Therapeutic relationships in critical care nursing: a reflection on practice

AIMS: The aim of this paper is to gain a greater understanding of the emotional intelligence required to form therapeutic nurse-patient relationships in the context of critical care nursing. CONTEXT: There is currently a demand for patient-centred nursing in all aspects of health care to improve both quality of care and consumer satisfaction. Central to patient-centred care is the presence of a therapeutic nurse-patient relationships, but the development of these relationships present a challenge in the acute and technological world of critical care nursing. THEORETICAL FRAMEWORK: Using Titchen's Skilled Companionship Model as a guide as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a reflection on a relationship that the author developed with a patient and his family encountered in her practice as a critical care nurse. REFLECTIVE CONCLUSIONS: Engaging in therapeutic nurse-patient relationships can expose nurses to emotional pain in the context of critical care nursing. The process of reflection can facilitate critical care nurses in the development of the emotional intelligence required to develop and maintain these relationships and this enhances the care of critically ill patients and their families.     

The arrogance of power: a reflection on contemporary mental health nursing practice*

This paper explores the role of contemporary mental health nursing and challenges practitioners to acknowledge the influence that power relationships have on therapeutic practice and client outcomes It is argued that empowerment and advocacy remain central concepts for nursing and that the art of accurate empathy is a pre-requisite for contemporary mental health care     

Interviewing women: using reflection to improve practice

Caryl Skene uses a model of reflection to revisit her experience as a novice researcher In doing so, she highlights the skills required to undertake qualitative research and suggests that nursing experience alone does not equip a researcher with those skills. A significant part of her reflection concentrates on the relationship between the researcher and the research, and the impact it may have on the research process and on those involved in it.     

Complementary therapies in practice: the ethical issues

Summary

• ? This article explores some of the ethical issues associated with the use of complementary therapies in practice.
• ? The adopted terminology and related concepts are clarified. The term ‘complementary therapy’ is compared and contrasted with ‘alternative medicine’ and ‘non-conventional therapy’.
• ? The increasing emphasis on holistic nursing care is also discussed.
• ? Ethical issues of patient choice, informed consent and the principle of beneficence are examined in relation to complementary therapies.
• ? The article highlights the obligation of the nurse, midwife or health visitor to provide or facilitate holistic care including complementary therapies, such as massage or aromatherapy, for those clients who request such care, and where it can be demonstrated that there will be benefits for the patient.
• ? It is concluded that nurses should consider the possibility of incorporating or facilitating certain complementary therapies in their practice in order to benefit their patients. There is a corresponding need for an appropriate knowledge base, founded on nursing research, into the effectiveness and outcomes of complementary therapies. In addition, relevant educational courses should be developed.

     

Humpty Dumpty: reflection and reflective nursing practice

The recent increase in the amount of published work relating reflection and reflective practice to nurses and nursing practice suggests that nurses value the opportunities which this approach is believed to provide There also appears to be an underlying assumption that we all share the same concepts, hence the association with Humpty Dumpty Indications of attempts to mechanize the processes and to endow the perceived skills with an élitism are becoming evident In contrast, there are other attempts to foster the notion of accepting uncertainty, unpredictability and the opportunity for increased understanding to emerge In this paper, the roots of some of these concepts are traced The appropriateness of traditional values and assumptions, based on natural science perspectives, in relation to reflective processes and the practice of nursing is questioned The development of a multi-faceted approach which takes account of differing contexts and the factors which influence them is suggested     

Exploring expert practice through reflection

This article describes an unusual experience drawn from clinical practice which has been used to enable self-criticism and expansion of personal knowledge. The importance of practice knowledge, knowing the patient and relatives, expanded eclectic knowledge and teamwork are highlighted. This paper, while exploring the complexity of expert practice, identifies the importance of viewing the individual patient holistically.     

Assisting students to use evidence as a part of reflection on practice

The practice environment is increasingly complex and requires that nursing students and graduates possess the ability to make evidence-based decisions. The factual overload current in many curricula, however, can suppress the reflective and critical thinking skills required for the development of searchable, answerable questions, the first step in the evidence-based nursing process. In order to prepare students to become users of evidence, nurse educators must nurture habits of mind that cultivate reflection on practice. This article examines the relationship between evidence-based nursing and reflection on practice and describes how faculty can assist students to use evidence as a part of their reflection on practice.     

Action and reflection: practice and theory in nursing

There are three issues related to theory and practice in nursing which are continually problematic. These are: the separation of theory from practice; reality vs the ideal; and nursing adherence to a scientific paradigm versus nursing adherence to an arts paradigm. It is suggested that Shotter's 'theory of personal action' (1974, 1975) may form the basis for a resolution of these three issues. Applying Shotter's work, a nursing action may be defined as an action which is deliberately thought out and which has as its goal the benefit of the patient and client. The 'deliberate thought and goal' of the action which is an integral component of it then forms the basis of nursing theory which is concerned with reasons for and reflections on action. This immediately unites theory and practice as two components of nursing action. The use which could be made of the theory of personal action in nursing practice, research and theory building and nurse education is explored.     

The role of reflection in the development of practice theory: a case study

Many authors view practice theory as the strongest form of theory for an applied discipline like nursing. It is based upon the idea that theory emanates from practice, is strengthened and is returned to inform practice. The first part of this paper is concerned with identifying the contribution that practice theory can make to patient care. While there are many positivistic ways of generating practice theory, one method which is getting increasing attention is reflection. In this paper, Boud et al.'s framework for reflection is used to identify phenomena related to the empowerment of patients and staff in psychiatric hospitals (Boud et al. 1985). A real life case study is described and concepts and beginning propositions are uncovered. Conclusions are drawn which from the basis for theory development and testing.     

Alternative therapies: a common practice among men and women living with HIV.

This study examined the prevalence and factors associated with alternative therapy use in an ethnically diverse, gender-balanced sample of persons living with HIV/AIDS. More than two thirds (67%) of the participants who were taking HIV-related medications were also taking an alternative supplement. Half of the sample (50%) reported that they took one or more multivitamins, 17% reported using mineral supplements, 12% reported using Chinese herbs, and 12% reported using botanicals. Substantial proportions of the sample also reported using acupuncture (31%), massage (23%), and meditation (28%) to specifically treat HIV-related symptoms. Women were four times more likely to use alternative therapies than men. Also, Caucasians were nearly four times more likely to use alternative treatments compared to other ethnic groups. The results of this study indicate a strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients.