Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings

Background

Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities.

Methods

The United Nations Children’s Fund (UNICEF) led Communities Care program is a primary prevention and response program designed from the understanding that within the context of conflict and displacement, there is an opportunity for positive change in social norms that support gender equity, and decrease GBV. The goal is to support communities in humanitarian settings to create healthy, safe and peaceful environments with quality response services for women and girls by transforming harmful social norms that uphold violence into norms that promote dignity, equity, and non-violence.

Conclusion

This manuscript will highlight the use of best practices in GBV research to rigorously evaluate the Communities Care program in two diverse in humanitarian settings, Somalia and South Sudan.

Sacred Journeys of Nurse Healers

This article reports on a hermeneutic phenomenological investigation of the transformational and extraordinary experiences, or sacred journeys, of 11 nurse healers. The study was guided by Watson’s conceptual model. An overarching theme, “walking two worlds,” was identified, along with five essential themes: belonging and connecting, opening to spirit, summoning, wounding and healing journey, and living as a healer. The importance of these phenomenologically uncovered holistic understandings to the teaching, practice, administration, knowledge development, and theoretical evolvement of nursing is argued.

Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings

Background

Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia.

Results

The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool.

Conclusion

The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.

An exploration of emotional protection and regulation in nurse-patient interactions: The role of the professional face and the emotional mirror

INTRODUCTION

While interpersonal styles of nurse-patient communication have become more relaxed in recent years, nurses remain challenged in emotional engagement with patients and other health professionals. In order to preserve a professional distance in patient care delivery however slight, nurses need to be able to regulate their emotions.

AIM

This research aimed to investigate nurses' perceptions of emotional protection and regulation in patient care delivery.

METHODS

A qualitative approach was used for the study utilising in-depth semi-structured interviews and researcher reflective journaling. Participants were drawn from rural New South Wales. Following institutional ethics approval 5 nurses were interviewed and reflective journaling commenced. The interviews and the reflective journal were transcribed verbatim.

RESULTS

The results revealed that nurses' emotional regulation demonstrated by a 'professional face' was an important strategy to enable delivery of quality care even though it resulted in emotional containment. Such regulation was a protective mechanism employed to look after self and was critical in situations of emotional dissonance. The results also found that nurses experience emotional dissonance in situations where they have unresolved personal emotional issues and the latter was a individual motivator to manage emotions in the workplace.

CONCLUSION

Emotions play a pivotal role within nurse-patient relationships. The professional face can be recognised as contributing to emotional health and therefore maintaining the emotional health of nurses in practice. This study foregrounds the importance of regulating emotions and nurturing nurses' emotional health in contemporary practice.

Stoichiometric control of live cell mixing to enable fluidically-encoded co-culture models in perfused microbioreactor arrays

A cell mixer microbioreactor array platform that permits the rapid establishment of perfused cell co-culture models in a high-throughput, programmable fashion.

Care in the home for seriously ill children with complex needs: A narrative literature review

This article reviews contemporary literature on home care of the seriously ill child with complex care needs and the sick child/parent dyad. The literature search revealed three major themes, namely the increasing acuity of child illness, the evolving role of the parent as care provider, and the health professional as care provider. While there is much known about the complexity of care of children and the role of family in that care, little is known about what families require in terms of support and sustenance during the long years of care provision.

Moments of speaking and silencing: Nurses share their experiences of manual handling in healthcare

Nursing care involves complex patient handling tasks, resulting in high musculoskeletal injury rates. Epidemiological studies from the 1980s estimated a lifetime prevalence of lower back injuries for nurses between 35 and 80%. National and international studies continue to mirror these findings. Despite the development of programs intended to reduce manual handling injuries, sustainable solutions remain elusive. This paper reports on a study of nurses speaking about their perspectives on current manual handling practices. Qualitative research conducted in 2012 investigated nurses' perceptions and experiences relating to manual handling in the healthcare context and their participation in injury prevention programs. There were two research methods: semi-structured interviews and researcher reflective journaling. The research was framed in critical emancipatory methodology. Thirteen nurses from two Australian states participated in the study. Thematic analysis revealed an overarching theme of 'power relations' with a subcategory of '(mis)power' that comprised two subthemes, these being 'how to practice' and 'voicing practice issues'. Specifically, this paper explores nurses verbalising their views in the workplace and responses which left them feeling silenced, punished and disillusioned. The findings suggest that the sociopolitical context within which nurses practice impacts upon their ability to voice concerns or ideas related to manual handling. Inclusion of nurses in the manual handling dialogue may generate an expanded understanding of, and the potential to transform, manual handling practices in healthcare environments.

Ethnicity and patient satisfaction with tuberculosis care: A cross-sectional study

Patients presenting in major tuberculosis (TB) centres in two Australian metropolitan hospitals and three central hospitals in Malawi were interviewed for health and other information, including their satisfaction with nursing care. The main objective of the study was to investigate differences in satisfaction rates among ethnically similar and different patients coming from two dissimilar health systems. A multivariable Generalized Estimating Equations model was constructed to identify sociodemographic and health-related factors associated with dissatisfaction, while focusing on ethnic differences between and within each country. The Australian and Malawian patients were similar in age, gender, marital status, and employment. However, the Malawians were mostly inpatients, with recurrent TB episodes, and were more seriously ill with impaired physical and mental wellbeing. Nonetheless, being Australian was more associated with dissatisfaction observed in all components of care. However, Australian ethnic minorities were less dissatisfied than their Anglo-Saxon or European counterparts, being more similar to Malawian patients irrespective of the health care provided. Our study suggests that patients coming from similar ethnic backgrounds may express similar satisfaction irrespective of the health system they belong to.

Examining sex differences in knee pain: the multicenter osteoarthritis study

OBJECTIVE

To determine whether women experience greater knee pain severity than men at equivalent levels of radiographic knee osteoarthritis (OA).

DESIGN AND METHODS

A cross-sectional analysis of 2712 individuals (60% women) without knee replacement or a recent steroid injection. Sex differences in pain severity at each Kellgren-Lawrence (KL) grade were assessed by knee using visual analog scale (VAS) scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) with and without adjustment for age, analgesic use, Body mass index (BMI), clinic site, comorbid conditions, depression score, education, race, and widespread pain (WSP) using generalized estimating equations. Effect sizes (Cohen's d) were also calculated. Analyses were repeated in those with and without patellofemoral OA (PFOA).

RESULTS

Women reported higher VAS pain at all KL grades in unadjusted analyses (d = 0.21-0.31, P < 0.0001-0.0038) and in analyses adjusted for all covariates except WSP (d = 0.16-0.22, P < 0.0001-0.0472). Pain severity differences further decreased with adjustment for WSP (d = 0.10-0.18) and were significant for KL grade ≤2 (P = 0.0015) and 2 (P = 0.0200). Presence compared with absence of WSP was associated with significantly greater knee pain at all KL grades (d = 0.32-0.52, P < 0.0001-0.0008). In knees with PFOA, VAS pain severity sex differences were greater at each KL grade (d = 0.45-0.62, P = 0.0006-0.0030) and remained significant for all KL grades in adjusted analyses (d = 0.31-0.57, P = 0.0013-0.0361). Results using WOMAC were similar.

CONCLUSIONS

Women reported greater knee pain than men regardless of KL grade, though effect sizes were generally small. These differences increased in the presence of PFOA. The strong contribution of WSP to sex differences in knee pain suggests that central sensitivity plays a role in these differences.

Nurses' Experiences of Managing and Management in a Critical Care Unit

In this article, we describe the major findings of an ethnographic study undertaken to investigate nurses’ experiences of managing nurses and being managed by nurses in an Australian critical care unit. Our purpose was to valorize and make space for nurses to speak of their experiences and investigate the cultural practices and knowledges that comprised nursing management discourses. Subjugated practices, knowledges, and discourses were identified, revealing how nurses were inscribed by, or resisted, the discourses, including their multiple mobile subject positions. Informed by critical, feminist, and postmodern perspectives, nine mobile subject positions were identified. Direct participant observation, participant interviews, and reflective field notes were analyzed for dominant and subjugated discourses. The major finding described is the subject position of “junior novice.” Nurses informed by dominant patriarchal and organizational discourses participated in constructing and reinscribing their own submissive identity reflected in interprofessional relations that lacked individual valuing and undermined their self-esteem.

Exploring physical health perceptions, fatigue and stress among health care professionals

Nurses, midwives, and paramedics are exposed to high degrees of job demand, which impacts health status and job satisfaction. The aim of this study was to explore the experiences and perceptions of health with a group of nurses, midwives and paramedics in Australia. Specifically, this paper reveals the findings related to the dataset on physical health. In this regard, the researchers sought to explore the relationship between physical health and job satisfaction, and the relationship between health status and stress levels. The study adopted a mixed methodology and used two methods for data collection: one-on-one interviews exploring the relationship between physical health and job satisfaction, and a survey questionnaire focusing on self-rated stress management. The individual interviews were conducted for further exploration of the participants’ responses to the survey. There were 24 health care participants who were drawn from metropolitan and regional Australia. The findings revealed participants: had a desire to increase their physical activity levels; had different perspectives of physical health from those recommended by government guidelines; and viewed physical health as important to job satisfaction, yet related to stress and fatigue.

Anxiety and surplus in nursing practice: lessons from Lacan and Bataille

It is well established, following Menzies' work, that nursing practice produces considerable anxiety. Like Menzies, we bring a psychoanalytic perspective to a theorization of anxiety in nursing and do so in order to consider nursing practice in the light of psychoanalytic theory, although from a Lacanian perspective. We also draw on Bataille's notion of 'surplus'. These concepts provide the theoretical framework for a study investigating how some clinical nurses are able to remain in clinical practice rather than leave the profession or seek work at a distance from the bedside. We conducted focus groups and present here an analysis of two fragments of nurses' speech. We found the nurses responded from one of two positions. In the first position, the nurses focus on doctors, complain about the surplus afforded them, and call for it to be eliminated. In this way, the nursing group is similar to other groups, considered by Bataille, who also attempt to get rid of a surplus. However, in the second position, the nurses stay with the surplus, tolerating it as they nurse the patient. This latter position is one where the nurse practises with a focus on the patient rather than being distracted by their dispute over the doctor's privilege. The importance of this paper is in its illustration of two distinct positions from which the nurse can practise: one that is not optimal because the nurse is distracted and the other that is more focused on practice, and thus the nurse is in a position to provide the best care possible to patients.

Defining professionalism in medical education: a systematic review

INTRODUCTION

We undertook a systematic review and narrative synthesis of the literature to identify how professionalism is defined in the medical education literature.

METHODS

Eligible studies included any articles published between 1999 and 2009 inclusive presenting viewpoints, opinions, or empirical research on defining medical professionalism.

RESULTS

We identified 195 papers on the topic of definition of professionalism in medicine. Of these, we rated 26 as high quality and included these in the narrative synthesis.

CONCLUSION

As yet there is no overarching conceptual context of medical professionalism that is universally agreed upon. The continually shifting nature of the organizational and social milieu in which medicine operates creates a dynamic situation where no definition has yet taken hold as definitive.

Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25

INTRODUCTION

We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught.

METHODS

Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism.

RESULTS

We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum.

DISCUSSION

Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.

A person-centred lifestyle change intervention model: working with older people experiencing chronic illness

A person-centred health promotion model of care to improve self-care and lifestyle changes for older people with chronic illnesses is conceptualized in this paper. The model supports effective interpersonal communication with nurses and health-care consumers and is developed to concept stage. Older people with chronic illnesses who experience stress, anxiety or social isolation are more likely to be admitted and re-admitted to acute hospitals. Interventions to decrease the risk factors are frequently unsuccessful in this patient group. Programmes, led by nurses, aimed at reducing stress, anxiety and social isolation while supporting older people postdischarge from hospital might be successful. The model integrates research from synthesized case studies and a critical literature review. The practices of interrelating four key elements-'construct', 'context', 'process' and 'outcome'-are proposed for nurses to assist patients advancing self-care and lifestyle change. The model is designed for implementation in outpatient, clinic or community settings.

It’s not about the hoist: A narrative literature review of manual handling in healthcare

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field.

The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.

Embodiment of the interpersonal nexus: revealing qualitative research findings on shoulder surgery patients

Background

The paper reports on the importance of the interpersonal nexus within qualitative research processes, from a recent research project on patient experiences of shoulder surgery. Our aim is to reveal the importance of qualitative research processes and specifically the role of the interpersonal nexus in generating quality data. Literature related to the importance of human interactions and interpersonal communication processes in health-related research remains limited. Shoulder surgery has been reported to be associated with significant postoperative pain. While shoulder surgery research has investigated various analgesic techniques to determine key efficacy and minimization of adverse side effects, little has been reported from the patient perspective.

Methods

Following institutional ethics approval, this project was conducted in two private hospitals in Victoria, Australia, in 2010. The methods included a survey questionnaire, semistructured interviews, and researcher-reflective journaling. Researcher-reflective journaling was utilized to highlight and discuss the interpersonal nexus.

Results

This research specifically addresses the importance of the contributions of qualitative methods and processes to understanding patient experiences of analgesic efficacy and shoulder surgery. The results reveal the importance of the established research process and the interwoven interpersonal nexus between the researcher and the research participants. The interpersonal skills of presencing and empathetic engagement are particularly highlighted.

Conclusion

The authors attest the significance of establishing an interpersonal nexus in order to reveal patient experiences of shoulder surgery. Interpersonal emotional engagement is particularly highlighted in data collection, in what may be otherwise understated and overlooked qualitative findings in patient experiences of shoulder surgery.

Resisting gender-bias: insights from Western Australian middle-level women nurses

An integrated feminist postmodernist ethnography was applied to explore the experiences of eight women nurses working in the corporate sector and/or management in public hospitals in Western Australia. Data were collected through participant observation, the researcher's field notes and journal and through semi-structured critical conversations. Data were analysed by the application of a trifocal analytic method (Glass & Davis, 2004; Savage, 2000b). This approach, consistent with the methodology, examined the data at multiple levels by applying realist, feminist and feminist postmodern lens which allowed the data to remain relevant to each participant, avoided objectifying the participants and uncovered knowledge relevant to the nursing profession. The findings revealed what it meant to be a nurse functioning within a corporate setting. Three culturally-constructed discourses emerged: values attributed to nursing, bureaucratic managerialism and medical science. The first was found to be empowering but the other two revealed evidence of patriarchal and oppressive behaviours by both medical staff and senior nurses. The findings also revealed that the nurses were sometimes unaware of the oppression they were subject to. The nurses avoided confronting their oppressors preferring strategies revealed as creep up/creep in. Discussion focuses upon the implications of the research project findings for senior and executive nurse leaders and managers and which may evoke a sense of commonality for women in general. The implications are that nurses could apply self-managing strategies in order to resist gendered oppression in senior-level workplace relationships. The authors recommend that more research and publications are needed that reveal and celebrate women's every-day exemplar empowering leadership practices.

An investigation of emotional wellbeing and its relationship to contemporary nursing practice

This paper is an investigation of emotional wellbeing and its relationship to contemporary nursing practice for women community health nurses (CHNs) who are providing palliative care. Palliative care provision has been acknowledged as a source of job satisfaction for many nurses however emotional interactions place increasing strain on nurses' wellbeing. Psychosocial aspects of care are reported as having a personal as well as a professional impact. Work related stress places nurses at increased risk of harm and impaired wellbeing. An emancipatory methodology was chosen for this study. Semi-structured interviews and reflective journaling were the methods used. The data was collected over a 16-month period during 2006-2007. There were fifteen participants. This qualitative study explored Australian rural and urban community nurses' experiences with wellbeing, emotional work and their professional practice. The findings revealed opposing social forces, an inner 'dialectical' tension between the nurses' expectations of their professional practices and what is valued in their practice settings. In terms of emotional wellbeing, two overarching themes will be discussed: feeling balanced and feeling out of balance. Workplace environments that were not always conducive to healing increased the emotional strain on nurses. Nurses' work promotes the healing of others therefore to deny the healing of nurses' is to deny others of healing. The need for further qualitative research investigating the emotional wellbeing and professional practice of community nurses who provide palliative care is necessary.

Self-efficacy and the sense of coherence: narrative review and a conceptual synthesis

In this study, the authors develop an exploratory synthesis of two major health concepts: Antonovsky's sense of coherence and Bandura's beliefs in one's own efficacy. Reinterpretation of each study in the light of the other can lead to greater conceptual development and expand existing knowledge. The mutual themes are presented with an explanation of their contribution to broader conceptual discussions. The existence of some similarities between the two concepts is suggested. Researchers can obtain valuable and additional arguments through cross-fertilization of ideas across presented studies united by shared assumptions. Further research is recommended among various age groups and social backgrounds in order to verify the possible benefits of such theoretical development. Theoretical and practical implications of such a synthesis are presented.

Mind-body medicine: a conceptual (re)synthesis?

The aim of this paper is to review the literature on mind-body medicine (MBM) in a narrative manner. A coherent construct is explored and developed that includes a conceptual synthesis of existing theories that is grounded in qualitative paradigms. Theoretical reflections on MBM are addressed in order to overview its practical implications. The logic and underlying principles of MBM are highlighted with regard to the benefits that this modality is reputed to produce. Its therapeutic and preventive values, as well as strategies for its development and promotion, are also considered. The paper proposes several recommendations for future healthcare practices. These include the need to build a complex, multidimensional model of MBM and the integral practical implications. The core information regarding the essence of MBM is discussed in relation to the existing literature and, in particular, quantum physics.

The importance of emancipatory research to contemporary nursing practice

When considering the significant changes that continue to transform nursing practice, a focus on evidenced-based practice has clearly placed nursing research at the forefront of professional practice. The aim of this paper is to highlight the important contribution that emancipatory research methodologies can make to the ongoing development of contemporary nursing practice. A research example demonstrates how an emancipatory framework was applied to a recent doctoral study undertaken with Australian community nurses who provided palliative care. The research focus was on exploring the relationship between the nurse's emotional well-being and their professional practice. The research was epistemologically located within a critical and feminist framework. Emancipatory research is well situated to address the subjective experiences of nurses and to contribute strongly to the future of nursing practice.

Nurses and palliation in the community: the current discourse

A core component of community nursing practice in Australia is the provision of palliative care, however this area of practice has been minimally researched. We, therefore, undertook a broader review of the contemporary literature in community nursing; palliative nursing; and community nursing palliative care. Literature was searched electronically in OVID, CINAHL and nursing databases and manually in relevant journals. Findings revealed community and palliative care nursing to be both complex and challenging. Community and palliative nurses ideals for care are compromised by competing practice demands. Changing health systems and philosophical views, limited resources and the perceived 'visibility/invisibility' polarity are identified as major job stressors. Therapeutic use of 'self' and interpersonal communication are recognized as contributing to job satisfaction. Community nurses providing palliative care is as an under researched area yet it is a role that arguably requires critical understanding and recognition. Further research is needed into the relationship between emotional well-being and professional satisfaction for community and palliative care nurses providing palliation.

Community mental health nurses speak out: the critical relationship between emotional wellbeing and satisfying professional practice

The article reports on selected findings of a research study concerning emotional wellbeing and professional nursing practice (Rose 2002). It highlights the relationship between community mental health nurses' and emotional wellbeing, and their capacity to provide satisfying professional nursing practice (Rose 2002). The notion of emotional wellbeing, factors that impacted upon the participants' emotional wellbeing, and the relationship of emotional wellbeing to professional practice were revealed in the study. These findings were based on a qualitative critical feminist research inquiry and specifically, interviews with five women community mental health nurses in Australia. Whilst complex, emotional wellbeing was found to be both implicitly and explicitly linked to the participants intertwined personal and professional experiences. Four key components were identified: the nebulous notion; the stress relationship; the mind, body, spirit connection; and, inner sense of balance. In terms of emotional wellbeing and professional practice, three themes were revealed. These were: being able to speak out (or not); being autonomous (or not) and being satisfied (or not). The authors argue that the emotional wellbeing of nurses working in community mental health settings is critical to satisfying professional practice. Furthermore nursing work involves emotional work which impacts on one's emotional wellbeing and emotional wellbeing is integrally linked to professional practice. It is recommended that health organisations must be pro-active in addressing the emotional needs of nurses to ensure the delivery of health care that is aligned to professional practice. This approach will ensure nurses will feel more recognised and validated in terms of their nursing practice.

Internationalizing nursing: valuing the multiple places and spaces of nursing education

Effective internationalization of nursing education means looking outside one's comfort zone. As Heinrich (1997, 2001) has shown, nurses can reflect on the risks related to maintenance of the status quo and perceptions of nurses' ways of being, and also become heroic in their educational approaches. If nurses are willing to learn from each other, regardless of where they received their nursing education, it is possible to enhance the rich tapestry of nursing actions, experiences, and expertise. The articles in this issue focusing on international nursing education provide greater insights into current research in this discourse and provide nurse educators with further knowledge that will enhance curriculum development and implementation, as well as professional nursing relationships.

Mobile subjectivities: positioning the nonunitary self in critical feminist and postmodern research

Most scholarly work is written from the perspective of the author being a unitary subject occupying a sole, rational, and unified position. This article argues that scholarship may be enhanced by the author adopting multiple subject positions as a methodological framework. Such an adoption is advantageous in working against the romance of the notion of a single truth while also maintaining teleological values congruent with critical and feminist agendas. This article outlines the conceptual development of this methodological framework, the rationale for its development, an explication of the concept of multiple subjectivity, and an exemplar of its application within nursing research.

Taking the Eagleʼs View

Watson's conceptual model of a caring-healing transpersonal understanding of nursing was used to underpin a hermeneutic phenomenological study of the extraordinary and transformational experiences of nurse healers. The 5 essential themes uncovered from the analysis of interviews with 11 nurse healers--Belonging & Connecting, Opening to Spirit, Summoning, Wounding & Healing Journey, and Living as a Healer--are set out, along with the overarching theme "Walking Two Worlds." Foundational understandings of Watson's model as they relate to the findings, and theoretical aspects, are discussed, and potential contributions of this study to the ongoing evolution of Watson's conceptual model are articulated.

Community mental health nurses and their emotional wellbeing: is anyone listening?

This paper highlights some of the findings from a recent study with women community mental health nurses which explored the relationship between emotional wellbeing and professional practice. Specifically, this article addresses the unique meaning of emotional wellbeing, self healing strategies used by participants, and identifies the relationship to professional practice. The findings revealed that the notion of emotional wellbeing whilst complex was explicitly linked to the iritertwining of their personal and professional experiences and situations. It is argued that the implications for failing to meet the needs of our nurses will not only jeopardise the nurses themselves but moreover the clients as recipients of such an essential service.

Reconceptualizing vulnerability: deconstruction and reconstruction as a postmodern feminist analytical research method

Nursing research informed by postmodern feminist perspectives has prompted many debates in recent times. While this is so, nurse researchers who have been tempted to break new ground have had few examples of appropriate analytical methods for a research design informed by the above perspectives. This article presents a deconstructive/reconstructive secondary analysis of a postmodern feminist ethnography in order to provide an analytical exemplar. In doing so, previous notions of vulnerability as a negative state have been challenged and reconstructed.

Studying women nurse academics: exposing workplace violence in Australia: Part 2

This article is the second in a series on workplace violence in academia. The specific findings on women nurse academics' experiences with violence in Australian universities are revealed. Findings indicate that Australian universities are competitive with wide spread violence. Participants revealed they were not supported nor recognised for their workplace contributions. Violence predominated in schools of nursing rather than the broader university. It is argued these findings need public dissemination to improve workplace environments and eliminate violence. It is noted that the results reported are part of a larger research study on progression and professional development of women nurse academics.

Studying women nurse academics: exposing workplace violence in Australia: Part 1

This article is the first in a two part series on research investigating the lived experiences of women nurse academics in Australia. This is part of a larger research study involving participants from Australia, New Zealand, the United States of America and the United Kingdom. The aim of this research was to investigate the participants' professional experiences and progression within their respective school of nursing and university. This article focuses on the literature on workplace violence and research methodology. The importance of storytelling and the relationship between emotional safety and sensitive disclosures is also addressed.

Difference still troubles university environments: emotional health issues associated with lesbian visibility in nursing schools

This article addresses some of the findings from a study, which investigated the lived experiences of women nurse academics in Australia, New Zealand, the United States of America and the United Kingdom. Specifically, this article reports on the findings of the experiences of lesbian nurse academics in the study. There were 15 lesbians who participated in this research. The results revealed that lesbian nurse academics are experiencing homophobia and as a consequence were suffering emotional health effects. Emotional health disruptions were irrespective of whether they were 'visible invisible' regarding their sexuality.

Safe sex and student nurses in rural Australia: nurses' knowledge and practices (Part 1)

This article is the first of a two-part series on a research study investigating student nurses' knowledge and attitudes to safe sex in a rural university in Australia. The article begins with a discussion of HIV/AIDS, particularly the current incidence and a discussion of the associated epidemiological data. Health care professionals responses to the disease and examples from relevant Australian literature are briefly explored. The authors then discuss the need for this current research study, reveal the associated ethical process, outline the instrument used and the sample population. The article concludes with a discussion of reliability and validity.

Safe sex and student nurses in rural Australia: nurses' knowledge and practices (Part 2)

In this article, the second in a two-part series on a research study investigating student nurses' knowledge and attitudes to safe sex in a rural university in Australia, the results are revealed. The major findings discussed in this article are focused on sexual preference, the need for safe sex, safe sex practices, the need for educational material regarding safe sex, exploration of sex/sexuality and, the need for study of conflict resolution, negotiation skills, and self esteem building. The article concludes with deliberations on educational recommendations associated with the research.

The dis-ease of nursing academia: putting the vulnerability 'out there' (Part 2)

In this article, the second in a two-part series on research investigating the lived experiences of women nurse academics in australia, the results of the study are revealed. The major findings indicated that the Australian university system remains competitive and non-supportive of women nurse academics. The women who participated in this study had a strong desire to share their stories and reveal their vulnerability associated with their everyday life experiences in universities. Cultural descriptions revealed the complexity of women nurse academics' vulnerability as well as the dimensions of emotional resilience and optimism for their associated emotional healing.

Epistemology at work: the ontological relationship between feminist methods, intersubjectivity and nursing research--a research exemplar

This article explores the importance of strong epistemological and ontological links in nursing research by examining the design and process of a recent research project. The research topic concerns the relationship between self-concept and nursing practice. In this article, the authors demonstrate that commitment to a methodologically consistent process and the necessary associated epistemological and ontological positions provides a depth and structure to nursing research. It is the authors' belief that such consistency within research acts to strengthen the research process, and consequently strengthens nursing's research base and knowledge.

The dis-ease of nursing academia: putting the vulnerability 'out there' (Part 1)

This article is the first in a two-part series on a recent research study investigating the lived experiences of women nurse academics in Australia. This article begins with a discussion on the growing necessity of nurses to care for one another while working in stressful environments. The author then discusses the need to research nurse academics. The majority of the article focuses on the methodological considerations associated with planning and researching the above topic. A comprehensive discussion of research methodology, methods and ethical concerns ensues.

Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments

OBJECTIVE

To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings.

SETTING

Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California.

PARTICIPANTS

All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts.

METHODS

An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period.

RESULTS

The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice.

CONCLUSION

The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.