Despite achieving broad acceptance of the moral case for treating animals fairly, the animal rights movement has reached an impasse concerning legal rights for animals. Zoopolis proposes a new approach to addressing this failure: integrating animal interests into human society via political institutions and practices. Zoopolis’s central theory that humans owe animals citizenship rights in a shared human-animal society, but that acceptance of responsibilities by animals also is required, has merit for the advancement of animal rights discourse. But its (...) anthropocentric approach, which itself exerts power over animals, necessitating suppression and policing of animals’ natural behavior, is problematic. (shrink)

By understanding the constructions of knowledge we currently label nursing theories as nursing ontologies, nurses can perceive these conceptualizations differently. Paul Ricoeur and Stephen White offer a conceptualization of ontology that differs from traditional, realist perspectives because they assume that a person's experience of a phenomenon (e.g., nursing) will change, but also maintain some stability. Discussing nursing ontologies, rather than nursing theories, might increase philosophy's status in nursing and may also more accurately reflect the (...) experience of being a nurse. (shrink)

The notion that genetics, through natural selection, determines innate traits has led to much debate and divergence of thought on the impact of innate traits on the human phenotype. The purpose of this synthesis was to examine how innate theory informs genetic research and how understanding innate theory through the lens of Martha Rogers’ theory of unitary human beings can offer a contemporary view of how innate traits can inform epigenetic and genetic research. We also propose a (...) new conceptual model for genetic and epigenetic research. The philosophical, theoretical, and research literatures were examined for this synthesis. We have merged philosophical and conceptual phenomena from innate theory with the theory of unitary beings into the University of Illinois at Chicago model for genetic and epigenetic research. Innate traits are the cornerstone of the framework but may be modified epigenetically by biological, physiological, psychological, and social determinants as they are transcribed. These modifiers serve as important links between the concept of innate traits and epigenetic modifications, and, like the theory of unitary human beings, the process is understood in the context of individual and environmental interaction that has the potential to evolve as the determinants change. (shrink)

This comprehensive collection offers a unique look at nursing practice, theory, research and nursing history from various critical theoretical perspectives. It aims to initiate an international discussion among scholars from diverse countries, particularly Germany and Anglo-American countries, coming from distinctive schools of thought, e.g. German Critical theory and Post-structural approaches, and influenced by their respective histories of sciences. This book analyzes and criticizes nursing theory, nursing research and practice along several dimensions: Nursing (...) Ethics, Subjectivity, Body and Flesh (Leib), Technology, Power, History, and Education. (shrink)

By using the concepts of intrinsicality/extrinsicality as analytic tools, the theology-based nursing theories of Ann Bradshaw and Katie Eriksson are analyzed regarding their explicit and/or implicit understanding of vocation as a motivational factor for nursing. The results show that both theories view intrinsic values as guarantees against reducing nursing practice to mechanistic applications of techniques and as being a way of reinforcing a high ethical standard. The theories explicitly (Bradshaw) or implicitly (Eriksson) advocate a vocational understanding of (...) nursing as being essential for nursing theories. Eriksson's theory has a potential for conceptualizing an understanding of extrinsic and intrinsic motivational factors for nursing but one weakness in the theory could be the risk of slipping over to moral judgments where intrinsic factors are valued as being superior to extrinsic. Bradshaw's theory is more complex and explicit in understanding the concept of vocation and is theologically more plausible, although also more confessional. (shrink)

Moral strangerhood is due in part to competing worldviews. The profession of nursing is experiencing a paradigm shift which creates ethical dilemmas for both Christian nurses and Christian patients. Nursing's new focus on spirituality and spiritual care presents itself as broadly defining a desired state or patient outcome — spiritual integrity — supposed to be applicable to all patients of all faiths. Analysis of nursing's definition of spirituality reveals assumptions and values consistent with an Eastern/New Age worldview (...) which may cause hostility towards Christian patients stereotyped as dogmatic or noncompliant. (shrink)

This article is about nursing theories, the development of nursing knowledge and the underlying, hidden epistemology. The current technical–economical rationality in society and health care calls for a specific kind of knowledge based on a traditional Western, Socratic view of science. This has an immense influence on the development of nursing knowledge. The purpose of the article was therefore to discuss the hidden epistemology of nursing knowledge and theories seen in a broad historical context and point (...) to an alternative epistemology for a future context. It is a question about which nursing theories and what nursing knowledge should be developed in order to benefit patients and relatives of the future. We suggest that future knowledge development in nursing be developed in an interchange between theory and practice and guided by philosophy like a kind of pendulum where all three elements are treated as equals. We suggest a framework for the development of nursing knowledge based on a caring‐ethical practice, a theory on life phenomena in suffering and relationship‐based nursing, and thereby, we may be able to help patients to be cured, to recover, to be alleviated or comforted when suffering. (shrink)

Science seems to develop by inducing new knowledge from observation. However, it is hard to find a rational justification for induction. Popper offers one attempt to resolve this problem. Nursing theorists have tended to ignore or reject Popper, often on the false belief that he is a logical positivist (and hence hostile to qualitative research). Logical positivism claims that meaningful sentences containing any empirical content should ultimately be reducible to simple, observation statements. Popper refutes positivism by showing that there (...) are no such simple statements. He is not a positivist. For Popper, the scientist begins with problems and puts forward trial solutions. These are subjected to rigorous testing aimed at falsifying them. A new theoretical position is then reached in which the scientist knows either that the trial solutions are false or that they have not yet been falsified. Science is characterized by the fact that it tests its ideas through attempted falsification. Nonscience tests its ideas through attempted refutation. Nursing theory is a mixture of science and non-science. Popper’s method requires rigorous testing of theory in both realms. As such, some nursing theory should be discarded. Popper’s view faces at least two important criticisms. One is that a scientist can always reject an apparent falsification by instead altering some auxiliary hypothesis (e.g. denying the accuracy of the falsifying observation). Popper can deal with this argument by saying that defence of a theory in this way will eventually break down if the theory is false. The second criticism is that Popper’s method does ultimately draw upon induction. This criticism is true, but his method can be usefully adapted. An adapted from of Popper’s philosophy of science provides a good basis for nursing theory. (shrink)

This manuscript represents one segment of a philosophical conversation held in a virtual webinar in February 2021 to consider some of the current debates in nursing theory, education and practice, and their relationship to philosophy. The webinar was sponsored by the International Philosophy of Nursing Society and the Centre for Nursing Philosophy at University of California, Irvine as an opportunity provide a venue for important philosophical and theoretical thinking to a wide audience of nurse educators and (...) practitioners around the world. (shrink)

The notion of social capital focuses attention on social connectedness within communities and the ways that this connectedness may affect health and well-being. There are many competing definitions of social capital but most suggest that it involves trust, social networks and reciprocity within communities, not necessarily geographically defined. The usefulness of social capital and related theories that help in understanding the function of nurses in rural communities are explored in this paper. Nurses and health service planners are becoming increasingly aware (...) of the potential contribution of community nurses in rural and/or remote areas, as evidenced in the development of nurse practitioners. Through their interrelational role and status in rural communities, nurses are often ‘immersed’ or ‘embedded’ in the social networks that make up the fabric of rural life and may therefore be important contributors to social capital. For a concept such as social capital to be useful in nursing research, it must have distinct attributes, delineated boundaries, and well-described preconditions and outcomes in multiple contexts. (shrink)

On 4 February 2021 a group of nurse scholar‐educators, nurses and other interested folks came together for the second of two virtual events to think together about the role of philosophy in the nursing world. The live streamed open access event provided an opportunity in the COVID‐19 pandemic for over 400 people to listen to five nursing scholars' presentations and to interact virtually through comments in chat and on the @IPONSociety Twitter social media platform. By reading the comments (...) and questions that were generated, and by looking at the social media comments related to the event, it is apparent that philosophy is an important thinking practice for nurses but many audience members critically expressed they felt excluded. Critical issues were raised by participants in chat and on Twitter—pointedly around the need for more representative voices—including the imperative to open nursing philosophy to diverse and disparate worldviews. This dialogue provides a summary of critical points raised during the live question and answer session for the panel entitled Addressing Current Debates in Nursing Theory, Education, Practice as well as examing comments selected from the @IPONSociety Twitter space in response to the panel. One commenter said it was great to see the discussion being lifted up from the influential roots of white supremacy, while other nurses expressed that they wished the panellists themselves were more diverse. In discussion of key takeaway, links are made to historical and ongoing structural oppressions in nursing where thinking practices like nursing philosophy and theory are still dominated by world views emanating from positionalities of able‐bodied cis‐gendered heterosexual western eurocentric whiteness. (shrink)

The current viewpoint on technology seems to derive from the optimistic idea of the existence of pre-established harmony that any technological progress leads to people's health, and welfare. But history has shown us that this is not always the case, and that we must select the proper direction which leads to health and welfare. For that purpose, this article presents the viewpoint of technology as a kind of human care service, along with the lessons from nursing theories. Five leading (...) nursing theories are introduced as well as their implications for technology. ‘The nursing model of technology’ is then presented. (shrink)

Pagpectrpes on power, communication and the medical encounter: implications for nursing theory and practice Over the past few decades there has been an increasing push towards ‘nhancing’ communication in the medical encounter, with a focus on moving towards a ‘mutuality’ of patient and health care professional that reduces a perceived ‘power imbalance’ between the two. Doctors in particular have been consmcted as dominating and coercive, either consciously or unconsciously repressing patient's capacity for autonomy. Nurses have typically been represented (...) as less authoritarian in their dealings with patients in their idealized role as caring, kindly and empathetic health professionals. It is therefore often argued that the nurse‐patient relationship is more ‘equal’ and less repressive than the doctor‐patient relationship. This article explores critically these assertions in the context of the Foucauldian perspective on the role of power in the medical encounter, and draws out implications for nursing theory and practice. (shrink)

This paper proposes that the philosophy of Bernard Lonergan can provide insight into the challenge of integrating nursing theory, research and practice. The author discusses Lonergan's work in regard to reflective understanding, authenticity and the human person as a subject of consciously developing unity. This is followed by a discussion of two key elements in Lonergan's work that relate to nursing: the subject–object challenge of nursing inquiry and common sense vs. scientific knowledge. The author suggests that (...) integration of nursing theory, science and practice may be achieved through self-transcendence. (shrink)

A critical examination of contemporary nursing theory suggests that two distinct discourses coexist within this field. On the one hand, proponents of the ‘knowledge discourse’ argue that nurses should drop the ‘virtue script’ and focus on the scientific and technical aspects of their work. On the other hand, proponents of the ‘caring discourse’ promote a view of nursing that embodies humanistic qualities such as compassion, empathy and mutuality. In view of this, we suggest a way to reconcile (...) both discourses despite the fact that they appear to be at odds theoretically and practically. To that end, we argue that nursing theory must give a prominent role to the Aristotelian conception of virtue, and we offer an account that includes both character and intellectual virtues. This account allows for a focus on moral competence but also accommodates the demands for discipline‐specific knowledge. Our account incorporates the caring discourse by suggesting a way for individuals to cultivate the conditions within themselves that make ‘caring in nursing’ possible, while the knowledge discourse is accommodated via the acquisition of the intellectual virtues. The process for achieving both these ends is the same: an intention to consistently develop, hone and exercise certain character traits over time. (shrink)

As nursing moves towards a holistic approach to care, its publications on sexuality have proliferated. 'Sexuality' and 'Gender' are concepts which are extremely difficult to define. While sex refers to the physical differences of the body, gender concerns the psychological and sociocultural differences between females and males. This distinction between sex and gender is fundamental, since many differences between females and males are not biological in origin. And, when a person's gender and sex fall together in accordance with social (...) norms, it may not necessarily be a similar correlation for every individual. The nature of these similarities is essentially threefold. First, Thomas, Savage and Webb accept that there should be a nursing definition of sexuality. In different ways they acknowledge and refer to it as an integral part of a person's being and self concept. Secondly, the authors underline some of the complexities and difficulties nurses have defining and dealing with it in professional relationships as well as on the level of self reflection, knowledge, attitudes and beliefs. Thirdly, all three surveys show why such difficulties prevail, and go on to make suggestions for change in nursing interventions and training. This article summarizes these contributions and discusses the ethical problems which nurses face in dealing with the sexuality of their patients. Pendant que les soins deviennent plus complet, les publications sur la sexualité se sont multipliés. Sexualité et genre sont des idées qui sont difficiles à définir. Pendant que 'sexualité' fait allusion aux différences entre les corps, 'genre' regarde les différences psychologiques et socioculturelles entre femmes et hommes. Cette distinction entre sexualité et genre est fondamentale, puisque beaucoup des différences entre femmes et hommes ne sont pas d'origine biologique. Et quand le genre et la sexualité d'une personne sont en accord avec les normes sociaux, il n'y a toujours pas une même correlation pour chaque individu. La nature de ces ressemblances est triple: premièrement, Thomas, Savage et Webb acceptent qu'une définition pour infirmiers/ères de las sexualité devrait exister. De plusières manières ils l'acceptent, et en réfèrent comme à un part total de l'être et idée de soi de la personne. Deuxièmement, les auteurs soulignent quelques-unes des difficultés et complexités que les infirmier/ères rencontrent dans leurs relations professionnelles aussi bien que dans leurs reflexions, compréhensions, attitudes et convictions personelles. Troisièmement, les trois études montrent pourquoi ces difficultès continuent encore, et suggèrent des changements en interventions et formation professionnelle. L'article-ci résume ces contributions et discute les problèmes éthiques des infirmier/ères vis-à-vis de la sexualité de leurs malades. Weil sich die ganzheitliche Pflege vermehrt, vermehren sich auch die Veröffentli chungen über Sexualität. Sexualität und Geschlecht sind Begriffe, die sehr schwierig zu beschreiben sind. Sexualität bezieht sich auf die physikalischen, und Geschlecht auf die psychologischen und kulturellen Unterschiede zwischen Frauen und Männern. Diese Unterschiede zwischen Sexualität und Geschlecht sind grundsätzlich, denn viele Verschiedenheiten zwischen Frauen und Männern haben keinen biologischen Ursprung. Wenn die Sexualität und das Geschlecht einer Person zusammen fallen mit den gesellschaftlichen Normen, bedeutet es noch nicht, dass es sich für alle solche Leute auf das selbe hinbezieht. Das bedeutende dieser Aehnlichkeiten ist dreifach: erstens, Thomas, Savage und Webb akzeptieren dass es eine Definition der Sexualität für die Krankenpflege geben sollte. Auf verschiedene Arten bestätigen sie sie, und weisen auf das Wesen der Person und deren Selbst-Vorstellung als etwas Vollständiges hin. Zweitens, diese Autoren betonen die Verwicklungen und Schwierigkeiten, die das Krankenpflegepersonal hat mit der Sexualität in beruflichen Beziehungen wie auch in persönlichem Nachdenken, Einstellungen und Ueberzeugungen. Drittens, alle drei Ueberblicke zeigen warum solche Schwierigkeiten weiterhin bestehen, und machen Vorschläge für Aenderungen in Pflegeeingriffen und Unterricht. Dieser Artikel fasst diese Beiträge zusammen und diskutiert die ethischen Probleme die das Krankenpflegepersonal hat mit der Sexualität der Patienten. (shrink)

As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

Specially selected articles from the Journal of Advanced Nursing have been updated where appropriate by the original author. Models, Theories and Concepts brings together international authorities in their specialist fields to consider the gaps occurring between theory and practice, as well as the evaluation of a selection of models and emerging theories.

OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and (...) respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory. (shrink)

In this paper it is argued that nurses should be holists whilst at the same time accepting that ‘holism’ is a contentious concept. One of the problems for a supporter of holism is that of which holism -- an attempt to outline the version of holism advocated is made by identifying only two versions of holism: The Strong theory and the Pragmatic theory of holism. By introducing this device it is hoped to avoid, if only by stipulation, some (...) of the more sophisticated nuances of holism drawn by other commentators. However despite a most judicious use of Ockham's Razor some detailed groundwork remains. In the first part of this paper a simple example is used which aims to articulate what are arguably some of the central issues within the holism debate. These issues are then placed within a wider philosophical context. The second part of the paper will offer definitions of Strong and Pragmatic holism. Drawing on specific examples from the nursing context it will be argued that the Pragmatic theory of holism is the theory of holism most compatible with nursing theory and practice. The methods employed in this paper are philosophical. Since the questions considered are conceptual rather than empirical requiring a discursive approach, utilising thought experiments and case implication to explore the issues. (shrink)

BackgroundProfessional ethics is the regulation and discipline of nurses’ daily nursing work. Nurses often encounter various ethical challenges and problems in their clinical work, but there are fe...

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach (...) over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses’ actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them. (shrink)

In this paper it is argued that nurses should be holists whilst at the same time accepting that ‘holism’ is a contentious concept. One of the problems for a supporter of holism is that of which holism -- an attempt to outline the version of holism advocated is made by identifying only two versions of holism: The Strong theory and the Pragmatic theory of holism. By introducing this device it is hoped to avoid, if only by stipulation, some (...) of the more sophisticated nuances of holism drawn by other commentators. However despite a most judicious use of Ockham's Razor some detailed groundwork remains. In the first part of this paper a simple example is used which aims to articulate what are arguably some of the central issues within the holism debate. These issues are then placed within a wider philosophical context. The second part of the paper will offer definitions of Strong and Pragmatic holism. Drawing on specific examples from the nursing context it will be argued that the Pragmatic theory of holism is the theory of holism most compatible with nursing theory and practice. The methods employed in this paper are philosophical. Since the questions considered are conceptual rather than empirical requiring a discursive approach, utilising thought experiments and case implication to explore the issues. (shrink)

The dual purpose of this article is to present a formal theory analysis combined with recommendations for the use of social justice in nursing as a framework for the study of obstetric violence in US hospitals. A theory analysis of emancipatory nursing praxis as a middle-range theory of social justice in nursing was conducted using the strategy by Walker and Avant. The theory of social justice in nursing was determined to be logical, (...) useful, and generalizable. The soundness and usability of the theory support the recommendations made for it to be applied to the study of obstetric violence, plus quality and outcome problems in maternity care that have been resistant to sustained progress and may benefit from a new paradigm for continued study. The alignment for obstetric violence to be studied with a social justice framework is linked to the theory’s origins in critical social theory and the evolving concept of obstetric violence as a sex-specific form of violence against women that is a violation of human rights. The postmodern expansion of the body of work based on critical theory provides examples from emancipatory and feminist researchers for recognizing how the study of obstetric violence is compatible with a theoretical framework for social justice in nursing. The suitability of this framework to guide the further research needed to better understand, identify, and minimize harms from the occurrence of obstetric violence is argued. In addition, “The Code” for the American Nurses Association (ANA) is cited as a professional reference that outlines nurses’ responsibilities for practice based on ethics, human rights, and social justice that are antithetical to the occurrence of obstetric violence. (shrink)

Background In June 2016, the Parliament of Canada passed federal legislation allowing eligible adults to request Medical Assistance in Dying (MAID). Since its implementation, there likely exists a degree of hesitancy among some healthcare providers due to the law being inconsistent with personal beliefs and values. It is imperative to explore how nurses in Quebec experience the shift from accompanying palliative clients through “a natural death” to participating in “a premeditated death.” Research question/aim/objectives This study aims to explore how Quebec (...) nurses personally and professionally face the new practice of MAID and their role evolution. Research design A grounded theory design was used. Participants and research context We recruited 37 nurses who participated in or coordinated at least one MAID. Semi-structured interviews and focus groups were conducted and audiotaped. Data collection and analysis followed Strauss and Corbin steps. Ethical considerations Ethics approval was received from the investigator’s affiliated University. Participants were informed regarding the research goal, signed a written consent, and were assigned pseudonyms. Findings/results Results show that nurses experienced the wide range of paradoxe during MAID centering around the following eight elements: 1) confrontation abouth death, 2) choice, 3) time of death, 4) emotional load, 5) new Bill, 6) relationship with the person, 7) communication skills, and 8) healthcare setting. The shifting of views and values in this new role is presented by the contradiction of opposites. Conclusions A better understanding of the paradox experienced by nurses involved with MAID paves the way for the development of interventions. (shrink)

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 (...) class='Hi'>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. (shrink)

While for decades nursing has advocated for theory‐informed practice, more recent attention has tended to focus on mid‐range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four‐quadrant (AQAL) perspective is familiar in nursing, little is known about how it is (...) being used by nurses in direct practice. The purpose of this interpretive descriptive study was to provide a practice‐based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self‐reflective. Challenges constraining nurses’ use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta‐framework are described. (shrink)

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent‐based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. The purpose (...) of this paper is to describe the work conducted in preparation for the development of an agent‐based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation. (shrink)

Traditional methods of teaching professional nursing ethics in the classroom have translated into limited success in clinical practice. Students don’t perceive an integration of ethics education in practical clinical settings, while educators grapple with a lack of perceived ‘excellence of moral character’ in their students when they are taught intellectual virtues and theoretical wisdom in the classroom that they do not see demonstrated in the clinical setting. Also traditionally, emphasis in ethics teaching has tended to focus on the nurse-patient (...) relationship, while less attention has been paid to nursing in a more inter/intra professional or global context. The purpose of using constructivist theory and concept-based learning strategies to teach junior level nursing students ethics was to present implications for nurse educators that will help them foster/improve their student’s critical thinking, and increase their mastery and global integration of the complex abstract concepts associated with professional nursing ethics. (shrink)

This article explores a problem of the articulation of an adequate account of the human person in both philosophical and nursing theory. It follows the lead of philosopher Norris Clarke in suggesting that there has been a significant division in the way philosophers have looked at the human person and goes on to suggest that this division is paralleled in prominent nursing theories. The paper reviews and argues for the synthesis of two contemporary philosophic theories of the (...) person that arise from the traditional philosophical division, and uses Clarke's account to show the ontological need for such a synthesis if we are to have a more adequate account of the human person. Next, accounts of the person identified in a number of the prominent theories of nursing are briefly reviewed revealing the vast complexity of the person encountered in nursing practice. It is suggested that each new theory of nursing is founded, at least in part, on the need to account for attributes of the person missing from prior nursing theories. It will be seen that the synthesized account of the person argued for here more adequately accounts for the various attributes identified in these nursing accounts and it is hoped that this synthesized account will serve as a somewhat more complete basis for a continued exploration of the persons encountered in nursing practice in its many and varied manifestations. (shrink)

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? Which strategies do nurses use to provide compassionate care? What is the specific model of compassionate care for the nursing context? A grounded (...) theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: contextual factors affecting compassionate care, the compassionate care actions, and the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model provides a model to guide nursing care and research. (shrink)

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory (...) presents a single‐system intuitive‐analytical approach to examining and understanding nurse cognition, analogous to the recommended single‐system approach to decision‐making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a ‘common sense’ blending of intuitive and analytical cognition, whereby cues presented to a decision‐maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition. (shrink)

This groundbreaking text is the most complete and detailed book devoted to middle-range theories and their applications in clinical nursing research. The book thoroughly explains the process of selecting an appropriate theory for a particular nursing research study and sets forth criteria for critiquing theories. Each chapter includes examples of research using middle-range theories, definitions of key terms, analysis exercises, reference lists, and relevant Websites. Instruments are presented in appendices. New features of this edition include analysis questions (...) for all theories; new chapters on learning theory and physiologic middle-range theories; "Part" introductions to frame the selection process for each middle-range theory chosen; and a glossary of terms. (shrink)

Recently, Edwards and Liaschenko questioned the validity of an argument put forward by Dr Søren Holm and Joseph Dunne concerning the impossibility of a theory of nursing. Taking into consideration the premises of the argument, I describe how Maritain's conception of philosophy allows for the possibility of a theory of nursing conceived as a philosophy of nursing art that is both practical and propositional in nature. As well, I identify how the philosophy of nursing (...) art guides nursing art in developing and applying other kinds of artistic practical nursing knowledge: artistic nursing rules and artistic prudential nursing judgements. Finally, the relationship of ethical knowledge to artistic practical nursing knowledge is set down. (shrink)

Recognition theory attempts to conceptualize interpersonal relationships and their normative political implications. British social philosopher Gillian Rose developed her own version of recognition rooted in the work of Georg Hegel. This article applies Rose's theory of recognition to care, arguing that its emphasis on lack of identity, the dynamic process of recognition and the existential risks involved accurately describes the relationship between nurse and patient. Rose's version is compared to both contemporary notions of the interpersonal in healthcare literature, (...) other forms of recognition theory and Emmanuel Levinas's vision of intersubjective relationships, a traditional philosophical basis for nursing care. In each case, I will argue that Rosean recognition is a fuller, more complex and ultimately more satisfying view of the relationships involved. (shrink)

Theories and models are not equivalent. I argue that an orientation towards models as a primary carrier of nursing knowledge overcomes many ongoing challenges in philosophy of nursing science, including the theory–practice divide and the paradoxical pursuit of predictive theories in a discipline that is defined by process and a commitment to the non‐reducibility of the health/care experience. Scientific models describe and explain the dynamics of specific phenomenon. This is distinct from theory, which is traditionally defined (...) as propositions that explain and/or predict the world. The philosophical case has been made against theoretical universalism, showing that a theory can be true in its domain, but that no domain is universal. Subsequently, philosophers focused on scientific models argued that they do the work of defining the boundary conditions—the domain(s)—of a theory. Further analysis has shown the ways models can be constructed and function independent of theory, meaning models can comprise distinct, autonomous “carriers of scientific knowledge.” Models are viewed as representations of the active dynamics, or mechanisms, of a phenomenon. Mechanisms are entities and activities organized such that they are productive of regular changes. Importantly, mechanisms are by definition not static: change may alter the mechanism and thereby alter or create entirely new phenomena. Orienting away from theory, and towards models, focuses scholarly activity on dynamics and change. This makes models arguably critical to nursing science, enabling the production of actionable knowledge about the dynamics of process and change in health/care. I briefly explore the implications for nursing—and health/care—knowledge and practice. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Nursing is possible owing to a series of intricate systemic relations. Building on an established tradition of sociological research, we critically analysed the nursing profession in Chile, with an emphasis on its education system, in the light of social systems theory. The paper's aim was to explore basic characteristics of nursing education as a system, so as to outline its current evolution. Drawing on recent developments in nursing, we applied an empirical framework to identify and (...) discuss functionally differentiated systems that are relevant to nursing and observe communications between them. We found that the dynamics of nursing as a whole develop from communications with closely related systems, including the nursing profession and the education system more broadly. While the discipline (as a system of representations) strives to control the profession (as an applied occupational field), the necessities of practicing nurses imply other forces mediating the making of the profession, a process framed by market dynamics in education and health. (shrink)

In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses’ work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the (...) profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses’ Ethical Reasoning Skills, is presented as a framework for nurses’ thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care. (shrink)

Drawing upon Aristotle’s claim that when one wants to learn right conduct or virtue, one should emulate those who practice it, this paper describes reasons for how the clear and conscious development of nursing role models can be used to model virtue theory in applied ethics courses. After providing a brief summary of Aristotle’s virtue ethics, the paper turns to a description of the basic models that describe the role of a nurse: surrogate mother, patient’s advocate, traditional caregiver, (...) and trained clinician. With these models in hand, the paper illustrates how virtues and duties can change when the role of the nurse changes and how different models of the nurse’s role connect virtue to practical action in different ways. Finally, the paper concludes with an extension of the above discussion to other areas of professional ethics and a step-by-step procedure for determining occupational duties. (shrink)