The persistence of ritual in nursing practice

As nursing attempts to become a research based profession, ritual has become stigmatized and associated with thoughtless repetition. Articles condemning ritualistic practice are frequently seen in nursing journals. Despite this condemnation, ritualistic practice appears to persist. This paper examines the origins and purpose of ritual, giving reasons for the negative association. It explores the role of ritual within western culture and nursing. This paper then draws on anthropological method to analyze the purpose of ritual within nursing and suggests reasons for its persistence. The paper concludes that there are cultural influences that promote a technical, rational approach to the study of the human condition. This worldview with its emphasis on cognition devalues the important emotional aspects of humanity by associating them with the primitive. The examination of factors which contribute to the persistence of ritual in nursing concludes that nursing work involves emotional encounters and breaches of the taboo aspects of culture. Rituals serve to normalize these transgressions. It helps the nurse and patient deal with emotions generated by these, the breaches of taboo, by re-labelling situations as caring rather than transgressing. Because they serve these emotional and social functions, rituals endure.Rationale for the article: my interest in ritual was re-awakened on reading Parker's (1999) article entitled Reason or ritual. It stimulated me to reflect on three questions: firstly, why do rituals persist when the nursing literature condemns them? Secondly, does ritual serve a purpose that ensures its survival in the face of criticism? Thirdly, why do the disciplines of nursing and anthropology perceive ritual in such different ways?This paper takes an anthropological approach to ritual, drawing on secondary anthropological and nursing data, in an attempt to answer the questions outlined above.     

'Out of the sighs'— an existential-phenomenological method of clinical supervision: the contribution to palliative care

This paper describes a method of clinical supervision that engages a Macmillan home care nurse in an existential-phenomenological exchange. A synthesis of Egan's method of problem management and phenomenological interviewing, is offered as an approach to clinical supervision considered appropriate for palliative care nursing. Through a case study approach the author affords glimpses into the life world of palliative care nursing. It is suggested that conflicts experienced in the field both manifest themselves in the supervisory encounter and parallel the nurse's and supervisor's own existential struggles. The discussion as such throws light on what is, frequently, the heart rending nature of palliative care nurses' chosen area of work and illuminates the mutual profundity of the experience of palliative care.     

An analysis of nursing in context: the effects of current health policy

This paper intends to analyse the effects of recent health policy changes in the United Kingdom upon nursing, examining some of the anomalies raised by the rhetoric of the politics and the actualities of the change process and exploring and analysing nursings'presence within that change process. Specific reference will be paid to the philosophy and ideology of the reforms and comparisons made with some of the original factors underpinning the purpose and functioning of the British National Health Service and professional groups within it.
In particular, this paper considers the functioning of nursing as an holistic, intuitive, humanistic, and caring act within the context of the scientific, rational, performance and outcomes-orientated new public management ideology presently sweeping the health service. The resultant tensions this apparent dichotomy is causing nursing will be tentatively explored. Lastly, an agenda for change will be proposed which will identify ways in which nursing can respond and, more importantly, be proactive within the contextual changes highlighted.     

In health visiting, a routine visit is one that has passed

Pressure on British health workers to be more explicit in articulating the function, purpose and outcome of their role has increased with the introduction of general management and shift to a market-place orientation, since implementation of the NHS and Community Care Act (1990) However, a recurring theme in the history of health visiting has been the difficulty which practitioners experience in trying to explain exactly what it is that they do This has often been portrayed as a major failing, and possibly even a reason to discontinue the service This paper will offer a potential explanation for this difficulty, and suggest that the management of uncertainty and ambiguity are central to the role It will draw on a grounded theory study which explored how health visitors choose which approach to use in any particular situation encountered in their work The analysis suggested that health visiting's central focus is on situations which are unpredictable, ambiguous or anomalous The study revealed an approach to health promotion which requires a highly developed ability to cope in a safe and therapeutic way with shifting, uncertain and ill-defined health needs, and to recognize and respond to complex, potentially risk-filled situations Drawing on examples which illustrate the implications of these concepts in practice, the paper suggests that, much as midwives have long claimed that a'normal delivery is one that is over, so in health visiting a'routine visit'can only be recognized as such once it has taken place Nevertheless, it will be contended that the particular approach to practice revealed in this study represents a valuable and necessary aspect of health promotion, which has the potential to ensure relevance and acceptability, and which maximizes unexpected opportunities for prevention