Understanding paradigms used for nursing research

The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis

PURPOSE

To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints.

METHODS

In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms.

RESULTS

The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour".

CONCLUSIONS

I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

Dialectical Pluralism for Nursing Knowledge Development

The purpose of this paper is to explore the potential of dialectical pluralism (DP) for nursing knowledge development. Nursing scholars have discussed ways of developing nursing knowledge, exploring the fit and relevance of various worldviews for knowledge development and examining the dynamic and perpetual processes of knowledge development. Scholars have argued that knowledge development occurs under a certain worldview to which the researcher adheres. Many nurses employ various worldviews, which can give rise to ontological and epistemological conflicts. DP can help nurses appreciate the diversity of worldviews and recognize the importance of implicit worldviews to generate more practical nursing knowledge. DP as a philosophical approach can enable nurses to communicate between diverse worldviews, become tolerant of conflicting differences, and develop an array of nursing knowledge.

Development of higher-order thinking skills in nursing students through online problem-based assessment

Background

The development of higher-order thinking skills (HOTS) in problem-based learning (PBL) is not confined to teaching and learning but extends to authentic assessment methods, similar to real-life situations. The assessments aligned to PBL attempt to eliminate the students' tendency towards memorisation. Rather, it instils and encourages their ability to analyse, interpret, synthesise, and evaluate knowledge and its sources.

Aim

The study had two primary aims: (1) to describe undergraduate nursing students' experiences of an online problem-based assessment (PBA), and (2) to explore how online PBA assessment contributed to the development of undergraduate student nurses' HOTS.

Setting

An urban-based South African higher education institution (HEI) in KwaZulu-Natal, Durban, South Africa.

Methods

A descriptive, exploratory qualitative approach was used. The target population was 4th-year psychiatric nursing students (N = 39) studying for the degree of Bachelor of Nursing at the preselected university, utilising two focus groups (n = 5, n = 7). Data were analysed through content analysis using the clinical reasoning model as a framework.

Results

Three categories (trigger problem, re-visioning the cues, treatment direction) and seven sub-categories (trigger problem posing, early cue identification, cue interpretation and clustering, focussed cue investigation, information processing and interpretation, reprioritise hypotheses, and diverse intervention[s]) emerged.

Conclusion

Psychiatry, Nursing and Midwifery practices require a practitioner skilled in HOTS to provide quality, efficient and cost-effective patient care.

Contribution

The findings in this study can benefit nursing education, particularly learning interruptions in HEIs.

Narrative Inquiry as a Caring and Relational Research Approach: Adopting an Evolving Paradigm

Humans are continuously storying and re-storying themselves through language and socially organizing language into narratives to create meaning through experiences. Storytelling through narrative inquiry can bridge world experiences and co-create new moments in time that honor human patterns as wholeness and illuminate the potential for evolving consciousness. This article aims to introduce narrative inquiry methodology as a caring and relational research approach aligned with the worldview grounding Unitary Caring Science. This article uses nursing as an exemplar to inform other human science disciplines interested in using narrative inquiry in research, while defining essential components of narrative inquiry through the theoretical lens of Unitary Caring Science. By exploring research questions through this renewed understanding of narrative inquiry informed by the ontological and ethical tenets of Unitary Caring Science, healthcare disciplines will be knowledgeable and prepared to facilitate knowledge development to contribute to the sustainment of humanity and healthcare beyond eliminating the cause of illness and into the experience of living well with illness. The co-creative process of narrative inquiry as a caring and healing inquiry can guide collective wisdom, moral force, and emancipatory actions by seeing and valuing human experiences through an evolved holistic and humanizing lens.

Using cultural historical activity theory to reflect on the sociocultural complexities in OSCE examiners' judgements

Examiners' judgements play a critical role in competency-based assessments such as objective structured clinical examinations (OSCEs). The standardised nature of OSCEs and their alignment with regulatory accountability assure their wide use as high-stakes assessment in medical education. Research into examiner behaviours has predominantly explored the desirable psychometric characteristics of OSCEs, or investigated examiners' judgements from a cognitive rather than a sociocultural perspective. This study applies cultural historical activity theory (CHAT) to address this gap in exploring examiners' judgements in a high-stakes OSCE. Based on the idea that OSCE examiners' judgements are socially constructed and mediated by their clinical roles, the objective was to explore the sociocultural factors that influenced examiners' judgements of student competence and use the findings to inform examiner training to enhance assessment practice. Seventeen semi-structured interviews were conducted with examiners who assessed medical student competence in progressing to the next stage of training in a large-scale OSCE at one Australian university. The initial thematic analysis provided a basis for applying CHAT iteratively to explore the sociocultural factors and, specifically, the contradictions created by interactions between different elements such as examiners and rules, thus highlighting the factors influencing examiners' judgements. The findings indicated four key factors that influenced examiners' judgements: examiners' contrasting beliefs about the purpose of the OSCE; their varying perceptions of the marking criteria; divergent expectations of student competence; and idiosyncratic judgement practices. These factors were interrelated with the activity systems of the medical school's assessment practices and the examiners' clinical work contexts. Contradictions were identified through the guiding principles of multi-voicedness and historicity. The exploration of the sociocultural factors that may influence the consistency of examiners' judgements was facilitated by applying CHAT as an analytical framework. Reflecting upon these factors at organisational and system levels generated insights for creating fit-for-purpose examiner training to enhance assessment practice.

Evaluation of the NANDA International, Inc. diagnostic classification in Spain: Development and validation of the EVALUAN-I tool

PURPOSE

To develop and validate a tool to evaluate the NANDA International, Inc. diagnostic classification.

METHODS

The tool, EVALUAN-I, was validated in a non-probabilistic sample (N = 460) on Spanish Registered Nurses (September-December 2019) in two phases. First, design and construct the instrument in three steps: (1) literature review to define the construct focusing on the orientation toward nursing concepts and theoretical foundations, the level of scientific evidence, the structural configuration, the applicability, the nurses' clinical reasoning skills, and the attitudes toward nursing diagnosis, (2) substantiation of the questionnaire items and design according to the criteria for a diagnostic classification, (3) expert test to establish the face validity and content validity. The second phase revolved around (4) conducting a pilot test and measuring the temporal stability (test-retest) and Cohen's kappa coefficient; assessing psychometric properties by measuring (5) reliability (internal consistency using Cronbach alpha and interfactor correlation) and (6) construct validity (exploratory and confirmatory factor analysis). The manuscript follows the STROBE checklist. The study was approved by the Research Ethics Committee with registration number 2019-190-1.

FINDINGS

EVALUAN-I displayed moderate test-retest stability, adequate construct validity, and excellent reliability. The confirmatory factor analysis provided evidence about the configuration of EVALUAN-I in relation to nine analytical dimensions: clinical competence, nurses' reasoning skills, attitudes towards nursing diagnosis, discipline's central concepts, classification's contents, physiopathological attributes, level of scientific evidence, diagnostic precision, and conceptual correspondence between terminologies.

CONCLUSIONS

EVALUAN-I is a valid and reliable instrument, which can be used to improve the epistemological, normative, and intuitive configuration of NANDA International, Inc. in a structured, systematic manner.

IMPLICATIONS FOR NURSING PRACTICE

Comprehensive evaluation of NANDA International, Inc. in different clinical settings around the world using a validated instrument, like EVALUAN-I, would allow strengths and weaknesses to be identified and contribute to the classification's development and practical application.

African American Perceptions of Participating in Health Research Despite Historical Mistrust

A qualitative descriptive approach examined perspectives of African Americans (AA) on their participation in health research despite historical research mistreatment. Nineteen AAs participated in semistructured interviews that provided data that were analyzed using thematic analysis. Salient themes included race concordance, being respected and valued by the researcher, research participation motivators, and cultural experiences of racism in health care. This study challenges dominant ideology that AAs are unwilling to participate in research and offers solutions to promote research inclusive of their perceptions. Therefore, researchers need to design research with inclusiveness and transparency that openly displays how research will impact future generations.

A participatory action research study to inform combined type 2 diabetes and chronic kidney disease care provided in the context of advanced practice nursing

AIM

To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision.

DESIGN

This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery.

METHODS

The study was undertaken in a series of three cycles of enquiry over a 20 month period (July 2018-February 2020) in five geographically diverse specialist diabetes and nephrology centres. Data collection methods included PAR group minute consensus, retrospective chart review, discovery and focus group interviews. Thematic analysis and descriptive statistics were used to analyse the data.

RESULTS

Compared with international standard care outcomes, a higher proportion of patients attending combined care achieved best practice recommendations for blood pressure, Hba1c and lipid management (64.3% vs. <40%). Patients attending combined care experienced improved detection and management of CKD-related anaemia. Additionally, the combined care service experienced significantly lower levels of patient's failure to attend scheduled reviews compared with participating standard care services (0% vs. 7%-23.3%).

CONCLUSIONS

Best practice clinical care outcomes and patient attendance improved when a combined type 2 diabetes and CKD care delivery strategy provided in the context of advanced practice nursing was adopted.

IMPACT

This alternative care strategy represented a departure from standard care delivery approaches, in which care for type 2 diabetes and CKD is provided separately and led by physicians. Outcomes demonstrate improved clinical and attendance outcomes which may inform the development of future services led by advanced nurse practitioners.

Challenges faced by people experiencing homelessness and their providers during the COVID-19 pandemic: a qualitative study

BACKGROUND

People experiencing homelessness are vulnerable to SARS-CoV-2 infection and its consequences. We aimed to understand the perspectives of people experiencing homelessness, and of the health care and shelter workers who cared for them, during the COVID-19 pandemic.

METHODS

We conducted an interpretivist qualitative study in Toronto, Canada, from December 2020 to June 2021. Participants were people experiencing homelessness who received SARS-CoV-2 testing, health care workers and homeless shelter staff. We recruited participants via email, telephone or recruitment flyers. Using individual interviews conducted via telephone or video call, we explored the experiences of people who were homeless during the pandemic, their interaction with shelter and health care settings, and related system challenges. We analyzed the data using reflexive thematic analysis.

RESULTS

Among 26 participants were 11 men experiencing homelessness (aged 28-68 yr), 9 health care workers (aged 33-59 yr), 4 health care leaders (aged 37-60 yr) and 2 shelter managers (aged 47-57 yr). We generated 3 main themes: navigating the unknown, wherein participants grappled with evolving public health guidelines that did not adequately account for homeless individuals; confronting placelessness, as people experiencing homelessness often had nowhere to go owing to public closures and lack of isolation options; and struggling with powerlessness, since people experiencing homelessness lacked agency in their placelessness, and health care and shelter workers lacked control in the care they could provide.

INTERPRETATION

Reduced shelter capacity, public closures and lack of isolation options during the COVID-19 pandemic exacerbated the displacement of people experiencing homelessness and led to moral distress among providers. Planning for future pandemics must account for the unique needs of those experiencing homelessness.

Listening to Parents of Children With Cancer—Between Life and its end

This study aimed to explore and provide an in-depth insight into the experience and perceptions of parents to children with cancer at the end of life (EOL). A sample of 15 parents of children (aged 2-18) with cancer participated in semi-structured interviews in an oncology department of an Israeli hospital. Data were analyzed using a phenomenological thematic analysis approach. The findings that emerged revealed: (a) the cultural aspect of the Israeli society of the importance of family and of the children within the family, (b) the parents’ unique way of coping, of holding a dual awareness, and (c) emphasizing that hope and support are necessary components for parents’ ability to cope with their child having terminal cancer, at the EOL. A number of important practical recommendations can be made for professionals treating child facing the EOL with cancer and their families. First, understanding the “double awareness” developed by parents of children facing with EOL cancer. Second, there is significance to bring the medical staff closer to the patient’s bed, which is to say, training medical staff in open communication on this subject. Third, it is recommended to construct intervention programs that would accompany the whole family and not just the parents. Fourth, there is some necessity to train healthcare teams working in pediatric oncology wards and providing palliative care, to teach them how to help people hold on hope and to evaluate hope in parents of children at the EOL.

"They Want You to Kill Your Inner Queer but Somehow Leave the Human Alive": Delineating the Impacts of Sexual Orientation and Gender Identity and Expression Change Efforts

Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to suppress the sexual and gender identities of Two-Spirit, lesbian, gay, bisexual, trans, and other queer (2SLGBTQ+) people. Exposure to SOGIECE is associated with significant psychosocial morbidity. Yet, there is a dearth of knowledge specifying the ways in which these psychosocial impacts are produced and experienced. This qualitative interpretive description study aimed to delineate the impacts of SOGIECE. To do so, we thematically analyzed data from in-depth interviews, conducted between January and July 2020, with 22 people with lived experience of SOGIECE. Study participants indicated that feelings of shame and brokenness related to their sexual and gender identities were deeply implicated in and shaped by experiences with SOGIECE. SOGIECE also had socially isolating effects, which had restricted participants' opportunities for meaningful connection with others, including romantic partners and 2SLGBTQ+ communities. Further, SOGIECE had contributed to experiences of profound emotional distress, mental illness (e.g., anxiety, depression), and suicidality. These findings underscore the need for several responsive policy and programmatic interventions, including legislation to prevent SOGIECE, enhanced sexuality- and gender-related educational efforts with the families and support persons of 2SLGBTQ+ people, and targeted mental health screening and supports for SOGIECE survivors.

Critical Research and Qualitative Methodologies: Theoretical Foundations and Contribution to Nursing Research

Background: Methodological approaches that draw on critical perspectives (critical ethnography, critical phenomenology, and critical grounded theory) share common concepts, including social justice, reflexivity, positionality, pragmatism and social transformation. These approaches differ from conventional phenomenology, ethnography and grounded theory despite sharing common methodological grounds.Purpose: In this article, we will outline the major contributions of critical theory, as a research paradigm, to the development and evolution of qualitative methodologies. In particular, we will discuss their application to nursing research. The historical and conceptual underpinnings of these critical methodologies will first be described to highlight their paradigmatic characteristics and implications for nursing.Implications for Practice: Although not yet widely employed in nursing research, critical qualitative methodologies are particularly well suited to the discipline as they shed light on issues of power, social control, and marginalization among the vulnerable populations with whom nurses practise on a daily basis. The use of critical approaches can expose the epistemic injustice and social and health inequality that continue to prevail in our society.

Needs assessment for health service design for people with back pain in a hospital setting: A qualitative study

BACKGROUND

There is a need for effective health service solutions to provide greater structure and support for implementing evidence-based practice in back pain care. Patient involvement in developing these solutions is crucial to increase relevance, acceptability and uptake.

OBJECTIVES

To determine patients' perceived needs and barriers to best-practice back pain care, and potential solutions to better address care needs. The study is the third in a series of needs assessment studies feeding into the 'idea generation' for service design in a large teaching hospital in a culturally and linguistically diverse community in metropolitan Sydney, Australia.

DESIGN

We conducted a combination of focus groups and in-depth interviews using an interpretive description approach. We used inductive thematic analysis to identify the main themes.

SETTING AND PARTICIPANTS

We purposively sampled patients with diverse characteristics from the neurosurgery and physiotherapy outpatient clinics, in particular those whose primary language was English, Arabic, Persian or Mandarin. Non-English audio recordings were translated and transcribed by bilingual researchers.

RESULTS

There were 24 participants (focus groups = 9; individual interviews = 15) when data saturation was reached. The analysis identified three key themes with several subthemes around what service designers needed to understand in helping people with back pain in this setting: (1) This is who I am; (2) It's not working for me; and (3) What I think I need.

DISCUSSION AND CONCLUSION

This study highlights that perceived unmet needs of patients are underpinned by unhelpful beliefs about the causes of and solutions for back pain, misaligned care expectations, unclear expectations of the hospital role and fragmentations in the health system. To design and implement a service that can deliver better back pain care, several solutions need to be integrated around: developing new resources that challenge unhelpful beliefs and set realistic expectations; improving access to education and self-management resources; focusing on individualized care; using a collaborative multidisciplinary approach within the hospital; and better connecting with and directing primary health care services.

PATIENT OR PUBLIC CONTRIBUTION

A consumer representative of the Western Sydney Local Health District provided input during study conceptualisation and is duly recognized in the Acknowledgements section.

Changemakers as digital makers: Connecting and co-creating

This paper presents data from two international projects focused on the interaction between changemaking and digital making in university students. The data is drawn from the contributions of 63 university students located in the United States, Romania, Spain, Belgium, Norway, Denmark and England. Using a design thinking methodology and a thematic analysis of student responses, the aim was to understand how the creative use of immersive technologies, such as augmented and virtual reality, might create an environment for changemaking practices in an international context. Findings suggest that students demonstrated not only enhanced digital skills and student engagement but increased cultural competence and global mindfulness. International digital collaboration can create conditions for students to develop changemaker attributes and identify as changemakers within the spheres of entrepreneurship and education, preparing them to be a force for change in the world.

What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System

PURPOSE

Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers' accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives.

DESIGN

Qualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically.

SETTING AND PARTICIPANTS

Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education-typically operations managers or process engineers. The latter group was represented by clinical staff-physicians and nurses-who received on-the-job training.

RESULTS

Three themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers.

CONCLUSIONS

We differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.

Communication skills learning through role models in Nepal; what are medical students really learning? A qualitative study

BACKGROUND

Communication skills (CS) are important and teachable, however, many Asian medical schools' curricula do not incorporate them. Patan Academy of Health Sciences in Nepal identifies CS within its' aims and curriculum. CS are taught from commencement of medical school and re-emphasised throughout preclinical learning (first 2 years). There is no explicit CS teaching in clinical years but placements allow students to learn through observation. These 'role-modelling' interactions form part of CS learning and development.

METHODS

This study is a qualitative evaluation of CS learning in PAHS, through participants' experiences. Through purposive sampling, twenty medical students from 2nd, 4th and Intern years were selected for inclusion. Data were collected via audio recorded, semi-structured interviews, employing a piloted schedule. Transcripts were manually coded and analysed thematically. Codes were organised into themes and subthemes. This paper discusses themes related to role-modelling.

RESULTS

The majority of participants described role-modelling in CS learning, recounting both positive and negative incidents, reflected in the themes of; Positive and Negative experiences. Subthemes of Personal Qualities and Inspiring, emerged from positive experiences, describing students' desire to imitate or aspire to be like their role models. Learners reported predominantly negative experiences and interns exclusively so. From these emerged subthemes of; Good doctors but.., Contradictory messages, How not to behave, Unprofessional behaviour and Affect-Emotional Distress. Learners received conflicting messages from observing behaviour contradictory to explicit CS teaching. Many identified learning "how not to behave" from such incidents, however, several described feeling distressed.

DISCUSSION

Role-modelling is a powerful and important CS learning tool, seen as positively reinforcing or negatively contradicting explicit CS teaching. Negative modelling created internal conflict, confusion and distress amongst learners, despite its' potential for positive learning. The worldwide problem of negative role-modelling is also prevalent in Nepal. Medical educators need to ensure the explicit curriculum aligns with implicit learning. Clinical tutors must be alerted to their powerful role-model position and supported in developing intentional modelling skills. Learners' reflections upon their experiences should be facilitated, enabling them to critically evaluate observations and hence consciously adopt or reject role-modelled behaviour and attitudes.

The Organic Turn: Coping With Pandemic and Non-pandemic Challenges by Integrating Evidence-, Theory-, Experience-, and Context-Based Knowledge in Advising Health Policy

The COVID-19 pandemic has posed an extraordinary challenge for public health and health policy. Questions have arisen concerning the main strategies to cope with this situation and the lessons to be learned from the pandemic. This conceptual paper aims to clarify these questions via sociological concepts. Regarding coping strategies used during the pandemic, there is a strong tendency for health policymakers to rely on expert knowledge rather than on evidence-based knowledge. This has caused the evidence-based healthcare community to respond to urgent demands for advice by rapidly processing new knowledge. Nonetheless, health policymakers still mainly rely on experts in making policy decisions. Our sociological analysis of this situation identified three lessons for coping with pandemic and non-pandemic health challenges: (1) the phenomenon of accelerating knowledge processing could be interpreted from the organizational innovation perspective as a shift from traditional mechanistic knowledge processing to more organic forms of knowledge processing. This can be described as an "organic turn." (2) The return of experts is part of this organic turn and shows that experts provide both evidence-based knowledge as well as theoretical, experiential, and contextual knowledge. (3) Experts can use theory to expeditiously provide advice at times when there is limited evidence available and to provide complexity-reducing orientation for decisionmakers at times where knowledge production leads to an overload of knowledge; thus, evidence-based knowledge should be complemented by theory-based knowledge in a structured two-way interaction to obtain the most comprehensive and valid recommendations for health policy.

Examining the cultural impacts of an emergency department move using ethnography

OBJECTIVE

The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space.

METHOD

Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews.

RESULTS

Over 720 h of participant observation and semi-structured interviews (n = 39) with emergency nurse, non-nurse clinicians, and unit administrators were collected and analyzed. One cross-cutting theme, "decisional power," and three supporting themes "inadequate move preparation," "change fatigue," and "lack of change standardization" were identified. "Decisional power" was the perceived influence certain ED groups had making move-related decisions over others. "Change fatigue" described the impact of frequent change implementation on participants' work processes, well-being, and job satisfaction. "Lack of change standardization" described power differentials between nurses striving to standardize new move-related processes and physicians implementing work styles discordant with such processes.

CONCLUSION

Findings can inform recommendations for health care policy and organizational operations such as: 1) including frontline stakeholder perspectives in move-related decisions; 2) allocating adequate time for clinician/employee training/education in the pre-move period; 3) assessing clinician/employee well-being throughout move implementation; 4) increasing unit administrator sensitivity to clinician change fatigue.

Introduction to Rivera's Gender Affirming Nursing Care Model: A Middle-Range Theory

Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera's Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice.

Enablers and barriers to implementing care quality improvement program in nursing homes in China

Objective

To explore the perspectives of key stakeholders on necessary factors to implement care quality improvement program.

Methods

We conducted qualitative descriptive research in eight nursing homes in four major prefecture-level cities of Changsha, Xiangtan, Zhuzhou, and Yueyang. Data of 50 clinical nurses and 64 nurse assistants were included and analyzed. Ethical approval was given by the medical ethics committee of Chinese Clinical Trial Registry (No. ChiCTR-IOC-17013109, https://www.chictr.org.cn/index.aspx). One-to-one interviews were used with the nursing managers, and separate focus group discussions were used with the clinical nurses and nurse assistants. All of the interviews were audio recorded and later transcribed verbatim. In addition, the first author documented the responses of every participant in the field notes during the interviews and focus groups.

Results

The participants’ perspectives were characterized by two main themes: (1) enablers, with four subthemes of “organizational support”, “the evidence-based practice ability”, “proactivity”, “nursing supervision and feedback;” and (2) barriers, with five sub-themes of “low educational background”, “the limitations of self-role orientation”, “resistance to change”, “lack of job motivation”, and “organizational constraints”.

Conclusion

These findings recognize factors at the organizational level, staff level and societal level that are necessary to implement effective mentoring. The results of this study can provide reference for nursing home in improving nursing management quality, formulating, implementing and revising training policies.

'The office of disaster management' nurse managers' experiences during COVID-19: A qualitative interview study using thematic analysis

AIM

The purpose of this study was to understand the experiences of nurse managers during the COVID-19 pandemic.

BACKGROUND

There is a growing body of knowledge about the experiences of clinical nurses during COVID-19. However, there is less evidence about the experiences of nurse managers during the pandemic.

METHODS

Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20-60 min. We used thematic analysis methods to analyse the interview transcripts.

FINDINGS

Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID-19.

CONCLUSION

Nurse managers' experiences during COVID-19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high-quality care despite working a difficult context.

IMPLICATIONS FOR NURSING MANAGEMENT

Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff.

What is nursing work? A meta-narrative review and integrated framework

BACKGROUND

There is ample evidence that modern nurses are under strain and that interventions to support the nursing workforce have not recognised the complexity inherent in nursing work. Creating a modern model of nursing work may assist nurses in developing workable solutions to professional problems. A new model may also foster cohesion among broad and diverse nursing roles.

AIM

The aim of this meta-narrative review was to investigate how researchers, using different methods and theoretical approaches, have contributed to the understanding of nursing work.

METHODS

A meta-narrative review was done to evaluate the trajectory of nursing work research, from 1953 to present. This review progressed through the stages of planning, searching, mapping, appraisal, and synthesis.

FINDINGS

A total of 121 articles were included in this meta-narrative review. These articles revealed five narratives of nursing work, where work is conceptualised as labour. These narratives were physical labour (n = 14), emotional (n = 53), cognitive (n = 24), and organisational (n = 1), and combinations of more than one type of labour (n = 29 articles). The paradigms identified in the meta-narrative were the positivist, interpretive, critical, and evidence-based paradigms. Each article in the review corresponded with a paradigm and a labour narrative, creating a comprehensive model.

CONCLUSIONS

Nursing work can be understood as a model of physical, emotional, cognitive, and organisational labour. These different types of labour may be hidden and taken for granted. Nurses can use this model to articulate what they do and how it supports patient safety. Nurses can also advocate for staffing allocations that consider all types of nursing labour. Tweetable abstract Nursing work is complex and includes physical, emotional, cognitive, and organisational labour. Staffing needs to take all nursing labour into account.

The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

INTRODUCTION

The global rise in the rate of induction of labor and cesarean birth shows considerable unexplained variation both within and between countries. Prior research suggests that the extent to which women are engaged in the decision-making process about birth options, such as elective cesarean, induction of labor, or use of fetal monitoring, is heavily influenced by clinician beliefs and preferences. The aim of this study was to investigate the beliefs about labor interventions and birth options held by midwives and obstetric medical staff from 8 Sydney hospitals and assess how the health care providers' beliefs were associated with discipline or years of experience.

METHODS

This is a survey study of midwives and obstetric staff that was distributed between November 2018 and July 2019. Modified from the previously validated birth attitudes survey for the Australian context, survey domains include (1) maternal choice and woman's role in birth, (2) safety by mode or place of birth, (3) attitudes toward cesarean birth for preventing urinary incontinence, (4) approaches to decrease cesarean birth rates, and (5) fears of birth mode. Responses were compared between professions and within professions by years of experience using Mann-Whitney U testing.

RESULTS

A total of 217 midwives and 58 medical staff completed the survey (response rate, 30.5%). Midwifery staff responses generally favored a physiologic approach to birth, versus beliefs more in favor of intervention (particularly cesarean birth) among medical staff. There was interprofessional discrepancy on most items, particularly regarding safety of mode or place of birth and approaches to decrease cesarean birth rates. Within disciplines, there was more variation in medical staff attitudes than within the midwifery staff. No clinically important differences in beliefs by years of experience were noted.

DISCUSSION

Clinicians need to be aware of their own beliefs and preferences about birth as a potential source of bias when counselling women, particularly when there are a range of treatment options and the evidence may not strongly favor one option over another. As both groups had similar perceptions about the importance of women's autonomy, shared decision-making training could help bridge belief gaps and improve care around birth decisions.

Embedded researchers in Australia: Survey of profile and experience across medical, nursing and midwifery and allied health disciplines

AIMS AND OBJECTIVES

This study explores embedded researcher's age, qualifications, research environment and experience in healthcare and academic organisations in Australia and makes comparisons across three core professional disciplines of nursing and midwifery, medicine and allied health.

BACKGROUND

The embedded researcher model, where a researcher is embedded as a core member of the clinical team, offers promise to support the implementation of research evidence into practice. Currently, there is a lack of clarity about how the model has been adopted across the three largest professional disciplines in Australian health care.

DESIGN

A cross-sectional survey was designed and reported, using the STROBE Statement.

METHODS

A purposive sample of embedded researchers was invited to participate in an exploratory online survey. Embedded researchers worked, or had worked, for a minimum of 30% of their time, in a healthcare organisation doing research or building research capacity. Participant responses were extracted from the survey and imported into SPSS for analysis.

RESULTS

Perspectives of 100 Australian embedded researchers were compared across nursing and midwifery (36%, n = 37), allied health (35%, n = 36) and medicine (26%, n = 27). Professional differences are reported in respondents' qualifications and experience, employment conditions and their research cultures and environments. Comparatively, most nursing and midwifery embedded researchers were older, more clinically experienced than allied health respondents, who were more research qualified. Medical-embedded researchers are typically older, more clinically experienced and focussed on producing personally relevant clinical research. Nursing and midwifery embedded researchers reported doing clinical research within their teams, as well as research capacity building, management and clinical practice roles.

CONCLUSIONS

Embedded researchers describe different career trajectories across the three largest professional disciplines in Australian health care.

RELEVANCE TO CLINICAL PRACTICE

Embedded researchers from different professional disciplines enact their work differently. It appears that when they engage in research capacity building via a range of management and networking roles, embedded researchers contribute to their organisation's research culture and receive greater recognition for their achievements.

Communication skills teaching and learning in Nepal; what are medical students' perceptions and experiences? A qualitative study

BACKGROUND

Communication skills (CS) are vital for doctors. Indeed, as the most important element of consultations, are highly valued by patients. CS are core, teachable skills, however, have not been widely taught in South Asian medical schools, unlike their western counterparts. Patan Academy of Health Sciences, is one of the first in Nepal to have CS central to its' aims and curriculum. CS are taught from the first weeks of medical school and re-enforced during preclinical study (first 2 years). Our study seeks to explore students' perceptions and experiences of CS teaching in this South Asian, Nepal context.

METHODS

This study is a qualitative evaluation of a CS course in Nepal, exploring the experiences and perceptions of participants. The study aims to also identify aspects that were helpful or not for student learning and areas for potential development. A purposive sample of twenty: second, fourth and Intern year students was selected for interview. Data were collected through audio recorded semi-structured interviews following a piloted schedule. Interview transcripts were manually coded and thematically analysed. Codes were arranged into themes and subthemes.

RESULTS

The two main themes: 1. Positivity 2. Experiential learning. Results demonstrate participants' positive perceptions of CS teaching: believing it is important, effective, relevant and valuable for personal development. Participants identified experiential learning features as valuable for CS acquisition. Intern students recognised CS relevance and requested expanding teaching to clinical years,incorporating challenging communication scenarios.

DISCUSSION

This study shows that PAHS' CS course is well perceived and valuable to learners. Experiential learning is powerful for CS development. Expansion of formal, structured CS teaching through all years in a spiral curriculum, should be considered. Violence towards doctors in South Asia is increasing. Students recognised CS teaching's significance in addressing this.

CONCLUSION

CS teaching,still in its' infancy in South Asia, is a pressing issue for medical educators here. Our study provides evidence it is well perceived with positive impacts in this context, particularly when employing experiential learning. Medical schools in south Asia should be encouraged to incorporate and strengthen their CS teaching curriculum. .

Methodological and ethical challenges while conducting qualitative research on spirituality and end of life in a Muslim context: a guide to novice researchers

Abstract Spirituality could be understood as a personal belief, a relation with sacred, divine experience, a sense of purpose and meaning towards life, authenticity and connectedness. It is a continually evolving, highly complex, contextual, subjective, and sensitive construct. A continuous development is seen around understanding about spirituality and spiritual concepts, such as spiritual experiences, spiritual pain and spiritual distress, especially among patients and families at the end of life. The concepts, values, attitudes, and beliefs around spirituality, spiritual needs and expressions vary among different individuals, cultures, and religions. There is a dearth of literature around spirituality, especially among Muslim patients and families at the end of life. The complexities around the concept of spirituality in the literature raise several ethical and methodological concerns for a novice researcher while planning and conducting a study on spirituality during end-of-life care in a hospice setting, especially among a Muslim population. This paper aims to share some of the methodological and ethical challenges that can be faced by qualitative researchers while conducting research around spirituality and end-of-life care in an Islamic/Muslim context. Major challenges include defining the term spirituality, spirituality and culture, communication, power relations, language and translation, recruitment and selection of the participants, emotional distress, and reflexivity and reciprocity. Having an in-depth understanding of these challenges can guide researchers to address these issues adequately in their spirituality research in a Muslim context.

Family caregivers' experiences of interaction with people with mild-to-moderate dementia in China: A qualitative study

Aim

This study aimed to explore the experiences of family caregivers interacting with people with dementia.

Background

A majority of people with mild‐to‐moderate dementia live at home with family caregivers. This interaction creates positive experiences and challenges for these caregivers.

Design

Descriptive phenomenological qualitative inquiry guided this study.

Methods

This qualitative study involved semi‐structured interviews with the caregivers of people with mild‐to‐moderate dementia (n = 10). Data were collected from June to September 2018, and then data were thematically analysed.

Results

Six categories of themes were identified from the interviews: (1) unexpected things often happen; (2) positive coping strategies; (3) sense of accomplishment because people with dementia actively participate in activities; (4) sense of frustration because of the reluctance of people with dementia to participate in activities; (5) hope for the happiness of people with dementia; and (6) want to have their own life.

Conclusions

This study reveals that caregivers could positively interact with people with dementia through creating opportunities and arranging meaningful activities. Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia.

What is already known about this topic?

A majority of people with mild‐to‐moderate dementia live at home with family caregivers.

Many caregivers suffer from depression, anxiety, fatigue, insomnia, family conflicts and low levels of life satisfaction.

How caregivers interact with people with dementia at home remains unclear.

What this paper adds?

Caregivers experience various feelings, such as a sense of accomplishment and occasionally frustration, when interacting with people with dementia.

Caregivers stated that they wanted people with dementia to be happy and live their life. Thus, the caregivers changed their attitude, accepted the situation and organized meaningful activities for people with dementia.

Caregivers employed various strategies for handling situations involving people with dementia and shared how they interacted with such individuals.

The implications of this paper:

Care organizations that can offer certain services for people with dementia should be developed to lessen caregivers' burden.

Community nurses should develop caregivers' strengths and enhance their abilities to improve interaction with people with dementia.

Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia.

Operationalist and inferentialist pragmatism: Implications for nursing knowledge development and practice

Philosophical inquiries in nursing are useful for analysing and critiquing existing practices, exploring contextual factors affecting practice, adapting to and sustaining ongoing changes in knowledge development, and facilitating the linkages between theory, research and practice. Nurse scholars used several philosophical schools of thought to guide knowledge development and practice. Pragmatism has been described as essential for bridging the theory-practice gap, for engaging in the inquiry-based practice and for translating knowledge into practice. The existing descriptions of pragmatism rely on rudimentary descriptions of "what works" and "inquiry-based action" aspects. However, the operationalist and inferentialist aspects of pragmatism and their worth for nursing knowledge development and practice are yet to be discussed. This paper explores the operationalist and inferentialist pragmatism and highlights the implications of these aspects for nursing knowledge development and practice. It has been argued that the dual aspect of pragmatism offers an approach to develop practical lines of action, evaluate actions in terms of their usefulness and assimilate already learned actions with the new actions. I suggested that moving beyond the rudimentary understanding of pragmatism and embracing and utilizing the dual aspect of pragmatism can bring more significant benefits for nursing. Embracing the dual aspect of pragmatism can enable nurses in developing philosophical reflexivity, emphasizing the experiential context of nursing, generating actionable and ready to use knowledge, and utilizing nursing theories to their fullest potential.

Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section

BACKGROUND

Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section.

AIM

To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation.

METHODS

A custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 "evidence-based" statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses.

FINDINGS

Total 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications "valid" compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age≥40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section.

DISCUSSION

Both inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines.

CONCLUSION

Greater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.

Phenomenology as a method applied to nursing science: research study

In a more inductive or deductive way, several theorists have problematized about nursing care in which they seek to clarify nursing science focus of attention. The phenomenological perspective allows us to perceive the human lived experience and unveil their meaningful understanding as a person. Stemming from the question 'What is the lived transition experience of the maternal role of women with problems of addiction to psychoactive substances, from pregnancy to the first year of the child's life?' This research distills the core principles of a qualitative research, with a phenomenological and interpretative design, with the objective of understanding the lived experience transition process of the maternal role of women with problems psychoactive substances addition. The research does not only reveal the contribution of phenomenological studies in the development of nursing science, but also enhances the living experience of women with addiction problems to psychoactive substances, during pregnancy, childbirth, postpartum and the first year of their children's life, enabling nurses to develop specific interventions to dealt with this problematic issue under study.

Postpositivism in Health Professions Education Scholarship

An understanding of the diversity of perspectives within the research paradigms of health professions education (HPE) is essential for rigorous research design and more purposeful engagement with the contributions of others. In this article, the authors explicitly discuss the underlying assumptions, notions of good scholarship, and shortcomings of the postpositivism research paradigm. While postpositivism is likely one of the more familiar paradigms within HPE research, it is rarely formally or explicitly described. Drawing on key literature and contemporary examples, the authors describe the ontology, epistemology, methodologies, axiology, signs of rigor, and common critiques of postpositivism. A case study provides the focus for a practical illustration of how a postpositivist approach to education research could be applied. Suggestions for further reading are provided for those who are keen to delve deeper into the history and key tenants of the postpositivist stance.

A Medical Science Educator's Guide to Selecting a Research Paradigm: Building a Basis for Better Research

A research paradigm, or set of common beliefs about research, should be a key facet of any research project. However, despite its importance, there is a paucity of general understanding in the medical sciences education community regarding what a research paradigm consists of and how to best construct one. With the move within medical sciences education towards greater methodological rigor, it is now more important than ever for all educators to understand simply how to better approach their research via paradigms. In this monograph, a simplified approach to selecting an appropriate research paradigm is outlined. Suggestions are based on broad literature, medical education sources, and the author's own experiences in solidifying and communicating their research paradigms. By assisting in detailing the philosophical underpinnings of individuals research approaches, this guide aims to help all researchers improve the rigor of their projects and improve upon overall understanding in research communication.

Registered Nurses' Experiences of Medication Errors-An Original Research Protocol: Methodology, Methods, and Ethics

BACKGROUND

The investigation of medication errors in nursing includes both methodological and ethical considerations because it is a sensitive field of research.

PURPOSE

To present an original research protocol for the investigation of nurses' experiences of medication errors with interpretative phenomenological analysis and the relevant methodological and ethical considerations.

METHODS

A discursive paper which presents an original research protocol about nurses' experiences of medication errors with interpretative phenomenological analysis followed by a literature review and personal reflections about the relevant methodological and ethical considerations. The review included papers published in English from 1990 to February 2019 on PubMed, BNI (British Nursing Index), CINAHL (Cumulative Index to Allied Health Literature), ScienceDirect, and Wiley Online Library.

RESULTS

The following methodological considerations were identified: recruitment of participants, data collection, and data analysis, and the ethical considerations included researcher's morality, ethics committees, sensitivity, phrasing of sentences and words, recruitment of participants, location of interviews, type of interviews, emotionality management, medication error incidents' management, researcher, or nurse?

CONCLUSION

By facing as many as possible methodological and ethical considerations and establishing solutions for them, the study's validity, reliability, and rigor are enhanced, and the study is ethically robust. Finally, their understanding enables researchers to uncover nurses' experiences and interpret the meanings they generate in depth.

The search for understanding: the role of paradigms

BACKGROUND

Kuhn's ( 1962 ) acknowledgement of a paradigm as a way that scientists make sense of their world and its reality gave recognition to the idea of 'paradigm shift'. This shift exposes the transience of paradigm development shaped by societal and scientific evolution. This ongoing evolutionary development provides the researcher with many paradigms to consider regarding how research is undertaken and the search for understanding achieved.

AIM

An understanding of paradigm development is necessary when planning a study and can shape the search for understanding. It is hoped that the discussion presented here will assist novice and experienced researchers in articulating the rationales for their paradigm choices.

DISCUSSION

An overview of the dominant paradigms is presented, reflecting ongoing paradigm development shaped by ontological, epistemological and methodological perspectives. Potential paradigm choices that shape research aims, objectives and focus in the search for understanding are considered.

CONCLUSION

The inherent debates about paradigm shift, division, war and synthesis leave the researcher many perspectives to consider. Articulating the world views underpinning constructivism, interpretivism and pragmatism is particularly challenging because of the blurring of boundaries between them.

IMPLICATIONS FOR PRACTICE

The evolutionary nature of paradigmatic development has provided nurse researchers with the opportunity for methodological openness to the myriad research approaches, methods and designs that they may choose to answer their research question. However, it is imperative that researchers consider their ontological stances and the nature of their research questions. This is challenging in constructivism, interpretivism and pragmatism, where there is often an overlap of paradigm world views.

De-implementation of tradition-based practices in critical care: A qualitative study

AIM

To explore the process of tradition-based practice (TBP) de-implementation by critical care nurses.

BACKGROUND

Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De-implementation (termination) of potentially harmful, ineffective, or non cost-effective TBP is necessary to facilitate evidence-based practice (EBP) in the clinical setting.

DESIGN

Descriptive qualitative inquiry guided this study.

METHODS

Twenty-two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis.

RESULTS

Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De-implementation processes and strategies appeared to replicate implementation processes.

CONCLUSION

More research is needed to evaluate de-implementation processes and strategies used for de-implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.

The State of Nursing Research in Ghana: An Integrative Literature Review

INTRODUCTION

For nursing practice to be responsive to the needs of patients, it must be driven by contextual research evidence. To guide institutional and national nursing research policy, there is need to determine the quantity and quality of nursing research in Ghana.

PURPOSE

The purpose of this integrative literature review was to quantify, critically evaluate, and describe nursing research publication in Ghana from January 2007 to December 2016 with regard to the country's research capacity to sustain evidence-based practice.

RESULTS

Sixty (60) out of 749 articles identified from EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar using three keywords (nursing, health, and Ghana) were included. A total of 60,778 human subjects were used in these studies. There were more quantitative (28) studies than qualitative (23) studies. These studies recorded 219 authors from 120 institutions, 55 of which were outside Ghana. Forty-five percent of the articles were published in journals with impact factor. There was a steady increase in publication in Ghana over the decade. A majority of the studies published in education were in curriculum implementation and evaluation.

CONCLUSIONS

The increasing number of peer-reviewed nursing research publications in Ghana and the curriculum implementation and evaluation in Ghana signified an increasing capacity of the country to implement and sustain evidence-based practice.

RECOMMENDATIONS

It is recommended that regular research be conducted to evaluate the responsiveness to old and new nursing programs in Ghana.

Elements of the socio-critical paradigm in nursing care practices: an integrative review

OBJECTIVE

Analyze the evidence available in Brazilian theses on the elements of the socio-critical paradigm in the construction of knowledge and practices of nursing care.

METHOD

An integrative literature review was carried out in the Theses Database of the Coordination for the Improvement of Higher Education Personnel and the Brazilian Digital Library of Theses and Dissertations.

RESULTS

Of a total of 320 theses, only 19 had elements of the socio-critical paradigm in their construction, among which the use of participatory investigations stand out (especially action-research), which present interaction between the researcher and the participants, the use of data collection techniques such as focus groups and culture circles, and theoretical frameworks for analyzing the phenomena in their complexity.

CONCLUSION

The support of the sociocritical paradigm attributes to nursing the character of a practical science and service to the community, being committed to social transformation by empowering people.

Employing a Qualitative Description Approach in Health Care Research

A qualitative description design is particularly relevant where information is required directly from those experiencing the phenomenon under investigation and where time and resources are limited. Nurses and midwives often have clinical questions suitable to a qualitative approach but little time to develop an exhaustive comprehension of qualitative methodological approaches. Qualitative description research is sometimes considered a less sophisticated approach for epistemological reasons. Another challenge when considering qualitative description design is differentiating qualitative description from other qualitative approaches. This article provides a systematic and robust journey through the philosophical, ontological, and epistemological perspectives, which evidences the purpose of qualitative description research. Methods and rigor issues underpinning qualitative description research are also appraised to provide the researcher with a systematic approach to conduct research utilizing this approach. The key attributes and value of qualitative description research in the health care professions will be highlighted with the aim of extending its usage.

Facilitating pragmatic skills through role-play in learners with language learning disability

BACKGROUND

Role-based learning involves the process whereby learners acquire skills, knowledge and understanding through the assumption of roles within real-life settings. Role-play holds potential as an effective learning strategy for children; however, there is limited research on the use of role-play as a therapy method within the field of speech-language pathology. Children with language learning disability (LLD) typically present with difficulties in social communication, which can negatively affect their social and academic achievement.

AIM

The aim of this study was to determine the effectiveness of role-play as a therapy approach targeting the pragmatic skills of stylistic variation and requesting for clarification in learners with LLD.

METHOD

The use of combined positivist and interpretivist paradigms allowed for the implementation of an embedded mixed methods design. An experimental pretest-posttest design was implemented. Eight participants, who were learners with a diagnosis of LLD, were purposefully selected. Data collection was conducted over five phases, utilising the Clinical Evaluation of Language Fundamentals (4th Ed.) Pragmatics Profile, discourse completion tasks, session plans and session records. Quantitative data were analysed using descriptive statistics and were supplemented by qualitative data from session records.

RESULTS

Results revealed improvements in stylistic variation and requesting for clarification post role-play intervention, with minimal changes in the control group. Limitations of the study have been reported for consideration when interpreting results.

CONCLUSION

Role-play as a therapy approach targeting two pragmatic skills, stylistic variation and requesting for clarification, was found to be beneficial for learners with LLD. Recommendations for the implementation of role-play as a therapy approach were made.

Emancipatory Nursing Praxis: A Theory of Social Justice in Nursing

Emancipatory nursing praxis (ENP) is a middle-range nursing theory of social justice developed from an international, grounded theory study of the critical factors influencing nurses' perceptions of their role in social justice. The ENPs implementing processes (becoming, awakening, engaging, and transforming) and 2 conditional contexts (relational and reflexive) provide an in-depth understanding of the transformative learning process that determines nurse engagement in social justice. Interpretive findings include the voice of Privilege primarily informed ENP theory, the lack of nursing educational and organizational support in social justice role development, and the advocate role should expand to include the role of an ally.

A qualitative study of community nurses' decision-making around the anticipatory prescribing of end-of-life medications

AIMS

The aim of this study was to explore community nurses' decision-making processes around the prescribing of anticipatory medications for people who are dying.

BACKGROUND

Community nurses frequently initiate the prescribing of anticipatory medications to help control symptoms in those who are dying. However, little is known about their decision-making processes in relation to when they instigate anticipatory prescribing and their discussions with families and General Practitioners.

DESIGN

A qualitative interpretive descriptive enquiry.

METHODS

A purposive sample of 11 Community Palliative Nurses and District Nurses working in one geographical area participated. Data were collected between March and June 2016 via audio recorded semi-structured interviews and analysed inductively using Braun and Clarke's thematic analysis.

RESULTS

Three themes were identified: (1) Drugs as a safety net. Anticipatory medications give nurses a sense of control in last days of life symptom management; (2) Reading the situation. The nurse judges when to introduce conversations around anticipatory medications, balancing the need for discussion with the dying person and their family's likely response; (3) Playing the game. The nurse owns the decision to initiate anticipatory medication prescribing and carefully negotiates with the General Practitioner.

CONCLUSION

Nurses view pain control through prescribed medication as key to symptom management for dying people. Consequently, they own the role of ascertaining when to initiate discussions with families about anticipatory medicines. Nurses believe they advocate for dying person and their families' needs and lead negotiations with General Practitioners for medications to go into the home. This nurse led care alters the traditional boundaries of the General Practitioners-nurse professional relationship.