Starry night: using story to inform aesthetic knowing in women's health nursing

A Two-Phase Qualitative Enquiry Into Storytelling's Potential to Support Palliative Care Patient-Led Change, Using a Systematic Review Approach

A terminal diagnosis can diminish an individual's sense of agency and identity. Leading change appears to restore a sense of agential self. The first phase of this literature review explores factors influencing patient-led change across the palliative care ecosystem. The second phase illuminates how storytelling can support palliative care patients in leading ecosystem-wide change. 35 studies were identified in Phase 1 and 36 in Phase 2. This research highlights the need to situate patient leadership activity within a palliative care ecosystem to understand factors likely to support or hinder patient leadership activity within it. The evidence indicates the potential use of storytelling to support patients with a life-limiting illness to lead change across the palliative care ecosystem. This challenges current conceptualisations of such patients and offers them instead as an additional source of palliative care support.

Storytelling as a Teaching Approach for Breastfeeding Education

Providing education on breastfeeding to women and their families can be nuanced as a nurse navigates through identifying their questions, ideas, and knowledge gaps. Storytelling as a teaching method may offer a valuable means of communication between a nurse and the person for whom she is providing care. In this article, we reflect on the concept of storytelling for breastfeeding education via an author-generated approach. Three components are identified for the practice of teaching by storytelling: (a) asking for the person's story, (b) genuinely listening to the story, and (c) responding by storytelling. These three components can be operationalized through a seven-step process that includes welcoming, creating the opening, listening, considering, developing the story, telling the story, and being brave. Storytelling as a teaching modality may facilitate a learner's absorption of information.

Developing the Comfort Care Case: An End-of-Life Resource for Pediatric Patients, Their Families, and Health Professionals

Caring for a child in hospital who is approaching death, in the terminal phase, requires a focus on caring for the physical, emotional, and spiritual needs of the child and family. Health professionals caring for these children and families may need to shift their focus from a treatment-focused approach aimed at cure or maintaining life to a comfort-focused approach. The Comfort Care Case (CCC) is a collection of resources designed for use in hospital to ease suffering and facilitate comfort within a pediatric end-of-life (EOL) context. The resources are intended to support the child, the family, and the health professionals involved in EOL care. This article describes the development, implementation, and education associated with the CCC in a tertiary pediatric hospital.

Reorienting Esthetic Knowing as an Appropriate "Object" of Scientific Inquiry to Advance Understanding of a Critical Pattern of Nursing Knowledge in Practice

The esthetic pattern of knowing is critical for nursing practice, yet remains weakly defined and understood. This gap has arguably relegated esthetic knowing to an "ineffable" creativity that resists transparency and understanding, which is a barrier to articulating its value for nursing and its importance in producing beneficial health outcomes. Current philosophy of science developments are synthesized to argue that esthetic knowing is an appropriate "object" of scientific inquiry. Examples of empirical scholarship that can be conceived as scientific inquiry into manifestations of esthetic knowing are highlighted. A program of research is outlined to advance a science of esthetic knowing.

The Hidden Lives of Nurses' Cognitive Artifacts

BACKGROUND

Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their "paper brains" - to support handoffs, indicating a deficiency in available electronic versions.

OBJECTIVE

The purpose of this qualitative study was to develop a deep understanding of nurses' paper-based cognitive artifacts in the context of a cancer specialty hospital.

METHODS

After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses' paper-based cognitive artifacts, and analytic memos.

RESULTS

Findings suggest nurses' paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse's career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse's individually styled, paper brain is triggered by a change in the nurse's environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support.

CONCLUSIONS

The "hidden lives" - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses' paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses' paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.

The Health Needs of Young Women: Applying a Feminist Philosophical Lens to Nursing Science and Practice

Ongoing development of nursing science requires attention to the philosophical and theoretical bases upon which the science is built. A feminist theoretical perspective offers a useful lens for understanding the needs of both nurses and their clients. Adolescent and young adult women are an underserved and understudied population for whom nursing care can be especially beneficial. Considering the needs of this population from a philosophical perspective, through a feminist lens, is one effective means of developing nursing science approaches that contribute to and ultimately improve care for adolescent and young adult women.

The Symbolic Functions of Nurses' Cognitive Artifacts on a Medical Oncology Unit

Acute care nurses continue to rely on personally created paper-based tools-their "paper brains"-to support work during a shift, although standardized handoff tools are recommended. This interpretive descriptive study examines the functions these paper brains serve beyond handoff in the medical oncology unit at a cancer specialty hospital. Thirteen medical oncology nurses were each shadowed for a single shift and interviewed afterward using a semistructured technique. Field notes, transcribed interviews, images of nurses' paper brains, and analytic memos were inductively coded, and analysis revealed paper brains are symbols of patient and nurse identity. Caution is necessary when attempting to standardize nurses' paper brains as nurses may be resistant to such changes due to their pride in constructing personal artifacts to support themselves and their patients.

Neonatal palliative care in action: moving beyond the rhetoric and influencing policy

The purpose of this paper is to move beyond the rhetoric of espousing the importance and timeliness of palliative care for the neonatal population, and to explore how what is known can influence health and social policy. A recent Commonwealth of Australia Senate enquiry into palliative care raised concerns about the current lack of specialist perinatal and neonatal palliative care in Australia. Inherent to the difficulties of moving a neonatal palliative care model forwards are the identified barriers to palliative care practice in the clinical setting, which have been well defined. To inform policy, it is imperative that health professionals in the neonatal discipline are knowledgeable about legislative priorities and the public concerns regarding palliative care for neonates. This paper argues that there are several priorities for moving this model of care forwards, which include legislation that supports access to care such as development and funding support of perinatal hospices, continuity of care, caregiver support, research and in particular education for the health care professionals caring for dying babies and their families. To achieve this, we need to set national research priorities that reflect a truly collaborative partnership. It is time to move beyond the rhetoric.

Understanding the Journey Through Homelessness: A Hermeneutic Study of Women Without Children

This study explored the meaning of the experience of homelessness and exiting homelessness among women without children. Convenience and snowball sampling techniques were used to recruit 12 women in an urban centre in Canada. Texts resulting from audiotaped interviews, participant observations, and reflective journal entries constituted data for analysis. Gadamerian hermeneutics informed the interpretive method used for analysis. The analysis yielded 5 subthemes that described the journey: (a) loss of self at home: the trigger; (b) non-feeling of “at-homeness”: dissociation; (c) disconnection and aloneness: homelessness; (d) simulating home: transitional shelter living; and (e) finding oneself: hopefulness. Findings suggest that exiting homelessness for women was a journey in search of hope, and reconnection with the self and others. This perspective suggests a new approach for policy and practice.

Holistic nurses' stories of personal healing

The purpose of this study was to uncover the nature, experiences, and meaning of personal healing for holistic nurses through their narrative accounts. The study employed a qualitative descriptive design with methods of narrative and story inquiry. Participants were nurse attendees at an American Holistic Nurses' Association conference who volunteered for the study. They were invited to share a story about healing self or another. Twenty-five stories were collected; seven were about personal healing, and these are the focus of this analysis. Data were analyzed using a hybrid approach from narrative and story inquiry methods. Eleven themes were clustered under three story segments. The themes within the Call to the Healing Encounter are the following: recognition of the need to resolve a personal or health crisis, knowledge of or engagement in self-care practices, and reliance on intuitive knowing. Themes under the Experience of Healing are the following: connections; profound sensations, perceptions, and events; awareness of the reciprocal nature of healing; inner resolution: forgiveness, awakening, and acceptance; use of multiple holistic approaches; and witnessing manifestations of healing. The themes for Insights are the following: gratitude and appreciation and ongoing journey. A metastory synthesizing the themes is presented, and findings are related to existing literature on healing.

The lived experience of knowing in childbirth

Research on knowing in childbirth has largely been a quantitative process. The purpose of this study was to understand the ways first-time mothers learn about birth. A phenomenological approach, using a feminist view, was used to analyze two in-depth interviews and journals to understand nine first-time expectant mothers' experiences of knowing in childbirth. The findings demonstrated a range of knowledge that contributed to issues of control and conflict. The participants also described an increased dependency on their mothers and a lack of their own intuition contiguous to the birth process. These findings contribute understanding to how expectant mothers know birth, suggesting that their knowing does not diminish conflict surrounding the event and may even exacerbate it when not combined with learning skills to manage conflict. Childbirth educators may want to include instruction on negotiating power differential in relationships encountered during childbirth in order to strengthen a first-time mother's ability to receive the care she wants. Educators may also want to assess the expectant mother's view of birth and her expectations for birth. Schools of nursing should consider the inclusion of women-centered care curricula at both the undergraduate and graduate levels. The mothers' responses in this study clearly reveal that the politics surrounding birthing remain in place and must be removed in order to provide a supportive environment for normal birth.

The value of listening to grandmothers' infant-feeding stories

The purpose of this study was to examine the usefulness of storytelling as a foundation for communicating with grandmothers about breastfeeding. The benefits of storytelling are applied to an analysis of infant-feeding stories that grandmothers told during a focus group study conducted by the authors. Thirty-five grandmothers participated in the study. A qualitative content analysis of the interview transcripts revealed that grandmothers' infant-feeding stories provided insights into the people (characters) and circumstances (setting) that affected their early experiences of infant feeding. By asking grandmothers to tell their stories, health-care professionals may understand the personal and cultural context grandmothers bring to their support of new mothers and facilitate a place for grandmothers' voices to be heard.

Telling family stories: learning strategies in family care

OBJECTIVE: To identify how nursing students experience telling their family stories as a learning strategy in family care. METHODS: This was a qualitative and descriptive study, conducted with 18 students (second year, Nursing undergraduate course, Federal University of São Paulo) who participated in four meetings. These were used as an additional resource in formation of family care. Content analysis as proposed by Bardin was used. RESULTS: Three categories emerged: changes in perception and expansion of the concept of family, and redefinition of ties; identification of similarities, beliefs, values, and rituals in family stories; enhancement of active listening as a strategy for family care. CONCLUSION: This study contributed to create new strategies for nursing education in family care so far as students could revise concepts and extend contexts based on stories told by participants.

An investigation of the division between espoused and actual practice in infection control and of the knowledge sources that may underpin this division

Aims: This paper aims to provide a better understanding of divisions between the espoused and actual infection control practice of staff working within a renal unit and to investigate the sources of knowledge used to underpin practice.

Background: Healthcare associated infection continues to be a major problem for health services. It has been claimed that healthcare associated infections may be reduced by around a third through the use of effective infection control measures. The effectiveness of these measures will rely upon the learning and skills of those implementing them.

Methods: The study employed a primarily qualitative approach using participant observation and semi structured interviews over a six month period on a renal unit within a district general hospital.

Results: Results gained provided some indication of a gap between espoused and actual compliance with infection control policy in practice while also indicating that tacit knowledge and learning in practice may offer an effective means of gaining and implementing infection control knowledge.

Conclusions: This study highlights divisions between espoused and actual infection control practice, it also emphasises the role of tacit learning and how tacit knowledge may be gained and employed in practice.

All That Holds

Stories convey meaning and open us to the deep mystery of compassion. Stories are methodological tools in the aesthetic domain of nursing, paratelic ways of knowing that carry us beyond logic to a higher order of understanding. Through stories we are connected to each other and to ourselves. The purpose of this article is to tell the story of Valerie and her journey into healing through metastatic breast cancer. Holistic nursing as a process is contextually illuminated by creating a story within a story. This is an aesthetic work woven together from Valerie's narrative, an interview with her mother after Valerie's death, and from the author's own impressions. Literary quotations are used to highlight different sections of the story with metaphors that speak to the nature of healing. It is hoped that this story will open the reader to his or her own unique understanding of the meaning of healing.

Lifeworld, the arts and mental health nursing

Various manifestations of the arts have been employed in mental health care as successful diversional and therapeutic interventions, and as an adjunct to mental healthcare professional education. There is now a current groundswell of the use of the arts and humanities in both the practice of research and the representation and dissemination of findings. Here, we first point to the potential ability of the arts that can be used to re-humanize the world of health and social care and its underpinning sciences. Second, we highlight the nature and relevance of this more aesthetic movement and its potential to enable meaningful engagement with people in order to facilitate shared understandings of concretely lived experiences. Finally, we use a long-standing philosophical framework, the 'lifeworld', as an exemplar to demonstrate how the wholeness and essence of human being can be revealed or shown through art. In doing so, we make the tentative suggestion that phenomenology and the lifeworld approach may be a useful philosophical framework for underpinning the use of arts in mental health nursing.

Patient narratives in the investigation and development of nursing practice expertise: a potential for transformation

This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners' concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient-participants' role as a sophisticated evaluator of health-care. As a result, we present a case for transformational qualitative research. Such research is values-driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its 'ends' (i.e. research products) but also, intentionally, through its 'means' (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self-reflection) to examine and critique their personal values.

Locating Carper's Aesthetic Pattern of Knowing within Contemporary Nursing Evidence, Praxis and Theory

Carper's (1978) seminal work has been used in nursing education for many years as a method for introducing students to the multitude of ways of knowing that support nursing practice. This manuscript focuses on the aesthetic pattern of knowing and the ongoing debate in nursing literature surrounding aesthetics, evidence and nursing practice. Writers will describe and critique a strategy used to introduce first year undergraduate nursing students to this pattern of knowing. The implications of the critique of the project and the ongoing debate in relation to Carper's (1978) work, evidenced based practice and nursing praxis are discussed.

Culture and ageing: reflections on the arts and nursing

AIM; In this paper, we focus on ageing as an area in which nursing, society and the humanities can be profitably conjoined. We illustrate our argument with three case studies of ageing: in painting, opera and ballet.

BACKGROUND

There has been a recent spectacular increase in papers devoted to the relatively new field of the medical humanities. We argue for a similar renaissance in thinking about the connections between the arts and nursing.

DISCUSSION

First, we consider the paintings of J.M.W. Turner (1775-1851) as examples of loss, ageing and death. Second, we draw upon Leos Janácek's opera 'The Makropulos Case' (1926) as a focus for debate about human mortality. Third, we review some ethnographic research on the balletic body as an example of cultures of youthful ageing.

CONCLUSION

A focus on the embodiment of vulnerability is a productive catalyst for research on the intimate connections between self and society, biology and culture, and reason and emotion. Such a research agenda would be the hallmark of a holistic approach to the arts and nursing.

Narrative vigilance: the analysis of stories in health care

The idea of narrative has been widely discussed in the recent health care literature, including nursing, and has been portrayed as a resource for both clinical work and research studies. However, the use of the term 'narrative' is inconsistent, and various assumptions are made about the nature (and functions) of narrative: narrative as a naive account of events; narrative as the source of 'subjective truth'; narrative as intrinsically fictional; and narrative as a mode of explanation. All these assumptions have left their mark on the nursing literature, and all of them (in our view) are misconceived. Here, we argue that a failure to distinguish between 'narrative' and 'story' is partly responsible for these misconceptions, and we offer an analysis that shows why the distinction between them is essential. In doing so, we borrow the concept of 'narrativity' from literary criticism. Narrativity is something that a text has degrees of, and our proposal is that the elements of narrativity can be 'sorted' roughly into a continuum, at the 'high narrativity' end of which we find 'story'. On our account, 'story' is an interweaving of plot and character, whose organization is designed to elicit a certain emotional response from the reader, while 'narrative' refers to the sequence of events and the (claimed) causal connections between them. We suggest that it is important not to confuse the emotional persuasiveness of the 'story' with the objective accuracy of the 'narrative', and to this end we recommend what might be called 'narrative vigilance'. There is nothing intrinsically authentic, or sacrosanct, or emancipatory, or paradigmatic about narrative itself, even though the recent health care literature has had a marked tendency to romanticize it.

Making Meaning: Women’s Birth Narratives

Birth stories are personal narratives grounded in the pivotal life experience of giving birth. Richly descriptive birth narratives from culturally diverse childbearing women document the importance of listening to the voices of women. Benefits of sharing birth stories include the opportunity for integration of a major event into the framework of a mother's life; the opportunity to share a significant life experience; the opportunity to discuss fears, concerns, "missing pieces" or feelings of inadequacy or disappointment; the opportunity for the woman to gain an understanding of her strengths; and the opportunity to connect with other women. Providing women with the opportunity to share their birth stories is an important nursing intervention.

Public Health Nursing in Ireland: A Critical Overview*

The World Health Organization have stressed the importance of nurses and midwives as a "force for health" in society's efforts to tackle the public health challenges of our time. The public health challenges are both diverse and complex. Principally, they emanate from a social model of health that takes cognizance of our behavior, our environment, and the historical, political, and cultural structures that facilitate health or militate against it. This paper provides a critical overview of public health nursing in Ireland, toward situating both our contribution to public health and some of the challenges that lie ahead of us. Specifically, it looks at nonquantifiable practice, where, through the presentation of stories, the wealth of public health nursing work is demonstrated in the ordinary voices of public health nurses. The potential risk of ignoring and minimizing the contribution of public health nursing in future developments in primary care in Ireland is discussed. Finally, it is proposed that public health nurses need to get political.

Giving birth. Voices of Chinese women

The meaning of the childbirth experience for Chinese women living in the People's Republic of China is described in this phenomenological study. Ten primiparous women participated in audiotaped interviews within 5 months of giving birth, 9 from Beijing and 1 from Chongqing. The interviews were translated by a bilingual native Chinese speaker and transcribed by the researcher. Themes were identified from the rich narrative data, including the One Child Policy's influence on childbearing, the transition to motherhood, and the influence of the cultural practice of "doing the month" (zuo yue zi). The findings provide insights into how nurses can provide better nursing care by learning about and validating specific cultural practices related to childbearing. The rising number of Chinese immigrants to the United States reflects the increasing need for more culturally competent care by nurses to ensure positive perinatal health outcomes.

Caring behaviors of advanced practice nursing students

The purpose of this project was to provide advanced practice nursing (APN) students with the opportunity to enrich their aesthetic knowing and acquire the meaning of caring in their practice by reflecting on their caring narratives. Students were asked to write about a caring encounter they experienced in their practice. The instructor analyzed and organized that data from each narrative. The instructor shared the data with the students for reflection and discussion. This report focuses on the caring practices of the APN students. Nine themes that embraced physical care, communication, comfort, presence, knowing, acceptance, touch, collaboration, and encouragement were identified. The APN students demonstrated aesthetic knowing as well as other ways of knowing in their caring narratives. Through reflection on the caring experiences and discussion in class, students were able to identify the meaning of caring in their practice.

Palliative and end-of-life care: policy analysis

PURPOSE/OBJECTIVES

To present an overview of policy issues affecting hospice and palliative care focusing on the nursing home and hospital settings and to discuss factors affecting end-of-life care, policy initiatives, recent legislation, and nursing implications.

DATA SOURCES

Published articles; technical, advisory, and research reports (from government, professional, and private organizations); newsletters; textbooks; meeting minutes; online references; and legislative documents.

DATA SYNTHESIS

Improvements are needed in end-of-life care, especially with regard to access, delivery, and financing of such services. Legal, organizational, and reimbursement policies, as well as healthcare professional education, have been identified as areas that need improvement. The nursing shortage and variable reimbursement policies for nursing services have a significant impact on access to quality end-of-life care, especially for underserved populations.

CONCLUSIONS

A need exists for further research, including demonstration projects to test new ways to deliver and integrate hospice and palliative care throughout the illness continuum. Education and research are needed regarding symptom management, communication and decision making, caregiver support, and other end-of-life issues. Nursing interventions, palliative care networks, and other models that promote a coordinated approach to care delivery have been shown to decrease costs and improve quality of care.

IMPLICATIONS FOR NURSING

Nurses play a key role in advancing improvements in palliative and end-of-life care through their involvement in educational, quality improvement, research, and legislative initiatives. Nursing activities in these areas may contribute to improved access, lower costs, and improved quality of care in advanced illness.

Coping with menstruation: understanding the needs of women with Parkinson's disease

AIMS

To understand how women with Parkinson's disease (PD) experience and cope with menstruation and associated gynaecological problems, and adjustments to womanhood. This paper focuses on menstruation.

RATIONALE

Unique hormonal fluctuations are known to affect women with idiopathic PD, however, our understanding of the impact of these changes on daily lives and opportunities for nursing support are limited.

METHODS

Descriptive multiple case study design was adopted, and data collection involved a variety of approaches. Including semi-structured interviews, conversational interviews, group interview, reflective diaries and creative writing. A flexible approach was encouraged whereby consenting women chose how and when they wanted to participate.

FINDINGS

A total of 19 women participated, 17 were experiencing naturally occurring periods. The majority had been diagnosed around the age of 39 years, and at the time of study participants ages ranged from 34 to 56 years. Three of the women reported no change in the experience of their periods following diagnosis, 15 reported worsening problems which in two extreme situations led to hysterectomy. During the monthly cycle PD symptoms were often exaggerated, medication effectiveness reduced and 'off times' increased. The period itself involved high levels of pain, fatigue and sometimes humiliating experiences when self-care was impossible.

CONCLUSIONS

This study offers a unique contribution to our understanding of the needs of young women with PD, and suggests that health professionals need to look beyond the mask of a disease associated with old age. The nursing profession has a responsibility to develop models of best practice to enable women of any age to be themselves and to adapt to the rhythm of their hormones as they live and grow older with PD.