Expert Nurses' Perceptions of the Relevance of Carper's Patterns of Knowing to Junior Nurses

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.

Development and validation of an instrument for measuring junior nurses' recognition and response abilities to clinical deterioration (RRCD)

BACKGROUND

Nurses of all levels are expected to be competent in managing clinical deterioration. Given their limited experience and basic-level knowledge, there is a concern about junior nurses' clinical and patient management skills. However, junior nurses' abilities to recognise and respond to clinical deterioration have not been adequately explored because of the absence of a comprehensive tool.

OBJECTIVES

The aim of this study was to develop a new self-assessment scale to assess the junior nurses' recognition and response abilities to clinical deterioration and to examine its reliability and validity.

METHODS

Scale items were based on literature reviews and interviews. The preliminary scale was generated through two rounds of expert review. A panel of five experts evaluated content validity. After a pilot study, the questionnaire was distributed to 168 junior nurses via convenience sampling. Subsequent statistical analysis of results included construct validity, internal consistency, and test-retest reliability.

RESULTS

Six factors were included, and 69.310% of the total variance was explained by the 25 items comprising the scale. The Cronbach's alpha coefficient was 0.905 (95% confidence interval [CI]: 0.812-0.979) for the overall scale and 0.655-0.838 for its subscales. The Guttman split-half reliability was 0.856 (95% CI: 0.806-0.894). The test-retest reliability of the scale was 0.878 (95% CI: 0.836-0.911).

CONCLUSION

We developed a scale for measuring the abilities of junior nurses to recognise and respond to clinical deterioration and confirmed its reliability and validity. More experimental studies are needed to further evaluate this instrument.

Assessment and Clinical Decision-Making During Imminent Death in Hospice Music Therapy

Assessment is a critical aspect of treatment planning, and while there exist standards for facilitating music therapy assessments in a variety of clinical settings, no such standards exist for music therapists in hospice and palliative care. This gap in knowledge, which limits music therapists' ability to provide patients and caregivers best practices promoting supported movement through the dying process, becomes particularly problematic when assessing patients who are imminently dying with a 24-72 hour prognosis. To further develop and define assessment and clinical decision-making processes used by music therapists in hospice and palliative care, the authors used a constructivist grounded theory and situational analysis methodology to analyze interviews of 15 hospice music therapists. The resulting theoretical model describes an ongoing process of assessment and clinical decision-making shaped by participants' individual epistemologies. Epistemologies were comprised of 5 ways of knowing, which were termed experiential, personal, musical, ethical, and integral, and provided participants critical foundations for their practice. The results support a development of a model for reflective practice as well as continued research on epistemological foundations of clinical practice.

Novice nurse's transitioning to emergency nurse during COVID-19 pandemic: A qualitative study

AIM

To explore the experiences and perceptions of recent nursing graduates working in emergency departments during the COVID-19 outbreak.

BACKGROUND

Overcrowding in emergency departments has been one of the most prominent issues arising in these units for more than 20 years. However, it has become even more problematic due to the novelty of the coronavirus pandemic, which has forced hospitals to recruit larger numbers of beginner nursing staff as the number of quarantined health professionals increases.

METHODS

Sixteen semi-structured interviews were conducted in Spanish emergency departments, which were analysed and synthesized using content analysis.

RESULTS

Three major themes emerged from the data analysis: (a) Fears and concerns, (b) Organisational issues and (c) Support for novice nurses.

CONCLUSIONS

Our findings may help to understand how shadowing periods as a learning programme for nurses, continuing professional development, evidence-based apps and better planning are needed to ensure both novice nurses' confidence in emergency departments and expert emergency room nurses' ability to cope with complications in critical situations.

IMPLICATIONS FOR NURSING MANAGEMENT

Training periods that include shadowing expert emergency room nurses, along with evidence-based technology, provide an opportunity to support novice nurses' transition into the workplace. These measures would provide a safety net and would increase novice nurses' confidence as well as high-quality care.

Rethinking Carper's personal knowing for 21st century nursing

In 1978, Barbara Carper named personal knowing as a fundamental way of knowing in our discipline. By that, she meant the discovery of self‐and‐other, arrived at through reflection, synthesis of perceptions and connecting with what is known. Along with empirics, aesthetics and ethics, personal knowing was understood as an essential attribute of nursing knowledge evolution, setting the context for the nurse to become receptively attentive to and engaged within the interpersonal processes of practice. Although much has been done over the 40 years since Carper described these ways of knowing, and we have seen enormous advances in empirics and ethics, and I would argue even in aesthetics (understanding the subtle craft of nursing in action), personal knowing may not have attracted its fair share of critical unpacking. Further, we see increasing evidence of a distortion on how forms of personal knowledge, including beliefs and attitudes, are being taken up within segments of the profession; these include legitimizing idiosyncratic positionings and, most worrisome, challenges to the idea that there are and ought to be fundamental truths within nursing that stand as central to disciplinary knowledge. In this paper, the author reflects on the confusion that a continued uncritical deference to personal knowing may be creating and the evolving interests it seems to serve.

A Phenomenographic Approach to Understanding the Expertise of Perioperative Nurses

Understanding the ways that perioperative nurses view the acquisition of expertise may provide foundational information for perioperative nurse educators. Our study aimed to evaluate specific types of expertise exhibited by experienced perioperative nurses and identify how nurses perceived these areas of expertise. We interviewed 20 perioperative nurses working in a university hospital in Korea. We extracted six themes regarding perioperative nursing expertise: sticking to principles, using available resources in complex situations, paying close attention to details, seeing the whole picture, prioritizing actions according to patients' conditions, and organizing a team to maximize efficiency. These findings may help perioperative educators develop practical educational strategies for novice perioperative nurses by providing a common language regarding the areas of expertise exhibited by experienced perioperative nurses.

Construction of nursing knowledge in commodified contexts: A discussion paper

This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.

Understanding and meeting your legal responsibilities as a nurse

Nurses, midwives and nursing students are legally responsible for their actions. This article discusses the legal standard of care required in relation to nursing and midwifery practice and nurses' professional standards and code of conduct. It examines how courts in the UK determine if nurses have met their duty of care and how nurses must ensure they maintain competence to provide safe care. It examines why organisational knowing - understanding the organisation in which one is employed; its people, values and how it works - is important for all nurses, regardless of their level in the organisation. It also discusses workplace incivility and its adverse effects on nurses, patient care and healthcare organisations. The article explains that if nurses are uncertain why they are doing something, they should investigate this further, because the law expects nurses to be able to justify their actions, or failure to act.