A fuzzy week for Nurse Der. Rolfian predilections?
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Humans↗
Biomedical subjects
G Rolfe
Publications and source records attributed to G Rolfe.
The theory-practice gap in nursing: from research-based practice to practitioner-based research.
The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research.
Humans↗
The marriage of heaven and hell: further remarks on the future for mental health research.
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Forecasting↗
The development and evaluation of the role of an advanced nurse practitioner in dementia--an action research project.
This action research project developed a new role of Advanced Nurse Practitioner (ANP) in dementia from first principles in response to the needs and requirements of the healthcare professionals already working in the service. In Phase 1 of the project, 42 workers were interviewed to determine their needs, hopes and fears of the role, from which a preliminary job description was constructed. In Phase 2, this role was implemented and continuously modified through regular reflective interviews with the ANP, resulting in some major changes to the original job description. In the final phase, the impact of the role was evaluated through interviews with patients who had used the new service, and questionnaires to the healthcare workers interviewed in Phase 1. The role that emerged from the project was therefore grounded in practice and proved to be an attractive proposition to the local healthcare trust.
Dementia↗
Writing ourselves: creating knowledge in a postmodern world.
In an attempt to encourage nurses and academics to write, there have been some recent journal papers that outline rules and guidelines for successful publication. This paper attempts to tackle the 'why' of writing rather than the 'how', and argues that writing is more than merely the representation of speech. Rather, writing is a creative act in which knowledge is produced as part of the process of writing itself, and at this level we might talk not merely of writing, but of writing. It is further argued that whereas the verb 'to write' always has an object (we write a book or an essay), the verb 'to write' is intransitive; it has no object. We do not write a paper, we merely write. We might, of course, choose to publish our writing, but it is done as an afterthought; we write for discovery, not for presentation. The act of writing is then compared to the act of teaching, and it is concluded that in order to teach, we must also write. Finally, this paper is offered as an example of writing (not an exemplar--there are as many ways to write as there are writers), and attempts to pull together material from a variety of sources including sociology, psychology, philosophy and literature as an act of discovery, of creating what I know about writing as I write.
Education, Nursing, Continuing↗
Science, abduction and the fuzzy nurse: an exploration of expertise.
Benner's work on expertise in nursing drew heavily on the writing of Dreyfus and Dreyfus in the field of computing. Dreyfus and Dreyfus argued that the continued failure of computer programmers to create an 'expert system', a program which could replicate the way that a human expert thinks, implied that experts do not think in a rational, analytic way. Dreyfus and Dreyfus therefore concluded that expertise is an intuitive process, and that 'the expert is simply not following any rules! He is ... recognising thousands of special cases'. Applied to nursing, this model of expertise has a number of profound implications for practice and education, and has been criticised for being elitist and deliberately obscure. This paper examines some recent innovations in computer logic, and argues that nursing can learn from a new breed of 'fuzzy' computer programmes which appear to be able not only to perform better than experts, but to verbalize their decision-making processes. By beginning to understand how experts think, it might be possible to develop expertise in a more controlled and logical way, thereby improving the practice of nursing.
Decision Making↗
Nursing praxis: a zealot responds.
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Nursing Faculty Practice↗
Beyond expertise: theory, practice and the reflexive practitioner.
This paper reconsiders Benner's book From Novice to Expert, in which the expert is portrayed as a reflective practitioner who works intuitively, drawing almost unconsciously on a repertoire of context-specific paradigm cases. In the light of more recent writings on informal, practice-based theory, it is suggested that there is a sixth level beyond expertise which is characterized by mindful practice and informal theory building. At this level, the practitioner constructs informal theory out of practice, applies that theory back into practice, and reflexively modifies the theory as a result of the changed clinical situation. Seen in this way, theory and practice are two parts of the same process, and the theory-practice gap is closed.
Clinical Competence↗
Going to extremes: action research, grounded practice and the theory-practice gap in nursing.
Action research is growing in popularity with nurse researchers, where it is often seen as a way of bridging the theory-practice gap. However, there is little agreement on exactly what is meant by the term, and most nurse researchers stop short of exploring the full potential of this methodology. This paper argues that, if taken to its logical conclusion, action research methodology goes beyond the confines of the scientific paradigm and is able to bring about improvements in practice directly without the mediation of theory. This has some important implications for how the research process is viewed, and results in a model of research which is participative, reflexive and unashamedly subjective, and which generates non-generalizable, personal knowledge directly out of practice.
Nursing Research↗
What to do with psychiatric nursing?
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Humans↗
An action research project to develop and evaluate the role of an advanced nurse practitioner in dementia.
This paper outlines the first phase of a project to generate and evaluate the role of an advanced nurse practitioner inductively from first principles. The role was developed by interviewing a wide range of health-care professionals, careers and patients. The resulting role is responsive to perceived need at grassroots level rather than to the needs of managers with no clinical experience. Although the role might not be generalizable to other settings, the method can be applied to any role in any clinical area.
Dementia↗
Playing at research: methodological pluralism and the creative researcher.
In its quest for acceptance by the scientific community, mental health nursing research has developed an unhealthy obsession with methodological rigour. This paper draws on the work of several writers from the philosophy of social science to argue that this focus on methodology stifles individual creativity and acts as a gatekeeper to the profession which excludes many of our brightest and most creative researchers. The author proposes a new approach to doing research that facilitates the creative process by encouraging a playful approach that temporarily abandons the accepted rules and methods of the research process in favour of an 'anarchistic epistemology' and a variety of unusual and not necessarily externally validated methods. It is only at the end of the research process that valid and generalizable methods are introduced, and the author calls for journals to open a creative dialogue by being more willing to publish papers describing the early, exploratory stages of research, based on a judgement of their creativity and innovation.
Creativity↗
Some factors associated with change in patient-centredness of student nurses during the Common Foundation Programme in Nursing.
This longitudinal study examines the changes in patient-centredness of a group of student nurses during their Common Foundation Programme in Nursing, and attempts to explore some of the social, psychological and educational factors which might be associated with such change. The Patient-centredness Multi-choice Questionnaire (PMQX) was administered to a sample of 267 student nurses on commencement and completion of their Common Foundation Programme in Nursing, and significant positive as well as negative changes in PMQX scores were found, although the mean scores for the sample were unchanged. A number of factors were found to be associated with high levels of patient-centredness on commencement of the course, including marital status, age, and radicalism. Positive change in patient-centredness during the CFP was associated with a variety of variables such as class size, a student-centred climate and a tenderminded attitude. Other factors, such as psychological stability and extroversion, were associated with both increase and decrease in patient-centredness during the CFP.
Adolescent↗
Listening to students: course evaluation as action research.
Course evaluation is an important but often neglected aspect of the education process, usually carried out too late and in a cursory fashion. The writer argues that evaluation should play an important part in curriculum development, and outlines a student-centred evaluation process in which the course members themselves design and implement a programme that uncovers issues that they feel are relevant and of value. Furthermore, the scheme described here is fully integrated into the curriculum, and the process of carrying out the evaluation is an important learning experience in itself. By implementing the findings and recommendations from the evaluation while the course is still in progress, students are able to reap the benefits of their own work, at the same time contributing to a living, growing, dynamic curriculum.
Curriculum↗
Towards a new model of nursing research.
Nursing research is generally located within the paradigm of the social sciences, and therefore reflects the concerns and agenda of social research. In particular, nursing has become embroiled in the ongoing dispute between the advocates of qualitative and quantitative methodologies. However, it is argued in this paper that whereas the aim of social research is to develop knowledge, the aim of nursing research is primarily to advance practice. This paper offers an alternative model of nursing research which categorizes approaches to research not according to the methodology employed but on the extent to which the research process is likely to bring about change. These approaches are termed level 1, level 2 and level 3 research, where level 1 researchers are concerned with generating information for others to conceptualize and implement, while level 3 researchers see their aim as directly bringing about clinical change. Two approaches to level 3 research are suggested, and examples of projects at all three levels are examined. Finally, it is contended that only by adopting an appropriate model of research for a practice-based discipline can nursing address the real issues of relevance to nurses and patients in clinical settings.
Clinical Nursing Research↗
A framework for a process-driven common foundation programme for graduates.
This paper discusses some of the problems encountered in writing a shortened Common Foundation Programme in nursing for graduates, and outlines a course which takes as its starting point the particular educational needs and requirements of the student group. Thus, the first question to be addressed by the curriculum writers when designing the course was "How can we teach these students?", rather than "What can we teach them?". The resulting process-driven course is heavily influenced by the student-centred philosophy of Carl Rogers, and utilizes a variety of large- and small-group methods to facilitate the students in gradually taking responsibility for, and making decisions about, their learning needs. The paper continues with some strategies for ensuring a smooth transition from a tutor-led, syllabus-driven start to the course, to a student-led, process-driven finish for both the theoretical and clinical components, and for the assessment schedule. Finally, a student-centred approach to evaluation is briefly outlined, and the paper concludes by suggesting that the principles employed in designing and implementing this course could be successfully transferred to a wide variety of other educational settings.
Curriculum↗
Towards a theory of student-centred nurse education: overcoming the constraints of a professional curriculum.
Student-centred learning is an educational philosophy which became popular during the 1960s, but which has gradually fallen from favour as the educational and political climate has changed over the years. This is particularly true of nursing, where the transition to higher education ushered in by Project 2000 has signalled a return to traditional teaching methods such as the lecture and the seminar. This paper argues that the current demands for holistic practice, professional autonomy and primary nursing can best be met by educationalists by employing a student-centred approach to learning. However, it is recognised that a radical student-centred approach will conflict with the constraints imposed on curriculum writers by a professional body, and that a modified strategy is required. The paper goes on to identify several of the more pressing constraints, and suggests some methods for overcoming these problems within a student-centred framework, while maintaining the requirements of a professional training which confers upon the students a license to practise. The paper concludes by suggesting that most problems will only be identified once courses are up and running, and that a new student-centred framework can only emerge from educational practice. Teachers and curriculum writers are therefore encouraged to come together to share ideas and experiences in order to carry forward the theory and practice of student-centred nurse education.
Curriculum↗
The Patient-Centredness Multi-Choice Questionnaire: developing an instrument for the measurement of patient-centredness in student nurses.
An earlier paper by the writer reported on the construction and administration of an instrument for the measurement of therapeutic attitudes in student nurses. This paper continues that work by producing a short, appropriate and easily administered test, known as the Patient-Centredness Multi-Choice Questionnaire. The instrument was tested for validity and reliability, and was piloted on a large group of new Project 2000 students from several colleges and institutes of nursing, to produce a database for use in further studies.
Attitude of Health Personnel↗