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Dufour E, Duhoux A. How can strategies based on performance measurement and feedback support changes in nursing practice? A theoretical reflection drawing on Habermas' social perspective. Nurs Inq 2024; 31:e12628. [PMID: 38409735 DOI: 10.1111/nin.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.
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Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
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Mingo SR, Wolf ZR. Academic program enhancement supporting the success of undergraduate nursing students and graduates. J Prof Nurs 2024; 53:8-15. [PMID: 38997202 DOI: 10.1016/j.profnurs.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 07/14/2024]
Abstract
Nursing program administrators, faculty, academic success coaches, and remediation specialists have implemented many interventions in support of baccalaureate nursing students' retention and graduates' NCLEX-RN® first-time pass rates. A private university's undergraduate nursing program's team incorporated additional evidence-based interventions aimed improving students' achievement of benchmarks following a 3-year decline in NCLEX-RN pass rates. Interventions expanded the prelicensure academic program's activities using a continuous quality improvement approach. A simulation center was constructed and a director was hired. A consultant also facilitated faculty engagement in curricular revisions. A new position, coordinator tutor/remediation specialist, was filled and the academic success coach launched interventions that complemented an initial and subsequent strategies for success initiative. New interventions were trialed and evaluated and became integral to students' and graduates' success. The academic success coach's commitment to students' achievements promoted their engagement in interventions. Pass rates increased and were sustained. Examples of interventions, supported by evidence, are presented in tables for review. A logic model depicts components of the program plan and its interventions as augmented by prospective strategies and remediation interventions. Continuous quality improvement processes will continue. Students and graduates have commented positively on the benefits of the assorted, success-promoting interventions.
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Affiliation(s)
- Sharon R Mingo
- School of Nursing and Health Sciences, La Salle University, 1900 West Olney Avenue, Philadelphia, PA 19141, USA.
| | - Zane Robinson Wolf
- School of Nursing and Health Sciences, La Salle University, 1900 West Olney Avenue, Philadelphia, PA 19141, USA.
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3
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O'Malley M, O'Mahony J, Happell B, Mulcahy H. The nurse bombarded, consumed and vulnerable: An interpretative phenomenological analysis of mental health nurses' self-care at work. J Psychiatr Ment Health Nurs 2024; 31:66-76. [PMID: 37534379 DOI: 10.1111/jpm.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/16/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Self-care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self-care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self-care practices is essential. There is currently a paucity of literature on this topic. AIM To explore mental health nurses' views about what influences their ability to self-care in relation to workplace stress and the impact on their practice and work environment. METHODS An Interpretative Phenomenological Analysis approach was utilized. In-depth interviews explored how nurses perceived the influence of environment and relationships on self-care practices in the workplace. RESULTS Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes-the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care. CONCLUSIONS Stressful working environments pose major barriers to effective self-care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally. IMPLICATIONS FOR PRACTICE Mental health nurses' self-care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self-care are therefore necessary.
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Affiliation(s)
- Maria O'Malley
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - James O'Mahony
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Brenda Happell
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
- Faculty of Health, Southern Cross University, East Lismore, New South Wales, Australia
| | - Helen Mulcahy
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Betriana F, Promnoi C, Nilmanat K. Aesthetic Expression as a Means to Nurture "Self" in a Basic Nursing Care Practicum. Nurs Educ Perspect 2024:00024776-990000000-00204. [PMID: 38227625 DOI: 10.1097/01.nep.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
ABSTRACT Nursing students develop their professional "self" through clinical placement experiences. Aesthetic expression can be used as a means to reflect students' personal knowing and to convey self as nurtured during their clinical journey. In a postconference session of the Basic Nursing Care Practicum course, six students were asked to draw pictures reflecting their clinical experience and then share their stories. It appeared that nursing students learned the meaning of nursing and caring, and through these meanings, their actual self as nurses was also developed.
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Affiliation(s)
- Feni Betriana
- About the Authors The authors are faculty at Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand. Feni Betriana, PhD, RN, is a lecturer. Chantra Promnoi, PhD, RN, is an assistant professor. Kittikorn Nilmanat, PhD, RN, is an associate professor. For more information, contact Dr. Betriana at
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Bergdahl E, Berterö CM. Creating theory: Encouragement for using creativity and deduction in qualitative nursing research. Nurs Philos 2023; 24:e12421. [PMID: 36846926 DOI: 10.1111/nup.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
Texts about theory in nursing often refer to theory construction by using inductive methods in a rigid way. In this paper, it is instead argued that theories are created, which is in line with most philosophers of science. Theory creation is regarded as a creative process that does not follow a specific method or logic. As in any creative endeavour, the inspiration for theory creation can come from many sources, including previous research and existing theory. The main idea put forward is that deductive qualitative research approaches should play a key role in theory creation. Furthermore, there is a need to differentiate between theory creation and theory justification. A model that emphasizes the creative aspects of theory creation and theory justification using qualitative approaches is presented. The model suggests that knowledge development is a deductive trial-and-error process where theory creation is followed by testing. Scientific theory creation and justification are presented as an iterative process that is deductive in that a testable hypothesis is derived from the theory. If the hypothesis is falsified, then the theory needs modification or might be altogether wrong. Several factors can block the creative process, both in theory development and in finding ways to test a theory in the justification phase. Some of these blockers are the idea of 'building blocks' and the inductive view of science often brought forward in nursing. Other blockers include striving for consensus and adherence to existing nursing philosophies and existing theories. Research and knowledge development are creative processes, and following predefined methods is not enough to ensure scientific rigour in qualitative nursing research.
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Affiliation(s)
| | - Carina M Berterö
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Bifarin O, Felton A, Prince Z. Defensive practices in mental health nursing: Professionalism and poignant tensions. Int J Ment Health Nurs 2022; 31:743-751. [PMID: 34564941 DOI: 10.1111/inm.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
Mental health nursing is a skilled profession, well positioned to support patients towards recovery with evidence-based therapeutic interventions. However, the profession continues to be challenged by tensions surrounding the delivery of restrictive interventions and concerns over tendencies towards defensive practices. This paper examines the ambiguity this creates within the mental health nursing role. Organizational cultures that overvalue metrics and administrative tasks create barriers for therapeutic engagement while contributing to role confusion and stress within nursing. We need to address such structural constraints on nurses as mental health nurses' well-being is crucial to service delivery and the realization of therapeutic goals. From the UK perspective, authors argue that there is a need to examine service structures that foster compassionate and transformational leadership to enable mental health nurses to exercise the agency to practice therapeutically. Education and quality nursing research have a pivotal role to play in enabling this shift.
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Affiliation(s)
- Oladayo Bifarin
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK.,Local Service Division, Risk and Governance Department, Mersey Care NHS FT, Liverpool, UK
| | - Anne Felton
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, UK
| | - Zoe Prince
- Associate Director of Nursing and Patient Experience, Local Service Division, Mersey Care NHS FT, Liverpool, UK
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Kim KS, Lor M. Art Making as a Health Intervention: Concept Analysis and Implications for Nursing Interventions. ANS Adv Nurs Sci 2022; 45:155-169. [PMID: 35020607 PMCID: PMC9064896 DOI: 10.1097/ans.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Art making has been adopted across multiple disciplines as a health intervention. However, our understanding of art making as a health intervention and how it differs from art therapy is still limited. Therefore, we conducted a concept analysis to better understand art making as a health intervention guided by Walker and Avant's approach. We examined 85 studies in which we found 4 defining attributes, 4 antecedents, and physical, cognitive, emotional, and psychological consequences. We suggest several nursing research and practical implications for nurse researchers and clinicians to aid in designing and implementing art making health interventions.
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Affiliation(s)
- Kyung Soo Kim
- University of Iowa College of Nursing, Iowa City (Dr Kim); and University of Wisconsin-Madison School of Nursing, Madison (Dr Lor)
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Sandvik AH, Hilli Y. Understanding and formation-A process of becoming a nurse. Nurs Philos 2022; 24:e12387. [PMID: 35324066 PMCID: PMC10078249 DOI: 10.1111/nup.12387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/04/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this 'understanding' in clinical education is and how it is promoted in clinical nursing education becomes important to clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third-year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding-based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding-based, interpretative education in nursing.
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Affiliation(s)
- Ann-Helén Sandvik
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden, UK.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Yvonne Hilli
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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Blaine Brown B, Dillard-Wright J, Hopkins-Walsh J, Littzen COR, Vo T. Patterns of Knowing and Being in the COVIDicene: An Epistemological and Ontological Reckoning for Posthumans. ANS Adv Nurs Sci 2022; 45:3-21. [PMID: 34225286 PMCID: PMC8757485 DOI: 10.1097/ans.0000000000000387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The crucible of the COVIDicene distills critical issues for nursing knowledge as we navigate our dystopian present while unpacking our oppressive past and reimagining a radical future. Using Barbara Carper's patterns of knowing as a jumping-off point, the authors instigate provocations around traditional disciplinary theorizing for how to value, ground, develop, and position knowledge as nurses. The pandemic has presented nurses with opportunities to shift toward creating a more inclusive and just epistemology. Moving forward, we propose an unfettering of the patterns of knowing, centering emancipatory knowing, ultimately resulting in liberating the patterns from siloization, cocreating justice for praxis.
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Affiliation(s)
- Brandon Blaine Brown
- College of Nursing and Health Sciences, University of Vermont, Burlington (Blaine Brown); Department of Physiological and Technological Nursing, Augusta University College of Nursing, Augusta, Georgia (Dr Dillard-Wright); Connell School of Nursing Boston College, Chestnut Hill, Massachusetts (Hopkins-Walsh); College of Nursing, The University of Arizona, Tucson (Littzen); School of Nursing, The University of Portland, Olympia, Washington (Littzen); and School of Nursing, University of Connecticut, Storrs (Vo)
| | - Jessica Dillard-Wright
- College of Nursing and Health Sciences, University of Vermont, Burlington (Blaine Brown); Department of Physiological and Technological Nursing, Augusta University College of Nursing, Augusta, Georgia (Dr Dillard-Wright); Connell School of Nursing Boston College, Chestnut Hill, Massachusetts (Hopkins-Walsh); College of Nursing, The University of Arizona, Tucson (Littzen); School of Nursing, The University of Portland, Olympia, Washington (Littzen); and School of Nursing, University of Connecticut, Storrs (Vo)
| | - Jane Hopkins-Walsh
- College of Nursing and Health Sciences, University of Vermont, Burlington (Blaine Brown); Department of Physiological and Technological Nursing, Augusta University College of Nursing, Augusta, Georgia (Dr Dillard-Wright); Connell School of Nursing Boston College, Chestnut Hill, Massachusetts (Hopkins-Walsh); College of Nursing, The University of Arizona, Tucson (Littzen); School of Nursing, The University of Portland, Olympia, Washington (Littzen); and School of Nursing, University of Connecticut, Storrs (Vo)
| | - Chloe O. R. Littzen
- College of Nursing and Health Sciences, University of Vermont, Burlington (Blaine Brown); Department of Physiological and Technological Nursing, Augusta University College of Nursing, Augusta, Georgia (Dr Dillard-Wright); Connell School of Nursing Boston College, Chestnut Hill, Massachusetts (Hopkins-Walsh); College of Nursing, The University of Arizona, Tucson (Littzen); School of Nursing, The University of Portland, Olympia, Washington (Littzen); and School of Nursing, University of Connecticut, Storrs (Vo)
| | - Timothea Vo
- College of Nursing and Health Sciences, University of Vermont, Burlington (Blaine Brown); Department of Physiological and Technological Nursing, Augusta University College of Nursing, Augusta, Georgia (Dr Dillard-Wright); Connell School of Nursing Boston College, Chestnut Hill, Massachusetts (Hopkins-Walsh); College of Nursing, The University of Arizona, Tucson (Littzen); School of Nursing, The University of Portland, Olympia, Washington (Littzen); and School of Nursing, University of Connecticut, Storrs (Vo)
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Lippe M, Eyer JC, Rosa WE, McKinney R, Patterson B, Matteo RA, Townsend H, Halli-Tierney A. Caring for an Unconscious Transgender Patient at the End of Life: Ethical Considerations and Implications. J Hosp Palliat Nurs 2021; 23:300-308. [PMID: 33901059 PMCID: PMC8568014 DOI: 10.1097/njh.0000000000000765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals who identify as transgender (trans) or other gender-diverse identities are highly marginalized populations within the United States health care system. Transgender individuals experience a broad range of health disparities leading to devastating health outcomes. Experiences with discrimination and biased care often result in a lack of trust in providers and reduced care seeking, yet providers frequently rely on communication with trans patients to build competence. Consequently, when a trans patient has restricted communication, whether due to biological or psychological reasons, their care can be further disrupted. The nursing code of ethics compels the provision of competent care to all patients, regardless of demographics or gender identity, including individuals with serious illness and injury. This article describes an approach to the provision of affirmative, trans-inclusive care in a palliative nursing context that integrates cultural humility and self-reflection into an established patient care framework. The approach is then applied to identify ethical dilemmas present in the case of a trans patient who arrived at a hospital in an unconscious state following serious injury. Nurses' use of the ethical approach when caring for seriously ill trans patients would represent important progress toward fostering a health care system that provides affirmative, trans-inclusive care.
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Kowalski CJ, Redman RW, Mrdjenovich AJ. The transition from inquiry to evidence to actionable clinical knowledge: A proposed roadmap. J Eval Clin Pract 2021; 27:667-676. [PMID: 33755289 DOI: 10.1111/jep.13562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way". The result will be an increased appreciation for the meaning and structure of "actionable clinical knowledge". METHODS We review the literature to identify pertinent works dealing with evidence production and translation into actionable clinical knowledge. We draw from insights in this literature about various aspects of reasoning relevant to clinical questions and integrate these into a unified approach to the processes that lead to actionable clinical knowledge. RESULTS We collect, collate, and integrate some of the work by Bauer, Carper, Goldman, Haack, McHugh and Walker, and Upshur and colleagues and obtain guidelines to aid in the evidence-to-actionable-clinical- knowledge transition. CONCLUSIONS Clinical decision-making is not infallible, and the steps we can take to minimize error are context dependent. Medical evidence, produced as it is by human effort, can never be perfect. We will be doing well by assuring that the evidence we use has been produced by a reliable process and is relevant to the question posed.
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Affiliation(s)
- Charles J Kowalski
- Health and Behavioral Sciences IRB, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard W Redman
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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Thorne S. Rethinking Carper's personal knowing for 21st century nursing. Nurs Philos 2020; 21:e12307. [PMID: 32567117 PMCID: PMC7583479 DOI: 10.1111/nup.12307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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