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[The importance of cultural coding in nursing practice, nursing research and nursing science--components of a critical concept of culture].

Based on the question, on which conditions the understanding of the strange is possible at all, this article points out--illustrated by research material on nursing practice, nursing education and nursing science--collective interpretative patterns that are based on binary codings like "nature-culture", "body-mind", "female-male", "strange-familiar", foreign-native", "you-we", "sick-healthy", "black people-white people", etc. These patterns and the value judgements expressed by them are social constructions within specific in certain historical and cultural contexts. Yet people neither experience collective interpretative patterns nor recognize them as such, but deal with them as if they were natural facts. This (unrecognised) process of naturalization of social-cultural phenomena provokes contradictions and conflicts in all fields of practical life--in nursing practice and nursing education too, which will be shown by examples. To describe and analyse these complex circumstances, an approach to a critical concept of culture is developed in this article. The approach includes social-cultural events, processes and structures as well as their implicated symbolization. However, this heuristic construct itself must not be naturalized and "essentialized".

Attitude to Health↗

'They think they can talk to nurses': practice nurses' views of their roles in caring for mental health problems.

BACKGROUND: Primary care teams have been encouraged to develop the care they provide to patients with mental health problems, and a greater role for practice nurses has been advocated. However, little is known about practice nurses' current level of involvement or their perceived strengths and limitations in caring for patients' mental health problems. AIM: To describe practice nurses' current experiences of caring for patients with mental health problems and to explore their perceptions about enlarging this role. METHOD: Pilot interviews were carried out with a purposeful sample of practice nurses to design a postal questionnaire, which was then sent to 635 practice nurses identified from family health services authority lists in six health authorities in the north-east of England. RESULTS: Completed questionnaires were returned by 445 (70%) practice nurses. Most nurses (83%) reported that they commonly saw patients with a range of mental health problems arising indirectly or directly in consultations. Many practice nurses (52%) lacked any formal mental health training and identified a broad range of training needs. A majority (80%) of responders had concerns about their abilities to address mental health problems effectively, given their existing workloads. However, most (61%) were keen to expand their role in mental health care if appropriate support and training were forthcoming. CONCLUSION: There is considerable potential for practice nurses to realize a greater and more effective role in the care of mental health problems in primary care. Developing practice nurses' contribution will require further training and support.

Community Mental Health Services↗

Attitudes of practicing nurses towards theory-based nursing practice.

Theory-based nursing practice is a topic of current importance in Canadian nursing settings. Both the CNA and provincial regulating bodies have included the concept in their standards of practice. Current nursing education programs based on nursing models have produced a growing cadre of nurses familiar with formal nursing theory. However, practicing nurses' exposure to nursing theories varies and this population has not been systematically investigated. As part of a larger study, responses of 362 nurses from three Ontario cities to the Nursing Theories Questionnaire revealed a moderately positive attitude towards theory-based nursing practice. Attitudes were significantly more positive among nurses working in agencies which had implemented theory-based practice. Nurses believed that theory-based practice would help them collect useful data, plan comprehensive care, would result in better care, should not be left for nurse scholars and was important to the development of the nursing profession. Nurses were most familiar with theories of Neuman, Orem and Roy; least familiar with Parse and Rogers. Community nurses preferred Neuman's theory; hospital nurses preferred those of Roy and Orem. These findings provide information about factors associated with nurses' knowledge and attitudes towards theory-based nursing practice and may be useful for nurse administrators in planning strategies for implementing theory-based practice.

Adult↗

Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK.

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experimental nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the 'nurse practitioner', 'clinical nurse specialist', 'nurse consultant' and 'nurse clinician', in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a 'generalist' and 'specialist' model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.

Curriculum↗

[The relationship between nursing practice, nursing, and nursing philosophy].

The activities of the three dimensions of nursing does not occur in isolation. Nursing practice, the field of study of nursing science, has characteristics which influence the scientific practice of nursing. Nursing practice is constituted by the nurse practitioner as a result of the fact that the pre-scientific interpretations of the nurse give form (gestalte) to nursing interactions. From a functional perception in nursing science, the scientific practitioner must take cognisance of the pre-scientific interpretations. Besides the empirical reality, specific values and assumptions form an integral part of this practice of science in Nursing. The third dimension, the philosophy of nursing brings greater clarity in that the activities of the first two dimensions can be organised, analysed and evaluated.

Humans↗

Enhancing psychiatric nursing practice: role of an advanced practice nurse.

In response to demands for alternative health models that deliver cost-effective quality care, one large Midwestern medical center implemented a change in their nursing practice model. The change involved the introduction of unit-based nursing leadership teams that included advanced practice nurses (APNs). This article reports the findings from an investigation that employed a case study design to evaluate the process and outcomes of integrating an APN on a psychiatric unit with experienced nurses. Data collection methods included a nursing survey (n = 34), interviews with nine randomly selected nurses, and two multidisciplinary open forums. Consistent with the staff nurses' survey ratings of important advanced practice role functions, responses from the nursing interviews and open forums suggested nurses' professional development to be the most positive outcome. Role confusion was identified as a negative outcome. Recommendations for improved integration and use of APNs in today's psychiatric health environments were identified.

Hospital Units↗

Impact of clinical information systems on nursing practice. Nurses' perspectives.

This article adds to the literature on the impact of computerized clinical information systems by asking nurses important questions about their nursing practices. A research tool was developed from collaborative work with clinicians who have used computers in their daily practice for more than two decades. A statewide study then was conducted on how nurses believed computer technology impacted their practice. This study also examined the different views that computer users and nonusers held. Questions were posed relating to resource consumption, nursing work practices, and professional and patient outcomes. It was found that nurses, whether computer naive or knowledgeable, clearly do not expect the technology to have negative impact on practice. The two groups differed mostly in the strength of their beliefs. One startling outcome, that slow computer response time delayed care, was identified within the computer-user group and direct action was taken as a result.

Attitude to Computers↗

A brief history of advanced practice nursing and its implications for WOC advanced nursing practice.

Although the evolution of clinical nurse specialists and nurse practitioners during the previous several decades has led to a sense of novelty regarding advanced practice, it is important to remember that nurses have engaged in such roles for nearly 100 years. This article will review the history of advanced nursing practice, summarize current definitions of specialty and advanced practice, discuss the evolution of advanced practice and its impact on contemporary nursing, and provide a background for advanced practice considerations for the WOC nurse, which are discussed in detail in subsequent articles by Janice Beitz (pp 55-64) and Dorothy Doughty (pp 65-8) in this issue.

History, 20th Century↗

Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: nurses' evaluations.

BACKGROUND: One of the barriers to effective pain management in critical care is the lack of systematic, comprehensive methods for assessing and treating pain. Use of a printed, standardized pain assessment and intervention tool can stimulate critical thinking and provide a framework for organizing pain assessment and management data. OBJECTIVES: The objectives of this study were to do the following: (1) describe the Pain Assessment and Intervention Notation (P.A.I.N.) tool, (2) detail critical care nurse participants' evaluations of the P.A.I.N. intervention tool when used during care of postoperative patients in pain, and (3) evaluate the tool's usefulness in practice and education. METHODS: Eleven intensive care unit (n = 7) and postanesthesia care unit (n = 4) nurses completed a questionnaire after they had used the pain tool in their clinical practices with 31 postoperative patients. RESULTS: Ten of the 11 nurses who returned an evaluation questionnaire found that the P.A.I.N. tool provided a consistent, systematic method of quantifying their assessment of patient pain and analgesic responsiveness. Five nurse participants believed that the P.A.I.N. tool improved their practice with regard to pain and sedation assessment. Three of the 11 nurses believed that the usefulness of the tool was limited because it was too detailed to be used routinely when caring for critically ill patients. All but 1 of the 11 nurses believed that the tool would have helped them earlier in their practice (ie, when they had less critical care nursing experience). CONCLUSIONS: The assessment and treatment of pain in critically ill patients are highly complex processes. This study identified many advantages of the use of a standardized, systematic approach to pain assessment and treatment by health professionals.

Adult↗