Reimagining a nursing ecosystem in an uncertain world

The discussion paper synthesises the insights shared during a keynote panel at the 26th International Philosophy of Nursing Conference, themed "Reimagining a nursing ecosystem in an uncertain world." It delves into the substantial impact uncertainty has on nursing, offering innovative strategies for reconceptualization. Through a critical examination of evidence-based practice, the tendency to homogenise nursing is discussed, prompting advocacy for a Nietzschean political framework as a form of resistance and emancipation. Drawing inspiration from Donna Haraway, a transition from individualistic to relational approaches is needed, especially amidst social and economic instability. Furthermore, the integration of caritas and Indigenous epistemologies underscore the significance of cultural sensitivity in nursing. Meanwhile, Ubuntu philosophy champions empathy and collective values, while a convergence of Eastern and Western philosophical traditions promises to enrich nursing practice. Ultimately, the panellists advocate for overcoming rigid ideologies in favour of a pluralistic approaches, ontologies, epistemologies and ethics to address contemporary challenges, and signal for a philosophical reorientation to engage uncertainty and reshape nursing roles in an ever-evolving and world.

Responsibility Gap(s) Due to the Introduction of AI in Healthcare: An Ubuntu-Inspired Approach

Due to its enormous potential, artificial intelligence (AI) can transform healthcare on a seemingly infinite scale. However, as we continue to explore the immense potential of AI, it is vital to consider the ethical concerns associated with its development and deployment. One specific concern that has been flagged in the literature is the responsibility gap (RG) due to the introduction of AI in healthcare. When the use of an AI algorithm or system results in a negative outcome for a patient(s), to whom can or should responsibility for that outcome be assigned? Although the concept of the RG was introduced in Anglo-American and European philosophy, this paper aims to broaden the debate by providing an Ubuntu-inspired perspective on the RG. Ubuntu, deeply rooted in African philosophy, calls for collective responsibility, and offers a uniquely forward-looking approach to address the alleged RG caused by AI in healthcare. An Ubuntu-inspired perspective can serve as a valuable guide and tool when addressing the alleged RG. Incorporating Ubuntu into the AI ethics discourse can contribute to a more ethical and responsible integration of AI in healthcare.

What does the Thinking about Relationalism and Humanness in African Philosophy imply for Different Modes of Being Present in the Metaverse?

In this article, I interrogate whether the deployment and development of the Metaverse should take into account African values and modes of knowing to foster the uptake of this hyped technology in Africa. Specifically, I draw on the moral norms arising from the components of communal interactions and humanness in Afro-communitarianism to contend that the deployment of the Metaverse and its development ought to reflect core African moral values to foster its uptake in the region. To adequately align the Metaverse with African core values and thus foster its uptake among Africans, significant technological advancement that makes simulating genuine human experiences possible must occur. Additionally, it would be necessary for the developers and deployers to ensure that higher forms of spiritual activities can be had in the Metaverse to foster its uptake in Africa. Finally, I justify why the preceding points do not necessarily imply that the Metaverse will have a higher moral status than real life on the moral scale that can be grounded in Afro-communitarianism.

Human Caring Perspectives of Care Meanings and Expressions in a Nigerian Cancer Care Setting

BACKGROUND

Caring in Africa is often viewed from sociopolitical and humanity perspectives.

OBJECTIVE

The aim of this study was to investigate the meanings and expressions of caring from the narratives of persons living with cancer and their nurses.

METHODS

This study adopted a qualitative ethnonursing methodology. A purposive sampling technique was used to select the key participants, who were grouped into 7 nurses and 6 patients. General participants included 4 physicians, 3 ward assistants, and 6 patients' relatives. Interviews of participants were digitally audio-taped and then transcribed verbatim. Data analysis in this study followed the phases of ethnonursing data analysis enabler and was conducted using NVivo 14 software. Data categories were reviewed and sorted to discover recurrent patterns within the data.

RESULTS

Caring was seen as a social practice that is both transactional and transformational. Six thematic patterns emerged: restoring hope, reaching out to the inner lifeworlds of the patients, mutual empathy, going the extra mile, compassionate presence, and being human/having a sense of human connection. The study revealed that there are discernible patterns in care needs and expectations, even though each cancer patient is unique in his or her specific care needs and expectations.

CONCLUSION

Caring in this study constituted a variety of meanings, and human caring was demonstrated and practiced interpersonally. Hence, there is evidence of living caring in everyday life, in observable ways.

IMPLICATIONS FOR PRACTICE

Nurses should enhance both their own and the patient's sense of personal meaning in the caring partnership to enable them to be present in concrete unique nursing situations with the suffering human being.

Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis

INTRODUCTION

The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA).

METHODS

Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis.

RESULTS

5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care.

CONCLUSION

The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC.

TRIAL REGISTRATION

PROSPERO Registration number CRD42021238411.

The place of philosophy in nursing

Philosophy adds humanness to nursing and facilitates holistic care. Philosophies like Ubuntu which purports that a person is only a person through other people and emphasises community cohesion and caring for each other can add humanness to nursing. Because Ubuntu validates subjective experience and its meaning in the lifeworld, it exemplifies the basis of holistic and individualised caring in nursing. Although nurses can make their own philosophy through critical reflexivity, the convergent point is the goal of meaningful caring that is, sustaining health and the well-being of patients and significant others. Philosophy transcends job description, it encompasses visceral experience, personal beliefs and goals, resulting in purpose and deeper meaning to the nursing profession of caring as emulated by Florence Nightingale. While contemporary philosophy has been met with criticism as being detached from human concern, narrowly focussed and technical, it evokes critical thinking and promotes sociality in nursing practice. The Covid-19 pandemic vividly brought philosophy to the fore as nurses sacrificially and vulnerably rose to the challenge of caring not only for the sick, but also for families who through infection control measures were deprived of sociality. This paper argues that philosophy adds humanness and substance to nursing in the context of COVID-19.

as an Instrument to Foster Holistic Nursing: The Views of South African Student Nurses

Introduction: Ubuntu is an African philosophy that reflects holistic and comprehensive care among people in the community. Holistic nursing is a philosophy of caring that focuses on holistic healing and humanism. The purpose of the study was to explore the views of the South African final-year student nurses on the ability of Ubuntu to foster holistic nursing. Methods: An exploratory descriptive qualitative method was used. Eight focus group interviews were conducted with final-year student nurses at selected universities. Colaizzi seven steps process of data analysis was utilized. Results: One of the themes that emerged was that Ubuntu can be an instrument to foster holistic nursing Ubuntu and holistic nursing share many common attributes, hence, the teaching and learning of Ubuntu could foster the type of caring embodied by holistic nursing. Discussion: Ubuntu represents an important care philosophy that can foster holistic nursing, especially when the inner driving force of the nurses is primarily to care for patients.

Goal Orientation and Adolescent Social Competence: Ubuntu as a Mediator Among Black American Adolescents

Social competence, which is the ability to demonstrate socio-emotional behavior skills, is crucial during adolescence with far-reaching implications across the lifespan. However, social competence development among youth is greatly influenced by social inequities, which places many Black American youth at a disadvantage due to the disproportionate burden on youth development in resource-constrained environments. Responsively, we sought to determine whether Afrocentric cultural norms (i.e., Ubuntu) and goal orientation contribute to the resilience of Black youth in developing social competence while controlling for social positions (i.e., social class and gender). For this study, we used the dataset of black boys and girls (average age of 14.68) from the Templeton Flourishing Children Project. Linear regression analysis followed by mediation analysis was conducted to identify the factors associated with higher degrees of social competence. Significant study findings indicate that Black youth reporting higher goal-oriented mindsets reported higher social competence scores. Goal orientation and social competence were mediated by Ubuntu, with the model explaining 63% variance in social competence in Black youth. The findings suggest prevention efforts that provide socialization centered around Afrocentric cultural norms may provide valuable means of bolstering social competence development in Black youth living in resource-constrained communities.

'We were not allowed to gather even for Christmas.' Impact of COVID-19 on South African young people: Exploring messaging and support

COVID-19 prevention measures including lockdowns, school closures, and restricted movement disrupted young people's lives. This longitudinal qualitative study conducted in Soweto, South Africa aimed to explore young people's knowledge and perceptions of COVID-19, vaccination, and the impact of infections. A convenience sample of 30 young black people (n = 15 men; n = 15 women, aged 16-21 years) from Soweto participated in 24 focus group discussions (FGDs), conducted in six phases - each phase had four FGDs stratified by gender and age. Young people's understanding of COVID-19 deepened throughout the study, however, did not always translate into adherence (following the government's COVID-19 prevention measures). Although deemed inadequate, TV and radio were preferred over internet COVID-19 information. Parents, teachers, and schools were trusted sources of information. Vaccines and limited access to information attributed to low-risk perception, while new COVID-19 variants attributed to high-risk perception. A low-risk perception and conspiracy theories contributed to non-adherence (disregarding COVID-19 preventative measures provided by the government), particularly among young men. Accessing reliable information that considers young people's lives and their living context is important. Communities, scientists, and policymakers must learn from the COVID-19 experience and implement localised preventive strategies for education, awareness, and economic support in future emergencies.

Community Health Workers in Time of Crisis: A COVID-19 Case Study

This article focuses on the lived experiences of those implementing community health worker (CHW) programs during the COVID-19 pandemic. Based in an upper mid-west state, this qualitative case study is bounded by the state-level context and two distinct local case sites—one rural and one urban—and includes the experiences of five CHWs, two program directors, and a state-level administrator. The acute crisis response galvanized the ongoing need for CHWs, not only because they are trusted health messengers, but because they advocate for—and organize with—communities to address inequalities and inform public health institutions. Author-practitioners described personal and community identity as intertwined, a perspective in solidarity with decolonized approaches to humanistic psychology. Highlights discussed include: (a) Personal relationships motivated author-practitioners to join the pandemic response; (b) All pandemic response efforts were interconnected with social determinants of health; (c) The pandemic was as an opportunity to do things differently with more flexibility, personally and organizationally; and (d) Privately funded opportunities enabled local areas to implement quick responses, which influenced eventual state-level responses. All authors described structural racism as a constant context of this work. This article fills gaps in the literature related to the implementation of crisis responses and CHW programs.

COVID-19 and older people’s wellbeing in northern KwaZulu-Natal – the importance of relationships

Background: The COVID-19 pandemic and the non-pharmacological prevention methods have affected the wellbeing of older people.  In this paper we focus on the wellbeing, and vulnerability, of older people in rural northern KwaZulu-Natal, South Africa during the first year of the pandemic. Methods: We conducted a series of up to four monthly in-depth interviews with 26 people aged 60 years and older.  Interviews were conducted by telephone, because of restrictions on face-to-face contact, and digitally recorded.  After transcription and translation, the data were coded thematically, with analysis guided by a wellbeing theoretical framework. Results: Having access to food, to healthcare and to somewhere they felt safe to stay, was essential for everyone, but for many managing expenses became more of a struggle as adult children who had lost their source of employment came home to stay.  However, despite the shortages of money, the importance of relationships, whether they are familial or the close community of neighbours, was highlighted in the accounts from a number of participants. Older people not only got help with day-to-day life from others, but also found solace in the company of others. The sense of community, from family and neighbours, helped to ease some of the stress experienced as a result of the lockdowns. Conclusions: The COVID-19 pandemic and the restrictions imposed to limit the spread of the virus impacted the wellbeing of older adults in rural KwaZulu-Natal. Wellbeing for many older people has been nurtured by relationships with family and friends.

Risk communication and community engagement during COVID-19

In today's information age, both excess and lack of information can cause a disaster. COVID-19 pandemic not only highlighted the significance of risk communication but also pointed out several unintended and distressing consequences due to information gaps and miscommunications. Despite facing a common threat, the local communities suffered differential impacts during the pandemic. This paper classifies the nature of risk communications experienced across different countries into three categories, namely: inadequate, ideal, and infodemic risk communication that influenced the local perceptions and responses. It further argues that inadequately planned risk communications tend to create new risks and compromise the efforts towards managing a disaster. As global risks are responded locally, there is a need for more inclusive and engaging risk communication that involves communities as responsible stakeholders who understand, plan, and respond to risks to increase their propensity for resilience during disasters and crisis situations.