Advancing nursing practice: an evaluation study of Parse's theory of human becoming

Let’s Get Real about Person- and Family-Centred Geriatric Home Care: A Realist Synthesis

Cette étude a examiné les mécanismes complexes intervenant lors de la prestation de soins axés sur la personne et la famille (SAPF) par des équipes de soins gériatriques à domicile. Une approche par synthèse réaliste a été utilisée pour élaborer un cadre d’évaluation qui a inclus 159 références provenant de la littérature scientifique, des consultations d’experts canadiens en SAPF, des recherches ciblées dans les bases PubMed/MEDLINE® et CINAHL, et des recensions de la littérature grise canadienne. Les références ont été sélectionnées par deux personnes, selon une approche consensuelle avec évaluation de la qualité. Les données ont été extraites et synthétisées en tenant compte du contexte, des mécanismes et des configurations des résultats dans un cadre théorique de SAPF d’équipe pour les soins gériatriques à domicile. Le cadre présente les contributions spécifiques prédominantes des infirmières, des ergothérapeutes et des physiothérapeutes, leurs apports collectifs impliquant des communications pour des équipes virtuelles, ainsi que le soutien du système nécessité pour la prestation de SAPF d’équipe complets. Les résultats de cette étude pourraient contribuer à l’amélioration de l’éducation sur les SAPF et des lignes directrices sur les pratiques exemplaires, en vue d’assurer une prestation plus intégrée des SAPF dans les soins gériatriques offerts à domicile ou dans d’autres milieux comportant des équipes de soins.

Review of Research Related to Parse's Theory of Human Becoming

Ninety-three retrievable studies guided by the human becoming theory between 1985 and 2006, are reviewed. A summary of the studies is tabulated according to the two basic human becoming research methods, the human becoming applied research method, and other qualitative research methods using human becoming as the frame of reference. The authors provide an overview of the studies and the human becoming research methods and further illuminate the findings of studies reviewed under four major themes that describe the phenomena studied.

Human Becoming and 80/20: An Innovative Professional Development Model for Nurses

The authors describe a study that evaluated implementation of a professional development model in which nurses spend 80% of their salaried time in direct patient care and 20% of their salaried time on professional development. The professional development time includes focused learning about patient-centered practice guided by the human becoming nursing theory. A qualitative descriptive preproject-process-postproject method and a longitudinal, repeated measures, descriptive-comparative method were used to answer the research questions. Participants were 33 nurses, 11 other nurse leaders and health professionals, and 55 patients and family members. The findings show that on the study unit overtime hours decreased significantly, the education hours were sustained throughout the study period, workload hours per patient day increased significantly, sick time stayed low, patient satisfaction scores increased, staff satisfaction scores were significantly higher than for comparator groups, and turnover was non-existent among study participants in year 2. Average variable direct labor cost increased over time, but the increase was not significantly higher than on the control units. Themes from the interviews with participants are presented. Ongoing evaluation of the model and implications for future research are discussed.

Research Issues

In this column the author synthesizes and discusses the findings of six studies conducted to examine what happens for nurses and patients when human becoming is the guide for practice. In all of the studies, nurse participants’ descriptions led to three main themes: transforming intent, unburdening joy, and struggling with change. Patient and family participants’ descriptions of nursing care guided by human becoming are also summarized. This column concludes with a presentation of the universal and overarching values for knowledge development in nursing that emerged with the synthesis of the findings and that have the potential to ensure personalized, meaningful, and dignified nursing service delivery.

The integration of a person-centered approach in palliative care

OBJECTIVE

The philosophy underlying palliative care places the respect of patients and their autonomy at the heart of clinical practice. A study was conducted at a palliative care facility to document changes that occurred after the integration of a person-centered approach focusing on human freedom (which is linked to autonomy): the humanbecoming school of thought. It aimed to describe changes observed in the beliefs and practices of healthcare providers, the concept and respect of autonomy by healthcare providers, care and respect of autonomy experienced by patients' relatives, and consideration of patients' wishes through their documentation.

METHOD

The method adopted consisted of a pre-project - process - post-project descriptive qualitative design and was inspired by teaching-learning and mentoring models. Data were collected from 51 healthcare providers and 10 relatives through semistructured interviews and from the medical records of 30 patients during the pre- and post-project phases. They were analyzed and compared at the end of the study. The process phase consisted of offering training sessions and mentoring, encouraging the involvement of healthcare providers, and cocreating integration and care tools.

RESULTS

While the analysis exposed some discrepancies with the language of the approach and differences between nurses and other healthcare providers, it revealed, above all, similarities in the changes observed between the different sources of data. The focus moved from being task-centered to being person-centered; the affirmation of the priority of respecting patients' choices, desires, and needs; a presence shifting from being available to true listening; the affirmation of following the ever-changing rhythm of the patient; and a notion of respect of autonomy now including the other.

SIGNIFICANCE OF RESULTS

In line with the philosophy of palliative care, the project demonstrated that the integration of the humanbecoming approach can result in changes that contribute to the development of a more person-centered practice.

Applying interdisciplinary theory in the care of Aboriginal women's mental health

This paper describes theories from various disciplines that are useful in conceptualizing and reflecting on the mental health of Aboriginal women. Critical social theory (sociology), Parse's human becoming theory (nursing) and ecological systems theory (developmental psychology) are considered valuable theories that aid in nursing praxis. These papers discuss how these different theoretical approaches are beneficial for achieving different goals and therefore provide important foundational underpinnings to challenging traditional assumptions that effect human behaviour and practice.

Parallels in practice: palliative nursing practice and Parse's theory of human becoming

Nurses experienced in the art and science of palliative nursing will find many elements of congruence between the principles and philosophy of palliative practice and the theory of human becoming. In this brief exploration of parallels in practice between Parse's theory of human becoming and traditional palliative and hospice nursing practice, the author suggests that the theory of human becoming is consistent and consonant with the values that shape palliative nursing practice. The theory is briefly described, and four parallels of practice are identifed: whole person care; the presence of paradox in human experience; primacy of the person; and presence and dialogue, or "being with, " dying persons. The theory of human becoming holds relevance and promise in its capacity to provide palliative and hospice nurses with a theoretical framework with which to inform and guide nursing practice with dying persons.