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PubMed2006

The knowledgeable practice of critical care nurses: a poststructural inquiry.

BACKGROUND: Contemporary nursing literature emphasises the desirability of clinical nurses being "knowledgeable". However, the need for nurses constantly to acquire more knowledge is reiterated. Lack of knowledge is seen to underlie an array of professional problems. Little is known of how nurses themselves understand what it means to practise knowledgeably. OBJECTIVE: To explore critical care nurses' understandings of knowledgeable practice and its relationship to being a "good nurse". METHODOLOGY: A poststructuralist framework informed the study. The study participants were 12 critical care nurses. Data were generated through three individual focused interviews with each participant. Data analysis involved deconstruction of the interview texts to reveal participants' discourses of knowledgeable practice and the implications of these discourses for their subjectivity and for their work. FINDINGS: A discourse of knowledgeable practice was revealed as central to participants' sense of identity as "good nurses". Participants believed their knowledge resided in their heads ("knowing why") and in their hands ("knowing how"). Fluency of action, which was achieved and maintained by frequent repetition of activities, contributed to their sense of being knowledgeable. Participants described being excluded from knowledge in some instances. In general, however, "actual" knowledge was of less importance than was being positioned, by themselves and others, as knowledgeable. This positioning was frequently undermined by other staff, both medical and nursing. Analysis revealed that the discourse of knowledgeable practice was underpinned by a dichotomy of ignorant/knowledgeable, in which "ignorant" was the dominant category; hence, nurses were assumed to be ignorant until they could "prove" otherwise. CONCLUSIONS: The findings contest the notion, espoused in nursing literature, that acquisition of knowledge can "empower" nurses, thus providing the solution to problems they may experience. Rather, strategies are required that challenge and disrupt relations of power that construct nurses as "ignorant".

Attitude of Health Personnel↗
PubMed2005

Nurses', midwives' and health visitors' perceptions of the impact of higher education on professional practice.

AIM: This study examines the perceptions of qualified nurses, midwives and health visitors of the impact of higher education on professional practice. METHODOLOGY: This is a qualitative study using a phenomenological approach. A non-probability convenience sample of 12 qualified nurses, midwives and health visitors who had enrolled upon a Master of Science programme in Professional Practice at a United Kingdom Higher Education Institution in the East Midlands were interviewed using semi-structured interviews, which were audio-taped and analysed using Colaizzi (1978) [Colaizzi, P., 1978. Psychological research as a phenomenologist views it. In: Valle, R., King, M., (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, pp. 48-71] approach. Approval to undertake this study was received from the University's Research Ethics Committee. RESULTS: Four themes emerged from the interview data. These were personal and professional motivation, workplace constraints, valuing "hands-on" nursing and client contact, and challenging and questioning practice. From the respondents' perspective, there was a strong view that higher education has a positive effect in practice, but a significant number of factors including time and support seemed to inhibit the possible benefits in practice. These are discussed in relation to the findings from similar studies. CONCLUSION: This study has highlighted the need for further research to explore the impact of higher education on client care and service delivery.

Adaptation, Psychological↗
PubMed2005

Knowing nursing and finding the professional voice: a study of enrolled nurses converting to first level registration.

This study explored the experiences of a group of second level registered nurses converting to first level registration in a two-year, part-time open learning programme. It aimed to examine the relationship between the mode of course delivery and the personal and professional development experienced by the learners. Data were collected by semi-structured interviews, conducted at five points over the two-year period and analyzed by constant comparative analysis. A theoretical model was developed to demonstrate the stages of knowing nursing, experienced by the students as they made the transition from passive to autonomous professional practice. In their 'Women's Ways of Knowing' [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] identified a progression through different stages of thinking about the nature of knowledge and evidence. This progression was evident in the nurses in this study. It was applied and developed to reflect the progression through ways of knowing nursing. This process consisted of three positions of development, each underpinned by their associated ways of knowing [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] and characterized by a specific approach to professional nursing practice. The changing ways of knowing nursing, described in this paper, are likely to be observed in registered nurses and health care assistants who are now entering Higher Education (HE) to undertake higher awards for the first time. A clearer understanding of this process of personal and professional change, and factors that impact upon it, will be a useful guide for those supporting learners both in the clinical and academic arenas.

Adult↗
PubMed2006

Is there a role for higher education in preparing nurses?

Nurse education is now almost wholly situated within universities internationally. However, issues such as the necessity of higher education for what is seen as a practical occupation and the question of whether or not nursing is a profession arise. Newman viewed universities as places where training was given but character was also formed and self-awareness was developed through exposure to a wide range of disciplines and this type of education has helped to shape other professions. If nursing fulfills the criteria for a profession then it requires nurses to be properly educated in higher education. Poor media images of nursing, opposition from within and outside of the profession and poor funding for research, especially in the UK, where most nurses still do not enter the register with a degree, mean that the place of nursing in higher education remains on the periphery. Nurses must be competent to practice and higher education is not incompatible with the development of competent practitioners. However, higher education should take competent practitioners to a higher level whereby they become capable: able to respond appropriately in unfamiliar situations and to unfamiliar events. This paper argues for the role of higher education for nurses in terms of developing capability.

Attitude of Health Personnel↗
PubMed2006

Independent extended supplementary nurse prescribers, their prescribing practice and confidence to educate and assess prescribing students.

BACKGROUND: No other country in the world has such extended prescribing rights for nurses as the United Kingdom. Concerns surround the move of nursing towards a medical model of care, and the level of medical practice support required by trainee prescribers. AIM: To provide an overview of the nurses adopting the role of independent extended supplementary prescriber, their prescribing practice and confidence to educate and assess prescribing students. METHODS: A convenience sample of 1187 independent extended supplementary nurse prescribers were sent a questionnaire. Eight hundred and sixty eight completed questionnaires were returned. RESULTS: The majority (82%) of nurses worked in primary care. Eighty seven percent used independent extended prescribing and 35% supplementary prescribing. Most were qualified to degree level or higher and had over 10 years nursing experience. Seventy four percent felt confident to act as a mentor during the prescribing programme. More highly qualified nurses and those who had undertaken, or had access to continuing professional development, were statistically more likely to feel confident to adopt this role. CONCLUSION: Appropriately qualified nurse prescribers might be best placed to support trainee prescribers. Exploration of the low uptake of supplementary prescribing and access to continuing professional development is required.

Adult↗
PubMedDate not supplied

Perceptions of nursing practice in Iran.

It is difficult to clarify the characteristics of the nursing profession and the problems that exist within this field. Gaining an understanding of nurses' perceptions regarding their profession can improve knowledge on this subject. The aim of this qualitative study was to describe the perceptions of Iranian Registered Nurses (IRNs) concerning issues related to their profession. Data were collected from semi-structured interviews with 26 IRNs and analyzed with latent content analysis. Two different but interrelated themes emerged: (1) nursing perceived from an institutional and socio-cultural perspective, and (2) nursing that alternates between a routine medical-technical approach and a caring approach. The findings have implications for nursing practice and education in Iran, and can facilitate changes that could effectively improve the status of nursing in Iran.

Adult↗
PubMed2005

Women's status and depressive symptoms: a multilevel analysis.

The effects of state-level women's status and autonomy on individual-level women's depressive symptoms were examined. We conducted a multi-level analysis of the 1991 longitudinal follow up of the 1988 National Maternal Infant Health Survey (NMIHS), with 7789 women nested within the fifty American states. State-level women's status was assessed by four composite indices measuring women's political participation, economic autonomy, employment & earnings, and reproductive rights. The main outcome measure was symptoms of depression (Center for Epidemiologic Studies Depression Scale, CES-D). The participants were a nationally representative stratified random sample of women in the USA aged between 17 and 40 years old who gave birth to live babies in 1988, were successfully contacted again in 1991 and provided complete information on depressive symptoms. Women who were younger, non-white, not currently married, less educated or had lower household income tended to report higher levels of depressive symptoms. Compared with states ranking low on the employment & earnings index, women residing in states that were high on the same index scored 0.85 points lower on the CES-D (p<0.01). Women who lived in states that were high on the economic autonomy index scored 0.83 points lower in depressive symptoms (p<0.01), compared with women who lived in states low on the same index. Finally, women who resided in states with high reproductive rights scored 0.62 points lower on the CES-D (p<0.05) compared with women who lived in states with lower reproductive rights. Gender inequality appears to contribute to depressive symptoms in women.

Adolescent↗
PubMedDate not supplied

Quality care and practice variation: the roles of practice guidelines and public profiles.

Goals of the quality-of-care initiative are to improve the structure, process, and outcome of health care. The effectiveness of methods to improve quality have been largely unverified. Most methods are costly to implement and time-consuming to perform; some threaten professional autonomy. The characteristic feature of modern medicine that fuels the debate over quality is the variation in the delivery of health care. This review examines the "variation phenomenon" in medicine and the roles that practice guidelines and physician profiling have in improving health care, in general, and for adult cataract, in particular.

Cataract Extraction↗
PubMed1996

Perceived inhibitors to rural practice among physiotherapy students.

This descriptive study was undertaken to determine perceptions of undergraduate physiotherapy students which would make them more or less likely to enter rural practice. A total of 607 self-administered questionnaires were distributed to undergraduates in The University of Sydney and 546 completed documents were returned. Students perceived the major inhibitors as social (isolation from family, friends and partner) and recreational (lack of theatre, entertainment, etc). InfIuences which would attract graduates to rural practice were lifestyle (relaxed, less stressful, healthier), lower cost of living, seeing more of Australia and professional autonomy. Knowledge of these perceptions will enable educators, the profession and potential employers to develop and implement strategies that will negate the negative and re-enforce the positive perceptions.

Journal Article↗
PubMed1997

Social epistemology, gender and nursing theory.

A major claim for nursing theory is that it contributes to the generation of a body of nursing knowledge that will be important in the definition of nursing's boundaries. It is argued here that the epistemic authority of nursing knowledge is determined by factors such as the gender structure of nursing. This means the knowledge products of nursing will be given low epistemic status by both nurses and non-nurses. The implications of this argument, in terms of professionalisation and the project to develop nursing theory, are examined.

Female↗
PubMed1997

Pharmacist and nurse: a team approach towards primary health care or a convenient "therapeutic alliance"?

This paper explores the nature of the therapeutic alliance between nurses and community pharmacists in the South African context. To gain a better insight into the relatively new phenomenon, a combination of qualitative and quantitative methods was employed. The partnership developed in S.A. between the nurse and the pharmacist allows the pharmacists to "expand" their professional activities without "invading" the nurses' professional domain, and reaping substantial benefits in the process. These include potential increases in profits, enlarging the clientele base and improving the image of the pharmacy, by shifting the focus from a place of disease to a place of health, as well as creating the vision of the pharmacist as a team member in providing primary health care. As far as the nurses are concerned, it grants them the possibility to practice their profession in a very convenient set-up and affords them greater professional autonomy.

Humans↗
PubMed2001

Risk factors for nosocomial pneumonia. Focus on prophylaxis.

Despite an increased understanding of the pathogenesis of NP and advances in diagnosis and treatment, the risk, cost, morbidity, and mortality of NP remain unacceptably high. This article has identified strategic areas for primary and secondary prophylaxis that are simple and cost-effective. Realizing that the pathogenesis of NP requires bacterial colonization and the subsequent entry of these bacteria into the lower respiratory tree helps highlight the role of cross-infection and the importance of standard infection control procedures. Similarly the role of sedation and devices as risk factors can be reduced by minimizing the duration and intensity of sedation and length of exposure to invasive devices. Additional low-cost interventions that have been shown to be effective in preventing NP are the positioning of patients in a semirecumbent position and the appropriate use of enteral feeding, antibiotics, and selected medical devices. Prophylaxis of NP and VAP is carried out best by a multidisciplinary management team comprised of physicians (critical care, pulmonary medicine, infectious diseases, and primary care), critical care and infection control nurses, and respiratory therapists, even though this approach may result in decreased professional autonomy and freedom. This group should review the current guidelines, pathways, and standards for short-term and long-term prophylaxis of NP and VAP, then integrate them into and monitor their use for routine patient care. The risk factors and prophylaxis strategies for NP discussed in this article apply primarily to patients in acute care facilities, but also are relevant to alternative health care settings as well as the care of ill patients in ambulatory settings. The routine use of effective team policies for prophylaxis needs to be monitored by the Joint Commission for the Accreditation of Health Care or other agencies. Research to delineate the most effective and feasible strategies for prophylaxis NP has been compromised by insufficient funding and lack of adequate, randomized multicenter studies to enable generalizability of results. Effective strategies for prophylaxis have not been disseminated widely or implemented in hospitals. Successful short-term and long-term strategies for prophylaxis must be evaluated and implemented by a team of physicians, nurses, and respiratory therapists. More than 100 years ago, Sir William Osler warned health care providers, "Remember how much you don't know." The authors would add that clinicians have acquired significant knowledge about risk factors and prophylaxis of NP in the 1980s and 1990s, but prophylaxis as a theory rather than an action. If the tree has not been planted, the time is now.

Cost-Benefit Analysis↗