Nursing's metaparadigm concepts: disimpacting the debates

Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review

PROBLEM

Trust is central to the development of nurse-patient relationships. Pediatric nurses encounter difficulties developing trust with children and their caregivers. The purpose of this scoping review was to identify, examine, and summarize available evidence on the concept of trust among nurses and children/caregivers when admitted to hospital inpatient care units.

ELIGIBILITY CRITERIA

Using the Joanna Briggs Institute (JBI) methodology for conducing and reporting scoping reviews, CINAHL, MEDLINE, PsycINFO, Cochrane DSR, Cochrane Central, and JBI EBP were searched for qualitative, quantitative, mixed methods, and review studies with no time limits published in English. Included studies presented findings on the experiences of developing trust between pediatric nurses and children under 18 years of age and their caregivers within inpatient care units.

RESULTS

A total of 12,269 titles and abstracts were reviewed independently by two reviewers. 366 full-text articles were retrieved, a final of 81 studies were included in the review.

CONCLUSIONS

Trust was bi-directional between nurses and children/caregivers, developed over time during multiple interactions, and foundational to the development of relationships. Distinct facilitators and barriers to the development of trust between nurses and children/caregivers were identified. The development of trust was rewarding and enriching for both nurses and children/caregivers and was the fundamental to the provision of safe and high-quality nursing care.

IMPLICATIONS

Findings provide nurses with direction and strategies on how to develop and maintain trust with children/caregivers on inpatient care units. The development of training programs and interventions geared at equipping nurses with the skills to develop trust with children/caregivers is needed.

Thoughts About the Metaparadigm of Nursing: Contemporary Status and Recommendations for Evolution

In this essay, I present my original and most recent versions of nursing's disciplinary metaparadigm, along with others' versions of the metaparadigm. I conclude the essay by joining others in issuing a call for decolonization of nursing knowledge, with an emphasis in this essay on decolonizing nursing's metaparadigm by asking if a metaparadigm is needed and, if so, what its content should be.

Climate Change, Environmental Health, and Challenges for Nursing Discipline

Current data and scientific predictions about the consequences of climate change are accurate in suggesting disaster. Since 2019, climate change has become a threat to human health, and major consequences on health and health systems are already observed. Climate change is a central concern for the nursing discipline, even though nursing theorists' understanding of the environment has led to problematic gaps that impact the current context. Today, nursing discipline is facing new challenges. Nurses are strategically placed to respond to the impacts of climate change through their practice, research, and training in developing, implementing, and sustaining innovation towards climate change mitigation and adaptation. It is urgent for them to adapt their practice to this reality to become agents of change.

Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge

The nursing metaparadigm, as described by Fawcett in 1984, includes human, health, nursing, and the environment, all of which support theory development by giving direction to our focus as a scientific body. Nursing scientists make their mark in biotechnological applications, mobile health, informatics, and human factors research. We give voice to the patient through design feedback and incorporating technological advancements in our evolving nursing knowledge; however, we have not formally acknowledged technology in our metaparadigm. To continue patient-centered care in this age where machines are enmeshed in daily human life, we propose technology must be a domain of the metaparadigm to continue advancing nursing science and knowledge. In this paper, we propose a separate domain of technology within the metaparadigm to challenge nurses to consider approaches within their research and practice of how technology will impact patient care and their personal development within the profession. A technology-specific domain within the metaparadigm also is a signal to other bodies of science of our willingness and ability to run at pace with novel, exciting new discoveries while adding our perspective. Nurses may become active agents in novel developments rather than passive adopters, continuing our legacy of patient advocacy through new knowledge generation. Emerging and continuing nurse leadership has set the stage for the next era of nurse-led innovation and technology development, which provides an opportunity to embed technology as a core aspect of the nursing metaparadigm.

Being and becoming a nurse: Toward an ontological and reflexive turn in first-year nursing education

In this paper, we call for an ontological and reflexive turn in first-year nursing education. An ontological turn focuses on formation, the 'being' and 'becoming' of a nurse, and emphasizes the value of nursing knowledge. First-year nursing students often possess romanticized ideals about being a nurse that devalues the knowledge and expertise of nurses. We posit a thoughtful ontological orientation within nursing education that shifts the emphasis toward becoming skillful nurses, with expertise grounded in nursing perspectives. A focus on formation includes discussions regarding ideologies, dominant perspectives, and reflexive explorations of students' views of nursing juxtaposed with the realities of nursing practice. We propose ontologic reflexivity as an approach to consider what perspectives are prioritized (or not) within the nursing classroom. Within pedagogical dialogic spaces, ontologic reflexivity calls on educators to create opportunities for students to learn the value of nursing knowledge along with other forms of knowledge. We consider ways in which an ontological and reflexive turn within the first year of nursing education may contribute to the formation of nursing students who value nursing knowledge, are open-minded to various forms of knowledge, and possess an intentional reflexive way of being.

Life History of an Omani Woman, Nursing Pioneer, and Nurse Leader

This study explored the lived experiences of an Omani nursing pioneer and nurse leader whose life and career have evolved amidst a time of rapid modernization in Oman that began in 1970, widely known as the Omani Renaissance. The life history method of qualitative research was used to examine personal and institutional facilitators and barriers to professional development, as well as aspects of the history of the nursing profession and healthcare in Oman during this time. This paper provides insight about the successes and challenges she faced in choosing nursing and along her career path. Inductive thematic analysis revealed three dominant themes: opportunity, visionary, and nurse; with subthemes: national identity, country building, nursing pioneer, leadership, perseverance, resilience, mentors, advocacy, caring, and fulfillment. Conclusions from this study are that opportunities, personal attributes, and motivations shaped decisions about employment and played a role in overcoming barriers to professional development in the workforce.

Moving On: From Metaparadigm to Midparadigm for Knowledge Development

This column on Philosophical Issues introduces a conceptual innovation, the midparadigm, designed to facilitate continued development of nursing knowledge while moving beyond the metaparadigm. The midparadigm is a conceptual structure lower in abstraction than a metaparadigm consisting of an organization of concepts that reflect shared scientific and practical values for theory development in reference to a practice-relevant context. In this introductory article, I explain its philosophical rationale and provide other groundwork about the midparadigm. The feature article is authored by a team of doctoral students who present an exemplar of a midparadigm, which they have called their prismatic midparadigm of nursing.

Thoughts About Nursing Science and Nursing Sciencing Revisited

This essay includes an update of the first essay for this column, published in the first issue of 2012. The current essay includes various definitions of nursing as a discipline, and definitions of science, nursing science, and Parsesciencing, as well as a discussion of the work of nurse scientists. The Nursing Now initiative is identified as a way in which the contributions of the work of nurse scientists can be highlighted on a global scale.

Nursing's metaparadigm, climate change and planetary health

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists' conceptualizations of both the environment and the nurse-environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate-resilient future.

Perspectives on the Unitary Transformative Person-Environment-Health Process for the Knowledge Base of Nursing

Nursing knowledge development continues to face significant challenges, as there is not yet widespread acceptance of the important role of nursing theory in research, education, and professional practice. The purpose of this article is to describe perspectives on person, environment, health from different levels of knowledge development for the discipline of nursing. The authors recommend continued discourse among nurse scholars to advance the discipline of nursing globally.

[Science and nursing science: What links, what issues and what future development for the discipline of nursing?]

This article examines the terms science, discipline and knowledge from the perspective of the use and advancement of knowledge in the discipline of nursing. It views the notion of organized knowledge as the foundation of a science as well as considering the use of scientific methods as imperative in any discipline that aims to contribute to the world of ideas by relying on rationality. This paper aims to trace the link between science and nursing science, to clarify scientific issues for nursing, and to begin thinking about understanding the concept of diversity and the effective contribution of doctoral training in nursing as a guarantee of the future evolution of this discipline.

Bearing witness in nursing practice: More than a moral obligation?

In this paper, we explore the concept of bearing witness in nursing practice. We examine the description of bearing witness in the nursing literature, particularly that offered by William Cody who suggests that bearing witness results in the limited moral obligation of "true presence." We then turn to Lorraine Code's work on testimony, drawing parallels between the concepts of testimony and bearing witness. Code suggests that receiving testimony results in a responsibility to respond, and that this is an ethico-political obligation. We discuss these ideas in relation to a Canadian exemplar of witnessing the Truth and Reconciliation Commission of Canada's work to understand and address the historical injustices done to Indigenous peoples in Canada. Here, we focus on the Commission's definition of witnessing and highlight the experience of Shelagh Rogers who served as an honorary witness. As an outcome of our analysis, we suggest that bearing witness in nursing practice is most usefully conceptualized as both a moral and a political obligation. Implications for nursing practice are suggested, including first, the need to critically examine our own understandings of power and privilege in order to authentically bear witness and avoid being complicit in injustice, and second, the concomitant responsibility to take action to challenge injustice once we have borne witness to it.

The central question and the scope of nursing research

As nursing continues to develop as a professional discipline, it is important for nurses to have a central question to guide their research. Since the 1800s, nursing practice and research have covered a wide scope in cooperation with other disciplines. This wide area of nursing practice and research has led to the proposal that the central question be: How can the well-being of a person, family, community, or population be improved? The proposed question must remain flexible and open to revision because nurses will continue to adapt to the changing needs of their patients and populations and to their complex and evolving work environments.

Transfusing our lifeblood: Reframing research impact through inter-disciplinary collaboration between health geography and nurse education

Geographers have long grappled with how their research can positively impact individuals, communities and society. Demonstrating research impact is an increasingly important aspect of academic life internationally. In this paper we argue that agendas for encouraging 'impact' would be well-served if impact through teaching was identified and stimulated more explicitly, and if academics better recognised and seized the opportunities that already exist for such impact. We take engagement between health geography and nurse education as an example of how social scientists could demonstrate research impact through inter-disciplinary involvement in the education of health care professionals, and specifically student nurses. We begin by showing how the UK's Research Excellence Framework (widely regarded as the key reference point for research performance management regimes internationally) has tended to produce an undervaluation of impact via education in many disciplines. A comprehensive overview of international scholarship at the intersection between geography and nursing is then presented. Here we trace three 'waves of enquiry' that have focused on research interactions before calling for a fourth focused on critical pedagogy. To illustrate the possibilities of this fourth wave, we sketch a case study that outlines how engagement with research around blood donation could help provide a foundation for critical pedagogy that challenges student nurses to practice reflexively, think geographically and act justly. Finally, we call for closer engagement between health geography and nurse education, by encouraging educators to translate, teach, and transfuse ideas and people between health geography and nurse education. In so doing, we argue that work at this interface can be mutually beneficial and demonstrate impact both within and beyond research assessment rubrics. Hence, our ideas are relevant beyond nurse education and geography insofar as this paper serves as an example of how reframing research impact can recover the importance of impact through education.

The Humanbecoming theory as a reinterpretation of the symbolic interactionism: a critique of its specific nature and scientific underpinnings

Discussions about real knowledge contained in grand theories and models seem to remain an active quest in the academic sphere. The most fervent of these defendants is Rosemarie Parse with her Humanbecoming School of Thought (1981, 1998). This article first highlights the similarities between Parse's theory and Blumer's symbolic interactionism (1969). This comparison will act as a counterargument to Parse's assertions that her theory is original 'nursing' material. Standing on the contemporary philosophy of science, the very possibility for discovering specific nursing knowledge will be questioned. Second, Parse's scientific assumptions will be thoroughly addressed and contrasted with Blumer's more moderate view of knowledge. It will lead to recognize that the valorization of the social nature of existence and reality does not necessarily induce requirements and methods such as those proposed by Parse. According to Blumer's point of view, her perspective may not even be desirable. Recommendations will be raised about the necessity for a distanced relationship to knowledge, being the key to the pursuit of its improvement, not its circular contemplation.

A practice theory approach to understanding the interdependency of nursing practice and the environment: implications for nurse-led care delivery models

Nursing has a rich knowledge base with which to develop care models that can transform the ways health is promoted and valued. However, theory linking the environment domain of the nursing metaparadigm with the real-world environments where nurses practice and patients experience their health care is tenuous. Practice theory is used to foreground the generative role of nursing practice in producing environments of care, providing the basis for a metaparadigm relational proposition explicitly linking nursing practice and environment metaparadigm domains. A theoretical and empirical focus on the significance of nursing practice dynamics in producing environments of care that promote health and healing will strengthen present and future nursing care models.

Patient perception of contemporary nurse attire: a pilot study

Patients have expressed difficulty accurately distinguishing registered nurses (RNs) from other hospital personnel because standardized uniforms are no longer worn by RNs. According to American studies, such complaints are widespread; moreover, patients' perceptions of nurse caring and competence and of other traits associated with nurses' professional image have been negatively affected by casual, non-conventional attire. As there are no published Canadian studies, we conducted a pilot study to examine patient perception of the nurse uniform. Adult patients viewed photographs of the same RN dressed in eight different uniforms and rated each uniform according to 10 traits associated with nurses' professional image. The white pantsuit scored higher for professionalism than uniforms with small print, bold print, or solid colour, and most patients preferred that the RN dress in white. Our preliminary findings suggest that RN attire warrants further investigation, and we are planning a large-scale, fully powered study to inform patient-driven change to existing uniform policies.

The necessary distinction between methodology and philosophical assumptions in healthcare research

Methodological discussions within healthcare research have traditionally described a methodological dichotomy between qualitative and quantitative methods. The aim of this article is to demonstrate that such a dichotomy presents unnecessary obstacles for good research design and is methodologically and philosophically unsustainable. The issue of incommensurability is not a question of method but rather a question of the philosophical premises underpinning a given method. Thus, transparency on the philosophical level is important for validity and consistency as well as for attempts to integrate or establish an interface to other research. I argue that it is necessary to make a distinction between methodology and philosophical assumptions and to ensure consistency in these correlations. Furthermore, I argue that the question of incommensurability is best answered at this basic philosophical level. The complexity of health care calls for methodological pluralism and creativity that utilises the strength of both qualitative and quantitative approaches. Transparency and consistency on the philosophical level can facilitate new mixed methods research designs that may be promising methodological assets for healthcare research. I believe we are ill served by fortified positions that continue to uphold old battle lines. Empirical research begins in the field of practice and requires a certain amount of pragmatism. However, this pragmatism must be philosophically informed.

Institutional geographies in dying: nurses' actions and observations on dying spaces inside and outside intensive care units

This paper articulates the geographies associated with intensive care nursing work with dying patients and their families. Six focus groups were conducted with 27 registered critical care nurses who practice in hospitals in a mid-western city in the United States. The analysis is structured by three emerging themes (i) the importance of a 'good' and 'sacred' place, (ii) the body as mapped by medical specialties, and (iii) problems with procedurally driven suspension of 'do not resuscitate' orders beyond intensive care units (ICUs). Recommendations describe the need for institutional recognition of the moral importance of strong relationships between nurses, clients, and their families, and nurses' wide-ranging roles in bridging the various spatial domains of intensive care.

Practicing the awareness of embodiment in qualitative health research: methodological reflections

Although the importance of the researcher's embodiment has been noted in health and social sciences research, in many instances, more attention has been paid to the embodiment of the researched. Thus, more in-depth analysis of the embodied researcher can illuminate qualitative inquiry. The influence of the embodied researcher became visible in a recent critical ethnographic study examining the negotiation of religious, spiritual, and cultural plurality in health care. In this article, we do not present research findings per se, but rather methodological reflections. As researchers, we highlight emotional and bodily ways of knowing and experiences of difference such as culture, race, and religion as embodied and a part of researcher-participant encounters. We aim to elucidate the awareness of being embodied researchers, and with this elucidation, we consider implications for knowledge generation for health and social sciences.

Student articulation of a nursing philosophical statement: an assignment to enhance critical thinking skills and promote learning

The development of a personal philosophical statement about nursing is a useful assignment for both undergraduate and graduate nursing students. Students are asked to write a paper describing their philosophical views about nursing related to the metaparadigm concepts and include in-depth examples from their clinical practice to illustrate these views. This article includes information regarding important preparatory activities and handouts to facilitate the writing and evaluation of this assignment. There are many potential benefits of this complex assignment. It promotes students' reflection on their personal clinical practice experiences and engages students in mental and verbal dialogue that elicits their philosophical ideas about the metaparadigm concepts. These activities promote critical thinking and reflective clinical practice, act as a foundation for building theoretical understanding, and promote confidence in learning about nursing and other theories.

A social constructionist analysis of talk in episodes of psychiatric student nurses conversations with clients in community clinics

AIM

This paper is a report of a study of the 'discursive doings' of psychiatric nursing students' practice as they are jointly constructed in conversations with clients in community psychiatric clinics.

BACKGROUND

This construction of psychiatric nursing as a therapeutic, holistic, person-centred, interactional process is central to the identity of psychiatric nursing as a discipline. However, recent studies are beginning to suggest a dissonance between the person-centred rhetoric and institutional practice.

METHODS

A discourse analysis was conducted in 2002-03 using the transcripts of seven conversations between nursing students and clients visiting psychiatric community clinics on a monthly basis. These were selected from a sample of 20 conversations based on their clarity and completeness. Texts were analysed using the notational systems of Silverman and Mishler and some of Fairclough's analytic text structure features.

FINDINGS

In all the transcripts, an agenda for surveillance was explicitly established in the students' opening sequences of each text. Almost all exchanges in the texts were organized around cycles of questions from students and responses from clients, which allowed students to control the conversations. Information delivery was also found to be at work within the texts, although it is not as prominent or as persistent as the question and answer structure. Students took up the responses of clients selectively as though working to a pre-set agenda.

CONCLUSION

These discursive activities manifest a symptom-like approach to nursing care and have the effect of disabling the development of client-authorized expressions of agency.

The scholarly work of Janice Morse: synthesis and reflection

The author was afforded opportunity during her doctoral studies to compile and reflect upon the scholarly work of nurse researcher, Dr Janice Morse. Morse's refinement and development of patient-centred, empirically based concepts and theories, and her mastery of a diverse research repertoire, are an indisputable contribution to nursing knowledge. The author delineates four ways by which Morse's work contributes to nursing's disciplinary body of knowledge: (i) the consistent focus on the nurse-patient domain; (ii) the multiplicity of knowledge forms; (iii) the promotion of paradigm integration and methodological pluralism; and (iv) the predominance of prescriptive theories. Additionally, conjecture is put forth regarding the philosophical assumptions underpinning Morse's work. Morse serves as an excellent role model for nurse researchers who strive to ensure that nursing theories are amenable to clinical application, to research investigation and to utilization as a pedagogical tool.

Clinical geography: nursing practice and the (re)making of institutional space

AIM

To present a geographical study that highlights the wide ranging spatial features of nursing agency. In turn, illustrate the further potential for geographical research to describe, support, challenge and guide clinical practice - particularly with regard to those 'everyday' activities and actions undertaken on a frequent basis.

BACKGROUND

To provide a focus, and to anchor the study in existing clinical knowledge and debates, the role of nursing in the (re)making of institutional experiences and life is specifically explored.

METHODS

In-depth semi-structured interviews were conducted with 15 nurses working in Buckinghamshire and West London, UK. The following specialties were represented: acute care including emergency (n = 3), midwifery (n = 3), children's nursing (n = 2), elderly care (n = 1), rehabilitation (n = 2), mental health (n = 3) and palliative care (n = 1).

RESULTS

Nurses claimed to actively manipulate, normalize and recreate clinical spaces as part of their everyday therapeutic practice. Specifically, the range of agency employed by them falls under the following six categories: adjusting social composition; introducing 'normal' activities; providing private spaces; seeking private spaces; explaining clinical spaces; spaces for personal escape and wellbeing.

IMPLICATIONS FOR NURSING MANAGEMENT

It is recommended that nurse leaders - including researchers, managers and clinical educators - explore geography as a source of social scientific evidence that sheds light on the complex nature of everyday professional practice. In this regard, some important disciplinary and structural issues are noted.

Nurturing natural resources: the ecology of interpersonal relationships in women who have thrived despite childhood maltreatment

Childhood maltreatment and its consequences are a public health issue. There continues to be a need for improving the lives and life prospects for survivors of child abuse. The important role that positive interactions can play was evident in a large study of women who considered themselves successful despite maltreatment. Interactions of import ranged from brief encounters with strangers to enduring relationships. Two distinct motifs emerged: The "Saw something in me" and "No matter what" relationships. Findings will be discussed within the context of extant theories with possible implications for researchers, practitioners, and careful, caring adults in any setting.

The dissection of risk: a conceptual analysis

Recently, patient safety has gained popularity in the nursing literature. While this topic is used extensively and has been analyzed thoroughly, some of the concepts upon which it relies, such as risk, have remained undertheorized. In fact, despite its considerable use, the term 'risk' has been largely assumed to be inherently neutral - meaning that its definition and discovery is seen as objective and impartial, and that risk avoidance is natural and logical. Such an oversight in evaluation requires that the concept of risk be thoroughly analyzed as it relates to nursing practices, particularly in relation to those practices surrounding bio-political nursing care, such as public health, as well as other more trendy nursing topics, such as patient safety. Thus, this paper applies the Evolutionary Model of concept analysis to explore 'risk', and expose it as one mechanism of maintaining prescribed/ proscribed social practices. Thereby, an analysis of risk results in the definitions and roles of the discipline and profession of nursing expanding from solely being dedicated to patient care, to include, in addition, its functions as a governmental body that unwittingly maintains hegemonic infrastructures.

Developing professional habitus: a Bernsteinian analysis of the modern nurse apprenticeship

This paper discusses the development of professional habitus in nursing students from a sociological, and specifically, a Bernsteinian perspective. It outlines the theoretical basis for the development of this trait, regarded as one of the defining characteristics of professional practice, and discusses how its development has shaped the modern nurse apprenticeship with its current emphasis on situated learning. The paper considers some of the pitfalls to this approach and raises some caveats about the assumptions which underpin nursing education at the current time. It discusses how students' legitimate peripheral participation in the workplace may be jeopardised, and outlines how they may be faced with untenable choices in respect of 'fitting in' to the ward team or challenging poor practice where this occurs. Moreover, the paper considers how the increasing abrogation of 'caring' activities to non-registered staff threatens the very notion of professional habitus in nursing and posits some possible explanations for this. The paper concludes by arguing that a better understanding of professional habitus is required by all within the profession, and suggests that this concept provides the means by which two seemingly disparate concepts, 'professionalism' and 'vocationalism' can be brought together to the benefit of the nursing profession.

Connecting philosophy and practice: implications of two philosophic approaches to pain for nurses' expert clinical decision making

McCaffery's definition of pain as 'whatever the patient says it is' was truly revolutionary for nursing because of its capacity to lend credibility to the patient's pain experience. However, this definition, still widely in use, represents a particular philosophic approach to pain that has limitations for nurses' expert clinical decision making. In this paper, we trace the evolution of explanations for pain and discuss two philosophic approaches to pain that are common today. The first approach, the externalist perceptual view of pain, considers pain as a perceptual experience, one that like any perceptual experience can be 'misperceived' by the person having the experience. The second approach, the non-representational view of pain, considers pain as a holistic experience, one where physical and existential aspects necessarily coincide. These two approaches, while both emphasizing the importance of believing the patient's expression, have different implications for clinical decision making. Only the first approach permits nurses to exercise the nuanced judgement that differentiates pain from other related conditions such as anxiety, suffering or meaninglessness.

Social justice: added metaparadigm concept for urban health nursing

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.

A view of nursing epistemology through reciprocal interdependence: towards a reflexive way of knowing

The discipline of nursing has experienced the movement from modernism to postmodernism through expressions ranging from dualistic and polarized discourse to contradicting pluralistic positions. For the purpose of this paper, these responses are described as ways of knowing and are examined for their impact on the evolution of the nursing discipline. Reciprocal interdependence is offered as an alternate way of knowing capable of incorporating differing world views into a coherent and comprehensive systemic whole. The reflexive and potentially transformational impact of reciprocal interdependence on the advancement of nursing knowledge is reviewed through a discussion of the value of polarity, as well as the contribution of complementary and dialectical perspectives to the maintenance of interactions between the whole and its constituents.

Toward a critical theoretical interpretation of social justice discourses in nursing

Despite widespread appeals to social justice, nursing conceptions of this ideal have been critiqued as incomplete and inconsistent. With the aim of contributing to a critical dialogue on discourses of social justice in nursing, we explore contemporary theories of social justice and their move beyond a distributive paradigm, employing techniques of replication and critique of social justice discourses in nursing. We consider how postcolonial feminist theory can help us understand the relevance of more recent critical interpretations of social justice, particularly in reinterpreting and broadening nursing's individualistic focus on social justice so that due consideration and actions are directed toward the intersecting impact of historically and socially mediated conditions on health and human suffering.

Geography: research and teaching in nurse education

This paper outlines how geography might be integrated into nurse education. At one level, researching nurse education geographically could add to the current academic understanding of the many transitional places that make educational experiences and influence outcomes. At another level, as part of a nursing curriculum, teaching geographical concepts and issues to students might provide them with unique insights into core subjects.

Space, Place, and the Evidence Base: Part II-Rereading Nursing Environment Through Geographical Research

This, the second and final article in the short health geography series, articulates how, moving beyond the models and assumptions associated with the metaparadigm of Nursing Environment, as a focused subdisciplinary approach, health geography might provide unique insights into nursing. A case study of a fictional yet somewhat typical children's hospital is presented and demonstrates some wide-ranging geographical issues and research questions (and hence potential geographical data) pertaining to nursing and the allied health professions. Indeed, this broad-brush approach is purposeful to make as many connections as possible to readers with varied theoretical, methodological, empirical, and practice expertise. In addition to the case study, to indicate further how geographical inquiry might locate quite comfortably in nursing research, the article also makes some initial and tentative connections between geography and an established nursing framework for the uptake of research evidence for practice. Although it is acknowledged that geographical inquiry should certainly never have the first call on researching the relationships between nurses and their environments, it is argued that its conceptual focus on space and place provides dedicated and detailed attention and a sound basis for a reformed, "spatialized" route to a more comprehensive understanding. Moreover, it is argued that it also demonstrates great versatility in terms of the scales and the subject matter with which it might engage. Some important issues certainly remain with respect to what might be the correct form of engagement between geographical and nursing research, but arguably, as a reformed disciplinary approach, health geography has the potential to provide a wealth of focused evidence for nursing practice.

‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice

With the geographical literatures and issues outlined in the first paper very much in mind, this paper focuses specifically on the places in the concepts and locales of gerontological nursing practice. Particular attention is paid to the role of nurses in the making of long-term care institutions and to some fundamental priorities of care. Consideration is also given to some broader impacts of neighbourhood and community as an important spatial context to nursing practice based both in institutions and the community. In the final section, the paper makes some observations on how place-sensitive practice and research might contribute to the uptake of evidence for practice. These discussions set the scene for the final paper in this special section focused on the future research agenda for place and older people nursing.

The problematic allure of the binary in nursing theoretical discourse1

Recent ideological positioning on the world stage has borne a startling resemblance to a form of positioning within nursing theory--that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of "othering" that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be--we argue for holding binaries in tension as a catalyst for stimulating dialogue--reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing.

Out of fertile muck: the evolving narrative of nursing

The ongoing debate over the appropriateness of embracing multiple research traditions in nursing is discussed, and the impacts of that debate on the development of nursing knowledge and the nature and structure of the discipline are explored. It is asserted that this previously healthy debate has become stalled between extreme positions of unbounded pluralism and critical exclusivism. The author suggests that one possible solution may lie in connecting the elements of human living, human healing, and human wholeness in an evolving narrative that crosses paradigmatic and theoretic boundaries, and reflects the unique meanings revealed in nursing practice and scholarship.