planning of the direction of future nursing research are made.     

Respect for human dignity: a central phenomenon to philosophically unite nursing theory and practice through consilience of knowledge

Nightingale suggested that there should be no distinction between "men of thought" and "men of action" and that an "Ideal" or philosophy should not be isolated but incorporated into everyday activities. This construct is analogous to the belief that nursing theory and nursing practice should be incorporated, and both should reflect a common central phenomenon. The pursuit of nursing knowledge by women of "thought" is not viewed as a central phenomenon but is an outcome of scholarly inquiry. Outcomes pursued by practicing nurses, women of "action," depend on their particular role and scope of practice. A number of outcomes are possible ranging from prevention, public health and policy, alleviation of pain and suffering, and individual health promotion and healing to palliative care. These outcomes are not viewed as the source of unity to guide nursing since they may vary, especially with developments in science, technology, and philosophy. A more unifying central phenomenon could be viewed as the respect for, or the restoration of, human dignity, our being in community, our being in the world, and our sea of a moral imperative. Consilience, a way to unify the knowledge that is needed to support this phenomenon, is suggested as an example of an approach to a philosophy of nursing that embraces multiple forms and sources of knowledge in all-encompassing morality that ultimately ennobles the lives of all human beings in covenantal relationships with nurses both in theory and in practice.     

Putting the action into learning: the experience of an action learning set

As part of a practice development initiative the nursing staff of a special care nursery unit chose to begin an action learning set. The set was established to enable nursing staff to participate in a learning activity which focused on personal as well as team development. This was facilitated by a practice development nurse (researcher) who although not part of the nursing team, worked within the unit on a supernumerary basis throughout the study period. The set members identified and explored issues from clinical practice through a process of questioning, reflection, and challenging one another with an aim to improving the care delivered to patients and their families. This paper describes the process involved in establishing the set and the journey the set has taken since its inception in May 2002. The main areas covered in this paper include an overview of the practice development initiative, a brief outline of action learning including the processes involved, how the set was established, what it is like to be a set member, the development of skills and knowledge, the personal growth that has resulted from participation, and how the set is being evaluated.