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PubMed1991

Responsibility and autonomous nursing practice.

In this paper, the consequences were there greater autonomy in nursing practice, are considered. Autonomous practice implies accountability which entails both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. In this context, discretionary responsibility implies: recognizing a patient's wants may not be consistent with a patient's needs; abstaining from collusion with noncompliant patients; supporting the patient's right to refuse treatment only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fraternity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of 'freedom' and 'accountability'.

Choice Behavior↗
PubMed1992

Quality of life as quality of being: an alternative to the subject-object dichotomy.

The opening section of this paper is concerned with certain questions concerning the concept 'quality of life'. Is it possible for one person to make judgements about the quality of life of another? If it is possible, then is it morally acceptable? Given that quality of life is a concept and therefore not amenable to direct observation, which visible phenomena will be chosen as its indicators, and how can their choice be justified? Do the components of a life of quality vary from person to person, or can features be identified which are common to all? Next, it is argued that instruments which have been developed to measure quality of life give clues to the ontological beliefs of their authors; those which address fragments of the human experience, or accept the artificial limits of the subjective/objective dichotomy, are expressive of a fractured and reductionist view of what it means to be a human being. Finally, it is suggested that the adoption of insights drawn from Heidegger's work would enable us to develop a rather more unified view of quality of life as quality of being, and that this theoretical principle might constitute a common link between nurses of varying professional backgrounds.

Attitude↗
PubMed1994

Issues in phenomenology for researchers of nursing.

Nursing today, with its individualistic approach to care, shares many of its underlying beliefs and values with the school of philosophical thought known as phenomenology. The research method derived from phenomenology considers that the true meaning of phenomena can only be explored through the experience of them as described by the individual. This paper explores the features of phenomenology as a research method in relation to its relevance for nursing by first discussing the philosophical underpinnings of the method, and then proceeding to an examination of the features of the method with relation to research design, and data analysis. The specific issues of validity and generalizability are developed further, with reference to the criticisms levelled at the phenomenological method from the alternative quantitative paradigm. Finally, the author discusses the relevance of phenomenology for nursing, and concludes that, as a research method within the qualitative paradigm, it has a great deal to offer nursing as a humanistic discipline.

Data Interpretation, Statistical↗
PubMed1994

Phenomenology without phenomena: a discussion of the use of phenomenology to examine expertise in long-term care of elderly patients.

Phenomenological approaches to research have gained popularity in nursing research over past years, in particular the use of critical incident technique. Phenomenology can be traced back to existentialist philosophy where it is expounded in the work of Husserl and Heidegger. One of the most notable examples of phenomenological research in nursing has been the work of Benner who has used this approach to examine expertise in nursing. This paper is an account of a study which attempted to adapt phenomenological methods to the investigation of expertise in nurses working in long-term care settings, which was curtailed by the apparent inability of nurses in the study to identify any significant incidents. The paper examines this problem in the light of existentialist philosophy and suggests that the apparent lack of expertise identified in the nurses might be due more to a tendency of phenomenological studies to focus more on articulation than on attunement or potential, the other elements of dasein. The paper concludes that attention to these elements is required when phenomenology is used.

Aged↗
PubMed1996

Intuition and expertise: comments on the Benner debate.

The rift between "science' and "phenomenology' in current nursing theory is explored through an examination of two recent evaluations of the work of Patricia Benner, who has proposed a model of skill acquisition, latterly within a Heideggerian framework. English offers a critique of Benner's ideas from the perspective of cognitive psychology; while Darbyshire defends them against what he describes as a "positivist' attack. No attempt is made, in this paper, to evaluate Benner's work directly, but Darbyshire's response to the "critique' is analysed; and it is noted that, in making his defence, he invokes a network of concepts which he ascribes to a "traditional notion of objective science', and accuses English of subscribing to it. It is suggested that this "Cartesian' worldview is an outmoded myth, superseded by the philosophy of science during the last 30 years, and based on the rhetoric rather than the reality of scientific practice. Nursing is not, therefore, obliged to choose between "positivism' and a philosophy whose chief virtue is that it represents a "challenge' to positivism. It could instead build a scientific basis for research and theory by drawing, not on mid-century thinking, but on a more contemporary understanding of the nature of science.

Clinical Competence↗
PubMed1996

Hermeneutic phenomenology: philosophical perspectives and current use in nursing research.

The wise choice of the postmodern tradition of hermeneutic phenomenology for nursing research is partly dependent upon an awareness of that tradition's base of philosophical hermeneutics. The origins of this philosophy within the work of Heidegger and especially Gadamer are detailed with an explanation of some major concepts intrinsic to their hermeneutic writings. Subsequently an analysis is offered of the ontological, epistemological and methodological perspectives of the tradition which is considered thereby to reside within an interpretivist/constructivist paradigm of inquiry. The contemporary use within the discipline of nursing of hermeneutic phenomenology is discussed, and the growing trend for using the tradition, across continents, is identified. However the question is posed as to whether all such research is accurately identified as belonging to the tradition. A further analysis suggests that hermeneutic phenomenology will increasingly be applied to the research of nursing phenomena.

Existentialism↗
PubMed2006

Critical appraisal of rigour in interpretive phenomenological nursing research.

AIM: This paper reports a critical review of published nursing research for expressions of rigour in interpretive phenomenology, and a new framework of rigour specific to this methodology is proposed. BACKGROUND: The rigour of interpretive phenomenology is an important nursing research methods issue that has direct implications for the legitimacy of nursing science. The use of a generic set of qualitative criteria of rigour for interpretive phenomenological studies is problematic because it is philosophically inconsistent with the methodology and creates obstacles to full expression of rigour in such studies. METHODS: A critical review was conducted of the published theoretical interpretive phenomenological nursing literature from 1994 to 2004 and the expressions of rigour in this literature identified. We used three sources to inform the derivation of a proposed framework of expressions of rigour for interpretive phenomenology: the phenomenological scholar van Manen, the theoretical interpretive phenomenological nursing literature, and Madison's criteria of rigour for hermeneutic phenomenology. FINDINGS: The nursing literature reveals a broad range of criteria for judging the rigour of interpretive phenomenological research. The proposed framework for evaluating rigour in this kind of research contains the following five expressions: balanced integration, openness, concreteness, resonance, and actualization. Balanced integration refers to the intertwining of philosophical concepts in the study methods and findings and a balance between the voices of study participants and the philosophical explanation. Openness is related to a systematic, explicit process of accounting for the multiple decisions made throughout the study process. Concreteness relates to usefulness for practice of study findings. Resonance encompasses the experiential or felt effect of reading study findings upon the reader. Finally, actualization refers to the future realization of the resonance of study findings. CONCLUSION: Adoption of this or similar frameworks of expressions of rigour could help to preserve the integrity and legitimacy of interpretive phenomenological nursing research.

Aged↗
PubMed2006

Caring or uncaring--meanings of being in an oncology environment.

AIM: This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. BACKGROUND: The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. METHODS: A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. FINDINGS: The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. CONCLUSION: To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.

Adult↗
PubMed2006

Attitudes to spiritual care among nursing staff in a Swedish oncology clinic.

AIMS AND OBJECTIVES: To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. (Journal of Clinical Nursing 2002;11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic (n=93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries. DESIGN AND METHODS: (i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies. RESULTS AND CONCLUSIONS: The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'. RELEVANCE TO CLINICAL PRACTICE: Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients.

Ambulatory Care↗
PubMed2006

Putting a puzzle together: making spirituality meaningful for nursing using an evolving theoretical framework.

AIMS AND OBJECTIVES: This paper addresses the need for a practical understanding of spirituality in nursing by means of a generic definition of spirituality, an emerging theoretical framework, and some general practice guidelines. BACKGROUND: Spirituality is being addressed more frequently in nursing literature, but there is still lacking a professional understanding of the phenomenon that is useful as a basis for practice and research. CONCLUSION: The history of spirituality in nursing is recognized, and then its role in peoples' and patients' lives, health and healing is examined. Spirituality is clarified through its various definitions in the literature, and identification of component concepts: connectedness, meaning, transcendence, values and beliefs, energy and emotion. A working definition and the concepts are brought together into a framework. Guidelines for how to incorporate spirituality into practice are presented. RELEVANCE TO CLINICAL PRACTICE: With this understanding of spirituality by means of a clarifying definition, a theoretical framework and six general guidelines, nurses may be better equipped to incorporate spirituality into their practice. This will fulfil professional and accrediting mandates and, more importantly, provide more holistic, ethical and balanced care for patients.

Attitude of Health Personnel↗
PubMed2006

Death the great leveller? Towards a transcultural spirituality of dying and bereavement.

AIMS AND OBJECTIVES: This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. BACKGROUND: There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients' belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. METHODS: Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. CONCLUSION: The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. RELEVANCE TO CLINICAL PRACTICE: In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient.

Attitude to Death↗
PubMed2006

Every person matters: enabling spirituality education for nurses.

AIMS AND OBJECTIVES: This paper aims to identify how the statutory requirements relating to spirituality in nurse education can be supported in preservice and in-service education, in the context of inter-professional working implied by every child matters (Department for Education and Skills (DfES) Every Child Matters: Change for Children. DfES, Nottingham DfES 2004a; Every Child Matters: Change for Children in Health Services. Department of Health, London 2004). BACKGROUND: The basis for this paper is an exploration of the current requirements relating to spirituality in nursing and the consequent requirements for training and education clarified in part through a consideration of parallel policies on spirituality in school education. Inter-professional work, for example, across health, social care and education professions, has a long history in nursing and the changes brought about by the every child matters policy initiative have given such inter-professional work a considerable boost. That policy change has encouraged consideration, in this article, of some common issues arising in nursing and school education professions. METHOD: This paper consists of a critical review of current and in-coming statutory requirements related to spirituality, nursing and nurse education, and a synthetic review of definitions of and approaches to meeting spiritual needs. CONCLUSION: The emergent relational framework for considering spirituality in nurse education acknowledges the ambiguity of spirituality and treats that ambiguity as in some ways enabling rather than constraining. RELEVANCE TO CLINICAL PRACTICE: It is not simply that nurse practice will be likely to change with respect to children. Every person will, in the terminology of the policy, 'matter': there is significant urgency to consideration of effective education and training provision.

Child↗
PubMed1996

Philosophical hermeneutics and the project of Hans Georg Gadamer: implications for nursing research.

The paper begins with an overview of the historical roots of philosophical hermeneutics grounded in the work of Husserl and Heidegger. It goes on to explore the philosophical hermeneutics of Hans Georg Gadamer as a philosophy useful to nursing research. The four concepts of prejudice, the fusion of horizons, the hermeneutic circle and play are discussed, as are the implications these concepts have for nursing research. These concepts have been utilized in the author's own research and examples from this research are given to illuminate how these concepts can be shaped to the purposes of nursing research. While the concepts discussed stem from the work of Gadamer, the ways they have been utilized by the author do not represent a Gadamerian method. Gadamer's project is purely philosophical.

Existentialism↗
PubMed1997

Tradition and culture in Heidegger's Being and Time.

In nursing literature, Heideggerian hermeneutics, as expounded in Being and Time, is taken well near unanimously to be an invitation to explore tradition and culture. Understanding, we are told in the name of Heidegger, is to be found in the realm of common meanings and shared practices. This interpretation of what Heidegger is about in Being and Time is neither unchallengeable nor unchallenged. While a number of scholars can be found to agree with it, there are many others who see it as an utter misreading of Heidegger. In their judgement, it is an interpretation diametrically opposed to what Heidegger sets forth in his treatise. For researchers interested in invoking Heidegger or following a Heideggerian approach, this is a frustrating impasse. The only valid starting point for resolving it, this article suggests, is a close reading of what Heidegger actually says in the pages of Being and Time.

Culture↗