This chapter contains sections titled: Professional Issues Educational Issues Policy Issues Leadership Issues Specific Issues References.

Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi‐Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the (...) ‘shards and fragments’ of the situation‐at‐hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi‐Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses ‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. (shrink)

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have ‘led the way’ in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses (...) are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest. (shrink)

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have ‘led the way’ in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses (...) are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest. (shrink)

The practice of nursing involves ongoing interactions between nurses' and clients' lived bodies. Despite this, several scholars have suggested that the “lived body” (Merleau‐Ponty, 1962) has not been given its due place in nursing practice, education or research (Draper, J Adv Nurs, 70, 2014, 2235). With the advent of electronic health records and increased use of technology, face‐to‐face assessment and embodied understanding of clients' lived bodies may be on the decline. Furthermore, staffing levels may not (...) afford the time nurses need to be as “present” with their clients in embodied ways. The failure to attend to the lived body may contribute to missed opportunities for care and decreased quality of life for both clients and healthcare practitioners. In this paper, we undertake an analysis of selected aspects of the work of Maurice Merleau‐Ponty. The aim is to advance understanding of the affordances this work may offer to enhancing client–nurse interactions within the practice of nursing. Merleau‐Ponty's notions of embodiment, intersubjectivity and intercorporeality as articulated in his seminal texts The Phenomenology of Perception (New York, NY: Routledge, 2012) and The Visible and the Invisible (Evanston, IL: Northwestern University Press, 1968) are examined. These three constructs are discussed as they relate to the lived body in client–nurse interactions in nursing practice and education. Finally, implications of how attention to “the lived body” could shape interactions and have the potential to foster increased quality of life of clients and nurses are considered. (shrink)

The professions of nursing and nurse education are currently experiencing a crisis of confidence, particularly in the UK, where the Francis Report and other recent reviews have highlighted a number of cases of nurses who no longer appear willing or able to ‘care’. The popular press, along with some elements of the nursing profession, has placed the blame for these failures firmly on the academy and particularly on the relatively recent move to all‐graduate status in England for (...) pre‐registration student nurses. This has come to be known in the UK as the ‘too‐posh‐to‐wash’ argument, that there is an incommensurability between being educated to degree level and performing basic nursing tasks. I will argue in this paper that the diagnosis of the problem is substantively correct, but the formulation and the prescription are misguided and dangerous. I will suggest that the growing emphasis on research‐based and evidence‐based practice is the logical conclusion of an inappropriate scientific paradigm for nursing which is underpinned by the social sciences, by technical rationality, and by a focus on people. In contrast, I will suggest that a more fruitful way of thinking about and practising nursing and nurse education is to consider it as a human science with a focus on persons in which evidence for practice derives largely from practice itself. The history of the idea of a human science is traced from its roots in nineteenth century hermeneutics to the work of Gadamer and R.D. Laing in the 1960s, and I attempt to imagine a paradigm for nursing practice, scholarship, and education based on Laing's ‘existential–phenomenological’ approach with a focus on the endeavour to understand and relate to individual persons rather than to make broad prescriptions for practice based on statistical and other generalizations. (shrink)

Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can (...) be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice. (shrink)

Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the “good” provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies (...) and institutional goal setting, and of educational programs. We offer several practical suggestions for PPCC implementation, including structuring healthcare systems so as to nurture professional meaning, integrity, and inter-personal reflective emotional processing as a buffer against burnout and as a key to better patient care. It should not bring into question the primacy of practitioner commitment to the good of patients, nor should it be taken to suggest in any way a shift in focus away from patients’ values and respect for patient autonomy. PPCC asserts that the respect for patient’s values and autonomous choices properly remains the ethical benchmark of modern healthcare systems, along with altruistic professional commitment to the optimal care of patients. However, it enunciates an explicit commitment to structuring systems that allow for and actively encourage the professional well-being and wellness upon which good patient care depends. (shrink)

IntroductionEnabling education programs, otherwise known as Foundation Studies or Preparatory programs, provide pathways for students typically under-represented in higher education. Students in Enabling programs often face distinct challenges in their induction to academic culture which can implicate them in cases of misconduct. This case study addresses a gap in the enabling literature reporting on how a culture of academic integrity can be developed for students and staff in these programs through an educative approach.Case descriptionThis paper outlines how an (...) educative approach to academic integrity is implemented within the Enabling programs of two Australian universities.Discussion and reflectionThis case study reflects upon an approach which makes specific reference to the key elements of ‘support’, ‘approach’ and ‘responsibility’ as highlighted in Bretag and Mahmud’s seminal paper. The paper reports a reduction in misconduct cases at the two institutions suggesting a positive correlation between the interventions and students’ understanding of ethical academic practice. This study reflects upon practitioner experiences with academic integrity investigations to evaluate the effectiveness of this approach.ConclusionsThe authors show that it is possible to ensure academic integrity practices and values are upheld within a supportive learning environment appropriate to a students’ level of study. (shrink)

The purpose of this study was to test a causal model of ethical conflict in practice and autonomy in a sample of 254 nurse practitioners working in the primary care areas of family health, pediatrics, adult health and obstetrics/gynecology in the state of Maryland. A test of the model was conducted using a path analytic approach with LISREL 8.30 hypothesizing individual, organizational and societal/market factors influencing ethical conflict in practice and autonomy. Maximum likelihood estimation was used to (...) estimate the parameters most likely to have generated the data. Forty-five percent of the total variance in ethical conflict was explained by the variables of ethical environment and ethical concern. Ethical concern, idealistic philosophy, ethics education in continuing education, percentage of client population enrolled in managed care, and market penetration explained 15% of the total variance in autonomy. The findings of this study indicate that the causal model of ethical conflict in practice and autonomy is consistent with the data and contributed to a fuller understanding of clinical decision making associated with practicing in a managed care environment. The final model supported a conceptual framework that is inclusive of three domains: individual, organizational and societal/market variables. (shrink)

Providing good care requires nurses to reflect critically on their nursing practices. Ethics education must provide nurses with tools to accomplish such critical reflection. It must also create a pedagogical context in which a caring attitude can be taught and cultivated. To achieve this twofold goal, we argue that the principles of a right-action approach, within which nurses conform to a number of minimum principles, must be integrated into a virtue ethics approach that cultivates a caring attitude. Ethics (...) education that incorporates both the `critical companionship' method and the use of codes of ethics contributes positively to cultivating critical reflection by nurses. (shrink)

This paper suggests that a consideration of health care practice is a necessary step in gaining insight into the appropriate composition of an ethics course for students in the health care professional. Health care practice, if it responds to the needs of society, is dynamic in nature. In the current climate of change in the health service, the author sug gests that the nursing profession needs to become more proactive in analysing and attempting to determine the future (...) shape of nursing. To protect patient care the nursing profession needs to have its eyes open to the ethical dimensions of changes in role and practice. The author argues that, in attempting to ensure that the education to which nursing students are exposed is of relevance, it is necessary to introduce an element of the ideal into the ethics component of their professional education. From early on in their profes sional development students should be aware of the scope and standards of practice, and the type of role enactment to which the profession requires them to aspire. (shrink)

The concept of emotional intelligence has grown in popularity over the last two decades, generating interest both at a social and a professional level. Concurrent developments in nursing relate to the recognition of the impact of self‐awareness and reflexive practice on the quality of the patient experience and the drive toward evidence‐based patient centred models of care. The move of nurse training into higher education heralded many changes and indeed challenges for the profession as a whole. Traditionally, (...) nurse education has been viewed as an essentialist education, the main emphasis being on fitness for practice and the statutory competencies. However, the transfer into the academy confronts the very notion of what constitutes this fitness for practice.Many curricula now make reference in some way to the notion of an emotionally intelligent practitioner, one for whom theory, practice and research are inextricably bound up with tacit and experiential knowledge. In this paper we argue that much of what is described within curriculum documentation is little more than rhetoric when the surface is scratched. Further, we propose that some educationalists and practitioners have embraced the concept of emotional intelligence uncritically, and without fully grasping the entirety of its meaning and application. We attempt to make explicit the manner in which emotional intelligence can be more realistically and appropriately integrated into the profession and conclude by suggesting a model of transformatory learning for nurse education. (shrink)

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing (...) care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science. (shrink)

Nursing and nursing education face a paradox whereby the world's most trusted profession seems not to trust its own students and practitioners. Much of nursing education has adopted what has been memorably described as the ‘cop shit’ approach. This is the panoply of surveillance, anti‐plagiarism and proctoring technologies that appear to be used more for policing and punishment of an inherently dishonest student body than to develop ethical and scholarly writing among future peers and (...) colleagues. Nurses in practice may experience similar levels of distrust as they face growing micromanagement and control of both their appearance and nursing practice. We propose that these practices of distrust emerge, not from malice, but rather from the omnipresent neoliberalism and managerialism that engulf almost every aspect of health and university life. Neoliberalism's success has been to reformat academia and practice to the point where such ingrained mistrust has become merely a neutral recognition of ‘the real world’. Dismantling nursing and education's ‘cop shit’ culture and replacing it with the trust and respect that the world's most trusted profession is accorded by wider society will not be easy, but it is vital for the future of nursing. (shrink)

Kant (Grounding for the Metaphysics of Morals. Hackett, Indianapolis, 1797) described honesty as ‘a sacred command of reason’ which should be obeyed at all times and at any cost. This study inquires into the practice of dishonesty, deception, and deceit by universities in the UK in the pursuit of quality indicators such as league table positions, Research Excellence Framework (REF) scores, and student satisfaction survey results. Deception occurs when the metrics which inform these tables and surveys are manipulated to (...) suggest an improvement in quality when, in fact, the raised scores are merely the result of clever strategic planning. Deceit occurs when these manipulated scores are deliberately and knowingly presented as real improvements in research and educational quality. It might be argued that, within the context of the artificial ivory tower world of academe, this is a game played by almost every academic in every higher education institution with no real losers and little wider consequence. However, this study suggests that some of the strategies employed by institutions to improve their scores without directly addressing the issue of quality can, in certain practice‐based disciplines such as nursing, result in dire consequences for practitioners and service users. It concludes with a number of suggestions taken from personal experience to resolve the tension between the contractual demands placed on nurse academics by their employers and the moral and practical obligations of their professional body, most notably the use of subversion. The conclusion, contra Kant, is that the most effective strategy against dishonesty and deception is often more dishonesty and deception. (shrink)

Background The twenty first- century marked the exponential growth in the use of intelligent robots and artificial intelligent in nursing compared to the previous decades. To the best of our knowledge, this article is first in responding to question, “Can nurses in clinical practice ascribe responsibility to intelligent robots and artificial intelligence when they commit errors?”. Purpose The objective of this article is to present two worldviews (anthropocentrism and biocentrism) in responding to the question at hand chosen based (...) on the roles of the entities involved in the use of intelligent robots and artificial intelligence in nursing. Methods The development of this article was motivated by the immense discoveries, the current landscape, and nurses’ role in relation to advanced technologies in healthcare. The paper begins the discussion by situating the use of intelligent robots and artificial intelligence in nursing and healthcare and presenting its ethical and moral implications. Then, we presented the two worldviews: anthropocentrism and biocentrism which are used to respond to the task at hand. Results Anthropocentrism puts humans in the center in terms of moral standing and thus responsibility rests on them alone. Biocentrism declares that all creations deserve moral consideration and thus responsibility is equally allocated to all entities. Within these two worldviews, consensus development was offered to resolve these issues. Consensus provides clarity and democracy between and among the societies. Conclusions The findings of this article can be basis in (1) instituting mechanisms of robust peer review and a rigorous series of simulation before adopting or implementing intelligent robots and artificial intelligence in clinical practice; (2) education and training of highly specialized nurse practitioners who can be focal persons in responding to ethical and moral issues with regard to these advanced technologies; and (3) harmonization of robotics research, manufacturing, and clinical practice. (shrink)

‘It comes together at the end’: the impact of a one‐year subject in Nursing Inquiry on philosophies of nursingThis paper reframes an interpretive study as critical inquiry as the researchers interrogate their roles and authority in the ‘reading’ of what is valued as reflective. Working from data collected in written philosophies and interviews within the context of a one‐year subject aimed at developing reflective practice and an appreciation of ways of knowing, this paper examines the change in philosophies (...) of nursing perceived by three university‐based educators and their students. The study reveals a growing appreciation of the complexity of nursing but a limited consideration of the dialectic of critical theorising and everyday engagement necessary to critical reflection and reconstruction of action. More importantly, the process of research collaboration raises questions of the soul‐searching necessary for university educators to act against the institutionalised political context that determines what is seen to be of value in student learning. (shrink)

Digital technologies have become a crucial factor in nursing. Given the fact that many tasks could also be done by robots or AI systems, the place for the nurse in this scenario is unclear. In what way and to what extent will the implementation of ever more sophisticated technology affect nursing practice? It is the aim of this paper to analyse the potential challenges of nursing practice in the digital age. The analysis is conducted through (...) the lens of new materialism, a set of theoretical models that understand the relationship between humans and technology as dynamic and performative. According to this view, there is no prefixed essence of technology. Rather, the meaning of technology is enacted in concrete practice. The analysis shows that in past debates on technology use in nursing, the nurses’ role has been defined as guardians of humanity, defending the patient against the dehumanizing effects of technology. This role has been transferred to the digital age, where it is the duty of nurses to cushion the negative effects of digital technology. As an alternative to this outdated role, nurses should be included in processes of technology design and policymaking. Enabling nursing professionals to shape the circumstances of a digitally enhanced holistic practice may empower their status within the healthcare system and also benefit the patient by contributing to a more person‐centred care. (shrink)

BackgroundA special characteristic of nursing education is that professional teaching takes place in various locations. The learning locations involved (such as learning in theory, learning in clinical practice, or learning in third facilities, which are becoming increasingly popular, such as the skills lab) have an impact on and promote the development of ethical competences among prospective nursing professionals in various ways. Furthermore, it has become evident that the structural conditions that are specific to teaching and learning (...) in nursing education programs shape the organization of ethics education and the promotion of ethical competence development among nurse trainees over the course of their education.ObjectivesThe aim of this article is to discuss the following key question: What are the specific pedagogical and didactical requirements and educational frameworks that arise in view of the various learning locations in nursing education in order to facilitate ethics education and ethical competence development among prospective nursing professionals?DiscussionThis article emphasises the importance of a systematic, methodically reflected and learning-location-coordinated approach to ethics education in the field of nursing education. Moreover, it highlights the relevance of the conscious promotion of settings for ethical reflection within the process of ethical competence development in the different locations of learning. The unique quality of ethics education in nursing emerges from the professional requirements that are characteristic to nursing care and the individual experiences of trainees at the various locations of learning throughout their nursing education program. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Estelle R. Jorgensen, “Four Philosophical Models of the Relationship Between Theory and Practice”W. Ann StokesEstelle Jorgensen has written a most interesting paper contrasting four different concepts of the relationship between theory and practice, and pointing out the advantages and disadvantages of each. Each approach introduces insights that the others have missed, but is not sufficient in itself to explain all the relationships between theory and (...) practice. In response to the concept of "dichotomy," I am also sympathetic to the attempt to distinguish practice and theory because it identifies two important constituents of experience, and it provides a fruitful way of investigating the relationship between the two concepts. However, I believe that a concept of dichotomy may put the two categoriees in too distant a relationship with each other. This distance may prevent us from recognizing the "interconnections and cross-fertilizations" that are often possible between them.The idea of "polarity" opens up the possibility of focusing on the ground [End Page 102] between the two concepts. It also provides a framework for allowing "practice to bubble up into theory," and "theory to bubble up into practice." Given that a theory may bring about a range of different practices and that practices may be based upon a range of differing theories, one needs to be able to move easily between the two worlds. Imagination, intuition, and rational thinking all contribute to our understanding of the relationship between the two concepts. In this situation of polarity one should not expect to find "a theory perfectly translated into a particular practice, or a practice drawing entirely and fully on one particular theory."I am also sympathetic to the view that "theory without practice is mentalism," and that "practice without theory is activism or instrumentalism bare of guiding principles," but like Jorgensen I find the concept of fusion the least helpful of the four concepts. Given the fact that very rarely (if ever) is theory perfectly exemplified in practice, or practice based solely upon one specific theory, the concept of fusion in many instances is too absolute. I am open to the suggestion that moral principles as well as aesthetic ones should guide the practice of music education despite the difficulties that a multiplicity of perspectives opens up. I also agree that democratic ideals can offer us one way of guiding the decisions made in the classroom and can offer a rallying point for persons coming from different ethnic, religious, political, and cultural backgrounds.The dialectical approach opens up a way to negotiate among differences of opinion and beliefs that influence practice. It assumes that there is no one perfect perspective on the relationship between theory and practice. The dialectical approach provides (1)a framework to investigate the theories and practices of which practitioners are aware, (2)opportunities to examine how practitioners adjudicate them, and (3)explanations of how and why they decide to act "in their particular lived situations." In contrast to the ontological approach, I like Jorgensen's epistemological approach to the investigation of theory and practice. It offers another perspective in addition to the influence that ontological theories can have in guiding music education practice.My view of the ideal relationship between theory and practice is one that acknowledges the differences between the two concepts, but allows for a variety of relationships between the two. It is one that recognizes that theory should influence practice and that practice should influence theory in an ongoing and continuous reciprocal exchange. It entails being sensitive to a variety of theories and particular practices, and being skilled at being able to pick which particular theory or theories best explains the practice observed.In addition to the concepts of dichotomy, polarity, fusion, and dialectic, another possible concept of the relationship between theory and practice might be based upon Michael Lewis, Margaret Sullivan, and Linda Michalson's view [End Page 103] of the "cognitive-emotional fugue."1 This perspective has the advantage of being very flexible. The authors describe emotion and cognition as being neither separate nor independent processes. "Rather both are elements of a continuous, inseparable stream of behavior like the parts of a fugue in which the theme is often lost... (shrink)

BackgroundMoral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience.AimThe aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil.Research designThe research design is the qualitative study with discursive textual analysis.Participants and research context: 44 nurse (...) managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions.Ethical considerationsThe Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity.FindingsPersonal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation.ConclusionFrom the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aestheticism and SpiritualismA Narrative Study of the Exploration of Self through the Practice of Chinese CalligraphyMing-Tak Hue (bio)IntroductionCalligraphy has been used to preserve significant writings and texts in a beautiful form and to make the different styles of writing enjoyable. It is not only the art of beautiful handwriting but also a cultural heritage and tradition that reflects the culture and history of a society, a race, a (...) nation, and a country. Hence, it has very great educational value. In China calligraphy is done with a brush, which was a common writing implement in ancient times. In addition to its utilitarian function, calligraphy is the most fundamental element in other types of art, such as painting and seal-carving, and is closely connected to many subject disciplines, such as literature, history, and philosophy. Brush calligraphy is still popular in Chinese society and is frequently used in different forms of publication, such as banners and newspapers; however, it is becoming more popular for these publications to be created mechanically or in electronic form with computers rather than by hand. In the context of schooling, a similar phenomenon can be seen. Many teachers in Hong Kong, as elsewhere, are concerned that fewer and fewer students have the chance to write with a pen and enjoy the beauty of writing, as the use of computers and different types of electronic devices for writing become more popular with the general public.The aim of this article is to examine the meaning of the practice of Chinese calligraphy from a cultural perspective and to draw school practitioners' attention to the importance of calligraphy education in the promotion of the whole-person growth of students and of multicultural education. Relevant literature on Western and Chinese calligraphy will be reviewed. Then an explanation will be given on how a narrative approach to the personal experience method and textual analysis were adopted for the data analysis. The article argues that calligraphy serves more than a utilitarian function. It [End Page 18] has also been used as an aesthetic practice and spiritual discipline. Hence, it is suggested that the calligraphy of brushwork is not only delightful to the eye but also an inspiration to the spirit. It is a practice of mindfulness for promoting self-reflection and self-cultivation, which leads calligraphy practitioners to reflect in their mind and heart, and so brings them into a harmonious relationship with others and the natural world.Literature ReviewIn Western societies for the last one hundred years, calligraphy has been rediscovered and relearned.1 Knight pointed out that the heritage and traditions of calligraphy have not been properly addressed and inherited in Western societies. Uyehara further suggested that calligraphy had been basically restudied and relearned in Europe and the United States up until the end of World War II. Edward Johnston (1872-1944) could be the most influential scholar who attempted to rediscover the art of Western calligraphy, lettering, and illuminating. In his study of ancient inscriptions and old manuscripts, three essential qualities of calligraphy were identified: "legibility," "beauty," and "character."2 When creating a piece of artwork, calligraphers have to ensure the legibility of the letter forms, the mastery of the skills of creating beautiful writing, and the readability of their works. As he explained,To make good letters and to arrange them well. To make good letters is not necessarily to "design" them—they have been designed long ago—but it is to take the best letters we can find, and to acquire them and make them our own. To arrange letters well requires no great art, but it requires a working knowledge of letter-forms and of the reasonable methods of grouping these forms to suit every circumstance.3Similarly, Knight highlighted the essential qualities of "legibility" and "beauty." Further, he stressed that the "creativity" of calligraphy should be imposed upon the tradition and cultural heritage of ancient manuscripts. As he said,[M]any of the conventions we use today in letter design and typography were established during the manuscript age. To know the classic work of this period is to know more about the ground we stand upon. If we grasp the... (shrink)

Reflective practice is one of the most popular theories of professional knowledge in the last 20 years and has been widely adopted by nursing, health, and social care professions. The term was coined by Donald Schön in his influential books The Reflective Practitioner , and Educating the Reflective Practitioner , and has garnered the unprecedented attention of theorists and practitioners of professional education and practice. Reflective practice has been integrated into professional preparatory programmes, continuing (...) education programmes, and by the regulatory bodies of a wide range of health and social care professions. Yet, despite its popularity and widespread adoption, a problem frequently raised in the literature concerns the lack of conceptual clarity surrounding the term reflective practice. This paper seeks to respond to this problem by offering an analysis of the epistemology of reflective practice as revealed through a critical examination of philosophical influences within the theory. The aim is to discern philosophical underpinnings of reflective practice in order to advance increasingly coherent interpretations, and to consider the implications for conceptions of professional knowledge in professional life. The paper briefly examines major philosophical underpinnings in reflective practice to explicate central themes that inform the epistemological assumptions of the theory. The study draws on the work of Donald Schön, and on texts from four philosophers: John Dewey, Nelson Goodman, Michael Polanyi, and Gilbert Ryle. Five central epistemological themes in reflective practice are illuminated: (1) a broad critique of technical rationality; (2) professional practice knowledge as artistry; (3) constructivist assumptions in the theory; (4) the significance of tacit knowledge for professional practice knowledge; and (5) overcoming mind body dualism to recognize the knowledge revealed in intelligent action. The paper reveals that the theory of reflective practice is concerned with deep epistemological questions of significance to conceptions of knowledge in health and social care professions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 38.1 (2004) 65-77 [Access article in PDF] In Defense of Observational Practice in Art and Design Education Howard Cannatella Introduction It is increasingly debatable whether observational drawing and making in nature are still regarded as principal activities of art and design learning. Against this, the aim of this article is to strengthen sympathetically a teacher'sunderstanding of observational creative work from nature (...) and to assert that such an approach should be central to art and design teaching and learning.My reasons for writing this article are to reconsider observational aspects of this approach that are not generally expounded in existing art and design educational practice circles. The reluctance by some to debate theimportance of the observational creative process may be construed as a questionable position to take, for a number of educational practitioners in art and design appear to see observations in nature as irrelevant to current art and design learning, as if it were a fashion item, one that has lost its appeal. Creative poiesis, some would argue, could never extend sufficiently to observations in nature. When observations in nature are seen as trite, not high art, there is the perception that art and design may have lost something precious, unable to nurture, becoming too introverted and sensational at the expense of grappling with common human realistic experiences. A decline in observational visual sensibilities may seem inevitable under these conditions.There is a persistent view in art and design education that seems to me to be a misconception — that observations in nature are restrictive and superficial, an experience that deals only with archaic approaches in learning. In the work of Immanuel Kant, imitation could not be an original factuality. 1 In Kantian terms, to imitate exactly a thing of beauty would be an act considered as "wholly destitute of taste." 2 A similar kind of sentiment is echoed by Georg Hegel, who considers imitation in art as "deceptive" and goes on to say: "the pursuit of imitation is on the same lines as the feat of the man who has taught himself to throw lentils through a small aperture [End Page 65] without missing." 3 More recently, Norman Bryson criticizes the idea of a "natural attitude" toward observations in natureas he denounces any suggestion of the purity of the universal visual image. 4 This backlash may make us feel a little uneasy as to why observations in nature should play a primary role in art and design education.My argument will be that although creative observations in nature do involve mimetic and regulative factors, these factors, when sensitively handled,can enlarge our imagination, touching us deeply in the process. Along these lines, it does not follow that because a work is mimetic in kind that it necessarily fails to produce significant learning. In accepting that there is a degree of control exerted normatively by what is being observed in the nature of such work, these perceptions in art and design become, through the creative process, refined and subtle experiences. Normative features and experiences may spur the artist or designer to create powerful expressions of them in the work.I will try to demonstrate that observational creative work, for all its reality checks, has the capability to be powerfully expressive and make discoveries that seem pertinent and true. As I see it, this encounter involves moral, social, perceptual, cognitive, and aesthetic orchestrations.Of course, some might insist that artistic autonomy could be a problem when having to work from observation in nature but the idea of autonomy relates to self-rule, a condition that is perhaps best understood, as Robert Young states, as being predominately dispositional as opposed to occurrent. 5 Educators like myself may want to argue that art and design teaching and learning requires, apart from other things, an understanding of theworld in which one lives as we come into contact with what actually and candidly stands publicly before us. This position cannot be reached through channelling our efforts exclusively via autonomist means.Certainly, in education, motivation, prior experience, personality, student... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 38.1 (2004) 65-77 [Access article in PDF] In Defense of Observational Practice in Art and Design Education Howard Cannatella Introduction It is increasingly debatable whether observational drawing and making in nature are still regarded as principal activities of art and design learning. Against this, the aim of this article is to strengthen sympathetically a teacher'sunderstanding of observational creative work from nature (...) and to assert that such an approach should be central to art and design teaching and learning.My reasons for writing this article are to reconsider observational aspects of this approach that are not generally expounded in existing art and design educational practice circles. The reluctance by some to debate theimportance of the observational creative process may be construed as a questionable position to take, for a number of educational practitioners in art and design appear to see observations in nature as irrelevant to current art and design learning, as if it were a fashion item, one that has lost its appeal. Creative poiesis, some would argue, could never extend sufficiently to observations in nature. When observations in nature are seen as trite, not high art, there is the perception that art and design may have lost something precious, unable to nurture, becoming too introverted and sensational at the expense of grappling with common human realistic experiences. A decline in observational visual sensibilities may seem inevitable under these conditions.There is a persistent view in art and design education that seems to me to be a misconception — that observations in nature are restrictive and superficial, an experience that deals only with archaic approaches in learning. In the work of Immanuel Kant, imitation could not be an original factuality. 1 In Kantian terms, to imitate exactly a thing of beauty would be an act considered as "wholly destitute of taste." 2 A similar kind of sentiment is echoed by Georg Hegel, who considers imitation in art as "deceptive" and goes on to say: "the pursuit of imitation is on the same lines as the feat of the man who has taught himself to throw lentils through a small aperture [End Page 65] without missing." 3 More recently, Norman Bryson criticizes the idea of a "natural attitude" toward observations in natureas he denounces any suggestion of the purity of the universal visual image. 4 This backlash may make us feel a little uneasy as to why observations in nature should play a primary role in art and design education.My argument will be that although creative observations in nature do involve mimetic and regulative factors, these factors, when sensitively handled,can enlarge our imagination, touching us deeply in the process. Along these lines, it does not follow that because a work is mimetic in kind that it necessarily fails to produce significant learning. In accepting that there is a degree of control exerted normatively by what is being observed in the nature of such work, these perceptions in art and design become, through the creative process, refined and subtle experiences. Normative features and experiences may spur the artist or designer to create powerful expressions of them in the work.I will try to demonstrate that observational creative work, for all its reality checks, has the capability to be powerfully expressive and make discoveries that seem pertinent and true. As I see it, this encounter involves moral, social, perceptual, cognitive, and aesthetic orchestrations.Of course, some might insist that artistic autonomy could be a problem when having to work from observation in nature but the idea of autonomy relates to self-rule, a condition that is perhaps best understood, as Robert Young states, as being predominately dispositional as opposed to occurrent. 5 Educators like myself may want to argue that art and design teaching and learning requires, apart from other things, an understanding of theworld in which one lives as we come into contact with what actually and candidly stands publicly before us. This position cannot be reached through channelling our efforts exclusively via autonomist means.Certainly, in education, motivation, prior experience, personality, student... (shrink)

The ongoing debate over the appropriateness of embracing multiple research traditions in nursing is discussed, and the impacts of that debate on the development of nursing knowledge and the nature and structure of the discipline are explored. It is asserted that this previously healthy debate has become stalled between extreme positions of unbounded pluralism and critical exclusivism. The author suggests that one possible solution may lie in connecting the elements of human living, human healing, and human wholeness in (...) an evolving narrative that crosses paradigmatic and theoretic boundaries, and reflects the unique meanings revealed in nursing practice and scholarship. (shrink)

Realities of the formed information society made actual for inclusive education a problem of formation of professionals of the new directions capable to apply information technologies to improvement of interaction between participants of process of distance learning. Until recent time the institute of distance learning had no analogs in our educational system. It has to become one of the most important elements of the organization of remote education. Inclusive education becomes the new strategic direction of modern (...) class='Hi'>education in Russia, its program of development to 2020 is designated by the Federal law ‘About the education in the Russian Federation‘ which has come into force on September 1, 2013. Ideas of inclusive training were born from a pressing need of society to help children to be integrated with features of development into society. Without it a creation of a new civilized society, the education system that meets the requirements of the humanistic principles is not possible. In this connection, creation of a substantial and technological basis of the organization of inclusive education of children in the mode of distance learning is an extremely important for today social, moral and pedagogical problem. In its center are the development of the subject, granting equal opportunities to each pupil to build the individual educational trajectory, culturological cultivation of the person capable to take an independent position in relation to external conditions. Distance learning serves as strong and active technology of socialization of such children. However, in the theory and a technique of training, the problem of distance learning of children with disabilities is insufficiently solved that is caused by unavailability of most of teachers to apply these technologies. There is a contradiction between objective practical need of distance learning for children with disabilities and insufficient readiness of a theoretical and technological basis. This is a main problem discussed in the study. In theoretical plan, it is a problem of development of the practical-focused theoretical and technological basis of distance learning of children with disabilities. On the practical level, it is a problem of formation of the subject information and education environment, designing of the contents, definition of methods, pedagogical technologies, the conditions of formation promoting achievement of the planned educational results and development of cognitive independent activity without prejudice to health of children on the basis of the accounting of their individual abilities. Technological effectiveness of the purposes is provided with prediction of educational results, their expression through requirements to actions of pupils. Recent time, children only start studying and mastering remote technologies therefore, first of all, they have to seize rational ways of educational activity and learn to work with information, i.e. priority value has to be allocated for formation of informative and logical and informative and information universal educational actions. (shrink)

The Mayday Scholars Program for 2001-2002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management. The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing (...) practices by certified registered nurse practitioners prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice.In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners. (shrink)

The Mayday Scholars Program for 2001-2002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management. The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing (...) practices by certified registered nurse practitioners prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice.In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners. (shrink)

This book is not just about thinking or acting in transdisciplinary ways, but about being transdisciplinary. To achieve this requires a deconstruction of our current way of acting within the definition of being that others impose upon us. Transdisciplinarity is a phenomenological perspective of reality and its manifestation in the world in which we exist. The volume develops a widely based transdisciplinary understanding of the issues faced by higher education institutions and those who work within and with these institutions (...) to educate professionals. It incorporates international contributions from organisational theory, anthropologists, historians, psychologists, social sciences, philosophers and practitioners to create a volume that makes an important and distinct contribution to the literature on higher education and professional practice. "Transdisciplinarity provides one of our greatest challenges in higher education, both to the way it is organized and to the nature of the curriculum. This book is an important contribution to the debate about its implications." "Higher education is being challenged by the nature of knowledge and how it is organized-the world is transdisciplinary but out institutions are constrained by the disciplines. This book contributes to the important debates about the challenges transdisciplinarity provides to our institutions." Professor David Boud Emeritus Professor, Faculty of Arts and Social Sciences, University of Technology, Sydney. (shrink)

Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing (...) a fatal disease to naturally run its course until an individual’s vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals’ wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the similarities and differences among religions and between secular and religious approaches to ethical issues. (shrink)

Introduction. The article is focused on studying the self-knowledge techniques used in Buddhism and their application in teaching philosophy. The relevance of the study is due to the search for new approaches to studying philosophy, including approaches related to philosophical practice, as well as the interest of modern scientists in the problem of consciousness. The problem of consciousness is interdisciplinary and its study is of practical importance for philosophers, psychologists, linguists, specialists in artificial intelligence. Buddhism as a philosophical doctrine (...) provides rich material for the study of the phenomenon of consciousness, which does not lose its relevance today. A feature of the Buddhist approach to consciousness is that it has an axiological orientation that is directly related to the problem of self-knowledge. The practices of self-knowledge used in Buddhism enable a person to become happier and more harmonious, which is so important for each of us. The aim of the study is to conduct a philosophical analysis of Buddhist practices of self-knowledge and self-transformation in order to use them in the educational process. Methods: the author uses general scientific methods of analysis and synthesis, deduction and induction; phenomenological method to identify the intentions that are key for consciousness. The author also uses the hermeneutical method to interpret Buddhist texts. The method of introspection as self-observation of consciousness is used in Buddhist meditation techniques. The scientific novelty of the study is that we approach the study of extensive material on Buddhism in the context of the problem of selfknowledge, which is inextricably linked with the Buddhist concept of consciousness. The revealed and studied Buddhist techniques of self-knowledge have been adapted for teaching philosophy. Results. A philosophical analysis of the literature on Buddhism in the context of the problem of self-knowledge was carried out. As a result of the analysis, Buddhist techniques for working with consciousness, such as meditation, the method of pondering Zen koans, the method of getting rid of material attachments, or the practice of austerities, were studied and described. A philosophical analysis of various Buddhist meditation techniques showed that they are based on the Buddhist concept of consciousness, which denies the existence of an individual “I”, considers the “I” to be nothing more than a combination of various dharmas, therefore the purpose of meditation in Buddhism is to identify oneself with one’s own “I”, to achieve a state of voidness in which we must comprehend our true identity. The method of pondering Zen koans is also one of the techniques for working with one’s consciousness in Buddhism. As a result of deliberation of these paradoxical miniatures, a person goes beyond the boundaries of logical thinking; there is a transition from the level of profane consciousness to the level of deep consciousness. The basis of the method of getting rid of material attachments or the practice of austerities in Buddhism is the concept of the middle path. We have established a similarity between the method of getting rid of material attachments, the concept of the middle path and minimalism as a way of life. Findings. Elements of the Buddhist practices of self-transformation can be successfully used in the teaching of philosophy at the university as a practical aspect of studying this discipline, forming students with the idea of philosophy as a way of life leading to positive self-transformation. Studying the practical aspects of Buddhist philosophy contributes to the formation of tolerance, awareness, education of humanism and altruism, and the skills of psycho-emotional self-regulation. (shrink)

Nursing professionals are in key positions to support end-of-life decisions and to advocate for patients and families across all health care settings. Advocacy has been identified as the common thread of quality end-of-life nursing care. The purpose of this comparative descriptive study was to reveal acute care nurses' perceptions of advocacy behaviors in end-of-life nursing practice. The 317 participating nurses reported frequent contact with dying patients despite modest exposure to end-of-life education. This study did not (...) confirm an overall difference in advocacy behaviors among novice, experienced and expert nurses; however, it offered insight into the supports and barriers nurses at different skill levels experienced in their practice of advocacy. (shrink)

This study explored tacit knowledge based on an expert nurse's practice who cares for stroke patients by using the hermeneutic phenomenological approach. The participant (‘Ms. A’) was a nursing researcher and college faculty member involved in the education of advanced practice nurses; her specialty was stroke rehabilitation nursing. She was asked to describe the meaning and value she gained from her memorable nursing experiences. Four interviews—approximately 1 h each—were conducted, and the associated data were (...) interpreted together with the participant based on the method of interpretive circulation. Notably, the analysis was ended when a fusion of horizons was recognized. The participant recalled her nursing experiences based on six model cases. During the analysis, the following five elements were extracted: [belief in the ability of vulnerable people to survive]; [being together]; [respect for human dignity]; [preparedness to respond to and bear suffering together]; and [theoretical knowledge base approaches true understanding of patient experience]. Further, the nursing model—the Roy Adaptation Model—utilized by Ms. A in the process of recognizing humans as whole beings was deeply interpreted and implemented as a guideline for her implicit advanced practice. Moreover, her deep understanding and utilization of theoretical knowledge base also built the foundation for her implicit advanced practice. In conclusion, Ms. A's tacit knowledge and the elements support the process of tacit knowledge acquisition. Her narratives, hermeneutic attitude as an interpreter, and learning attitude throughout interaction with others will strongly help her knowledge development. We intend to continue the study with multiple participants and explore the structure of tacit knowledge possessed by advanced practitioners. Future endeavours will include the development of a tacit knowledge learning strategy. (shrink)

Debate over the status of medicine as an Art or Science continues. The aim of this paper is to discuss the meaning of Art and Science in terms of medicine, and to find out to what extent they have their roots in the field of medical practice. What is analysed is whether medicine is an "art based on science"; or, the "art of medicine" has lost its sheen (what with the rapid advancements of science in course of time, which (...) has made present day medicine more sophisticated). What is also analysed is whether the "science of medicine" is a pure one, or merely applied science; or the element of science in it is full of uncertainty, simply because what is accepted as "scientific" today is discarded by medical practitioners tomorrow in the light of newer evidence. The paper also briefly touches upon how, in the field of present medical education, the introduction of medical humanities or humanistic education has the potential to swing the pendulum of medicine more towards the lost "art of medicine". The paper concludes by saying that the art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine. (shrink)

Can we take the purpose of nurse education for granted, and, more importantly, should we? That is the issue at stake in this paper. The question of purpose is conspicuously absent in the nursing literature; our aim here is to urge that it not be overlooked by demonstrating its importance to the future of nursing. We approach the question of nurse education's purpose in concrete and speculative terms through two distinct yet interrelated questions: what is the (...) purpose of nurse education? and what should it be? Amidst the complexity and uncertainty of our time, we cast doubt on the adequacy of manualised and regulated approaches—ubiquitous in nurse education—to prepare nurses who can meet the challenges of contemporary practice. We also assert that transgressive approaches to education, as the antithesis of manualisation, reach the same impasse by (over)predetermining what the educational ‘output’ will be. To move beyond this impasse, we draw on the theory of Gert Biesta and Ron Barnett to contrast cultivation and existential‐type education. In so doing, we do not seek to provide ‘answers’ to nurse education's purpose but, rather, raise the profile of what we believe is a right and proper question for the discipline to grapple with. (shrink)

In this essay, Elizabeth Campbell reviews three recent books that address the ethical nature of professional practice: Knowledge and Virtue in Teaching and Learning: The Primacy of Dispositions, by Hugh Sockett; The Good Life of Teaching: An Ethics of Professional Practice, by Chris Higgins; and Towards Professional Wisdom: Practical Deliberation in the People Professions, edited by Liz Bondi, David Carr, Chris Clark, and Cecelia Clegg. While the first two books are situated within the context of teaching and (...) class='Hi'>education, the third book, as an edited volume, contains chapters that represent a multidisciplinary perspective on the work of professionals within nursing, social work, counseling, and the ministry, as well as in teaching. Each of the books engages in the careful inquiry into philosophy broadly and educational philosophy specifically from conceptual frameworks widely associated with Aristotelian virtue ethics. Writing from an applied perspective on the field of scholarship relating to the moral and ethical dimensions of teaching, Campbell applauds the books for their timely reminder of the central role or persona of the individual professional as a moral agent and ethical practitioner. She argues that within the contemporary context of teacher education, which tends either to neglect or narrowly define the ethics of the profession, such an emphasis on the cultivation of personal character and responsibility within a framework of clear ethical dispositions or virtues is a welcome contribution to the field. It enables teachers, teacher educators, and student teachers to concentrate on both the ethics of practice and the practice of ethics in the ongoing quest to further their own development of virtue, practical wisdom, and personal and professional knowledge. (shrink)

Care, we suspect, is initiated with an appeal. Something appeals to us which becomes a matter of concern. In accordance with this concern, we develop a volition: we want that which promotes the thriving – even to the smallest extent – of that which has appealed to us, regardless of how we may establish what that entails. Eventually we take practical action: we act according to our volition. Immediately after this has taken effect, as the case may be, we release (...) the source of the appeal from our care. As far as we can see, this quartet – appeal, concern, volition and practice – covers the four constitutive moments of care, although these moments are only theoretically separable from one another. The practice, as we have said, follows the volition. The volition, however, has arisen because we wanted to foster the wellbeing, however we may have recognised this, of the subject from which the initial appeal came. We have thus placed our volition in the service of this wellbeing, that is to say: we have subjected ourselves to an ought which we instantiated ourselves with the acceptance of the appeal. This seems to us to be the decisive point: in the act of caring, we instantiate an ought, a regulative element, which we then willingly follow. In the process of caring, we thus bring forth an ought, from our own being as it were – and as short-lived as this may be – to which we subject ourselves: in the process of caring, normativity only appears at all because we produce a will in the interest of the subject of the initial appeal to which we then dedicate ourselves, as if this were not our own will. Normativity is thus, as we further suspect, to be understood as a descriptive term of a phenomenology of care, or indeed a phenomenology of normativity. The phenomenon of caring provides the first indication that the ought arises directly from the practical experience of our lives. The phenomenology of care seems to us to be of eminent importance for health care ethics. To denote professional caring, we use the term nursing. The professional caregiver purposefully exposes him/herself to appeals, making him/herself receptive to such an appeal and reliably allowing the appeal to become a concern. The first fundamental principle of nursing ethics thus appears to us to be: to make known one’s receptiveness to an appeal – in a particular situation at a particular time – and to process this appeal reliably such that it becomes a concern. This encompasses the professionalism of care at its initiation. We believe that a precise phenomenology of care will provide, on the one hand, an exact understanding of the genesis of normativity, and on the other hand, in its practical application, a definition of the professional care that is nursing and an ethics of nursing for the care-giving professions. (shrink)

This paper is a review of the experiences gained whilst working with the ‘expertise in practice project’. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice‐based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to (...) the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners’ concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient‐participants’ role as a sophisticated evaluator of health‐care. As a result, we present a case for transformational qualitative research. Such research is values‐driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its ‘ends’ (i.e. research products) but also, intentionally, through its ‘means’ (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self‐reflection) to examine and critique their personal values. (shrink)

The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other (...) hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making. (shrink)

We hear much these days of lifelong learning and higher levels of nursing practice. We have even been introduced to the concept of the supernurse. This paper seeks to contribute an ethico-political dimension to the largely performative uses of these terms in contemporary nursing politics. This is done by exploring the promise of certain elements of Nietzsche's philosophy for nursing. Certain major Nietzschean themes are outlined in the context of modernity followed by their exploration in a (...) nursing context. These themes come principally from Thus Spake Zarathustra, and include not only that of Übermensch (Superman), but also the related ideas of eternal recurrence, nihilism, and the last Man. It is argued that the conditions in which nurses now learn and practice have become increasingly instrumentalized and technorational to the extent that they are in danger of effecting a nihilism in what becomes a culture of perpetual obligation to those who would seek to measure our performance. It is against this background that Nietzsche's idea of the Übermensch is explored as a figure for self-overcoming the professional subjectivity that may be constructed in the face of these conditions. However, it will be seen that this raises certain issues which beg the question of the productive value of Nietzsche's philosophy in this particular context. At this point, in the last part of the paper, by considering the tensive relation between the discourse practices of present-day managerialism and nursing ethics, it is argued that it is these very problems that present the Übermensch as a tensive but potentially productive figure for nursing and nurse education in its broadest sense. (shrink)

It has been claimed that there are certain acts that nurses as people practising nursing must never do because they are nurses and this is regardless of what the same agent should do; that certain actions are not part of proper nursing practice. The concept of an internal morality has been discussed in relation to medicine and has been used to ground the actions proper to medicine in a realist tradition. Although the concept of an internal morality (...) of nursing is not explicitly mentioned in the literature the underpinning ideas about the proper practice of nursing based on philosophical realism I argue equate with it and a discussion of the method of an internal morality can help to understand how arguments against euthanasia related to the profession of nursing are far from clear. Ultimately, although the idea of particular acts proper to nurses qua nurses is not clear, the concept of an internal morality can help to get practitioners to see how the profession is tightly linked to moral actions, even so the hard problems in bioethics such as the morality of euthanasia remain hard for all and the easy ones easy for all. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care Setting Part I:Survey of the LiteratureMary Carrington Coutts (bio)The last twenty years have brought important changes to health care and health care education. Educators and students alike face an enormous number of new fields of study and new medical technologies. Health care professionals and institutions are also facing new challenges in the form of shrinking economic resources, and the AIDS epidemic. They (...) must also respond to increased patient participation in health care decisions, and public concern about abortion and euthanasia. These challenges to the health care professional have compelled educators to accommodate ethics within their already overcrowded curriculum. Those same dilemmas have influenced health care institutions to become active in health care ethics education.Medical ethics education gained a foothold in the United States during the late 1960s, when the medical schools of Pennsylvania State University, the University of Florida, and the State University of New York at Stonybrook established programs in the humanities (Pellegrino 1982). In 1978 Robert Veatch noted that formal teaching in medical ethics was rare; most institutions that taught medical ethics used "informal instruction in the apprenticeship mode" (Veatch 1978). However, by 1982 a survey by the American Medical Association (AMA) revealed that all but one of the 127 medical schools had courses that included medical ethics. Thirty eight of these had medical ethics as a required course (Pellegrino 1985). And by 1989, 43 of the 127 medical schools had separate courses in medical ethics, while 100 covered medical ethics within required courses. Medical ethics is now an accepted part of medical curriculum, though it is not fully mature, and its future remains somewhat unclear (Miles 1989).The evolution of ethics in the nursing curriculum has essentially mirrored that of the medical curriculum. A 1977 survey of baccalaureate nursing programs revealed that only 7 percent of nursing programs required courses in ethics [End Page 171] (Aroskar 1977). A decade later a second survey of undergraduate programs identified 85 percent of responding nursing schools as teaching nursing ethics either in separate ethics courses or within other required courses (Cassells and Redman 1989).Though the precise future of health care ethics may be unpredictable, there is little thought that the role of ethics will diminish in importance as the 21st century approaches. Ethics is seen as part of a larger plan to develop and enhance the health professional's human values, social conscience, and interpersonal skills. "This broader effort derives from concerns about the personal attributes and humanistic sensitivity of physicians, the recent overly 'scientized' trend in premedical education, the selection of medical students, and the socialization and cynicism engendered by medical education" (Miles 1989, p. 705).While nearly every medical and nursing school in the United States now teaches ethics in one form or another, the degree to which ethics is integrated into the curriculum varies from school to school. Some ethics courses are required elements of the students' education; some institutions require attendance at seminars and ethics grand rounds. Other schools offer an array of elective courses in topics that relate to ethics in medicine and nursing (including medical humanities, medicine and the law, literature and medicine, history of medicine, patient advocacy, and human values in nursing.) "Brown bag" seminars and journal clubs are also common.There is much debate over how health care ethics should be taught. Some argue that medical professionals should be conversant with theories of ethics and principles of biomedical ethics. Others think that a theoretical approach will alienate already over-worked medical or nursing students, and that instruction in ethical theory should be kept to a minimum. Case studies are frequently cited as a way to involve students in medical decision making, forcing them to analyze problems that they can relate to their own experiences.Additional concerns center around who should teach health care ethics. Frequently, physicians and nurses interested in ethics teach courses. Some commentators see this as the most desirable arrangement, asserting that practicing health care professionals best understand the conflicts faced by physicians and nurses-in-training. However, there is a growing pool of professionals who are undergoing training as medical ethicists. These individuals study ethical theory and bioethical... (shrink)

The rapid advances and scope of the Human Genome Project bring into sharp focus the relevance of genetics and ethics for nursing and midwifery practice in the new millennium. This article offers a UK perspective on how education plays a crucial part in preparing practitioners to integrate clinical advances effectively and ethically, yet may be failing in this role. Provision for teaching genetics in the UK has been found to be largely inadequate and the ethical implications (...) of this are reviewed. The context of genetics teaching is a further issue. Genetics is classified in the bioscience component of training courses in nearly 70% of UK nursing colleges; this may be of significance in its perceived relevance to practice. Finally, the ethical issues around the teaching of genetics will be discussed. Educators who are involved in delivering the genetics component of the curriculum are under an obligation to consider how learning is best achieved and how the delivery itself should be ‘ethical’. (shrink)

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25th conference of the International Philosophy of Nursing Society 16th August 2022. Using the literary meaning of ‘whither’, that is ‘to what place’, this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led (...) to where it sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners. (shrink)

This article considers the multifaceted concept of ethics and how, despite being a familiar notion within education, it is still much contested within literature and professional practice. Drawing on postmodern, feminist and political literature, the authors explore conceptualisations of ethics and ethicality in relation to ethical identity, professionalism and practice. Applying philosophical and metaphorical tools, such as the rhizome and nomad, the authors suggest there is the potential to accommodate the multiple and often divergent facets of ethics, (...) thereby engaging with different ethical possibilities. It is argued that the propensity for reducing ethics to merely procedural protocols and guidelines marginalises the richness of ethics and, all too frequently, leaves practitioners ill-equipped to navigate the reality of day-to-day ethics.The article is positioned within the field of early years practice and training EY practitioners. This reflects the authors’ own specialism but also celebrates the propensity of the EY practitioner to reflect upon, question and challenge their own practice and ethical identities. This does not reduce the applicability of the subject matter which is relevant to educators of children of any age. The term ‘practitioner’ is used throughout to refer to any adult working with children in an educative role, this includes, but is not limited to nursery nurses, teachers or teaching assistants. (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)

O objetivo deste artigo é analisar a ética do cuidado de enfermagem no tratamento de pacientes oncológicos. Optou-se pela pesquisa bibliográfica de abordagem qualitativa cuja metodologia foi dividida em etapas. Na primeira etapa, foi realizado um levantamento de artigos publicados, no período de 2000 a 2009, em periódicos do Scielo, utilizando os descritores: saúde/doença, enfermagem, ética do cuidado e oncologia. Esse levantamento culminou com a seleção de 28 artigos, 21 dos quais foram eleitos posteriormente para leitura aprofundada, assim como para (...) utilização no estudo. Na segunda etapa, foram explorados dados do campo, com a transcrição e análise de depoimentos de profissionais da enfermagem sobre a concepção de cuidado bem como de dados sobre pacientes oncológicos, acompanhados no período de 2007 e 2008. A pesquisa e suas exigências protocolares, sob o número CAAE - 0147.0.213.000-10, foi aprovada pelo Comitê de Ética da PUC Minas em 31 de agosto de 2010. O referencial teórico foi composto por autores que discutem o cuidado na perspectiva filosófica e teológica - Boff (2001, 2005 e 2006), Efken (2005) - e autores da área da saúde oncológica, entre eles, Carvalho et al. (2002), Popim & Boemer (2005), Visentin, Labronici & Lenardt (2007) e Araújo et al. (2009). Os resultados evidenciaram o cuidado na enfermagem como princípio ético essencial, assim como a necessidade de investimentos em políticas públicas de saúde no Brasil, que efetivem o trabalho de prevenção, educação e cura do câncer. Palavras-Chave: Saúde/Doença; Enfermagem; Ética do cuidado; Oncologia.The objective of this article is to analyze the nursing care in the treatment of oncology patients. We have opted for bibliographical research of qualitative nature, a methodology divided into stages. In the first stage we gathered articles in a publication called Scielo from 2000 to 2009, which described: health/illness, nursing, ethics of care, and oncology. Through this process the selection of twenty-eight articles was accomplished, however only twenty-one articles were utilized in the production of this study. In the second stage field data were explored, we transcribed and analyzed the statements of nursing professionals on the conception of care and on oncology patients overseen by them in the period of 2007 to 2008. The research protocol and its requirements under the number CAAE - 0147.0.213.000-10, was approved by the Ethics Committee of PUC Minas on August 31, 2010. The theoretical support was provided by authors who discuss care in a philosophical and theological perspective: Boff (2001, 2005, and 2006), Efken (2005); and authors in the field of healthcare, among them Popim & Boemer (2005), Silva et. al , (2005), Souza et al. (2005), Visentin, et al. (2007), and Araújo, et. al. (2008). The results demonstrated the care in nursing as an essential ethical principal, as much as the necessity of investment in public health policies in Brazil, for the effective promotion of cancer prevention, education and cure. Key words : Health/Illness; Nursing; Ethics of Care; Oncology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to Estelle R. Jorgensen, “Four Philosophical Models of the Relationship Between Theory and Practice”W. Ann StokesEstelle Jorgensen has written a most interesting paper contrasting four different concepts of the relationship between theory and practice, and pointing out the advantages and disadvantages of each. Each approach introduces insights that the others have missed, but is not sufficient in itself to explain all the relationships between theory and (...) practice. In response to the concept of "dichotomy," I am also sympathetic to the attempt to distinguish practice and theory because it identifies two important constituents of experience, and it provides a fruitful way of investigating the relationship between the two concepts. However, I believe that a concept of dichotomy may put the two categoriees in too distant a relationship with each other. This distance may prevent us from recognizing the "interconnections and cross-fertilizations" that are often possible between them.The idea of "polarity" opens up the possibility of focusing on the ground [End Page 102] between the two concepts. It also provides a framework for allowing "practice to bubble up into theory," and "theory to bubble up into practice." Given that a theory may bring about a range of different practices and that practices may be based upon a range of differing theories, one needs to be able to move easily between the two worlds. Imagination, intuition, and rational thinking all contribute to our understanding of the relationship between the two concepts. In this situation of polarity one should not expect to find "a theory perfectly translated into a particular practice, or a practice drawing entirely and fully on one particular theory."I am also sympathetic to the view that "theory without practice is mentalism," and that "practice without theory is activism or instrumentalism bare of guiding principles," but like Jorgensen I find the concept of fusion the least helpful of the four concepts. Given the fact that very rarely (if ever) is theory perfectly exemplified in practice, or practice based solely upon one specific theory, the concept of fusion in many instances is too absolute. I am open to the suggestion that moral principles as well as aesthetic ones should guide the practice of music education despite the difficulties that a multiplicity of perspectives opens up. I also agree that democratic ideals can offer us one way of guiding the decisions made in the classroom and can offer a rallying point for persons coming from different ethnic, religious, political, and cultural backgrounds.The dialectical approach opens up a way to negotiate among differences of opinion and beliefs that influence practice. It assumes that there is no one perfect perspective on the relationship between theory and practice. The dialectical approach provides (1)a framework to investigate the theories and practices of which practitioners are aware, (2)opportunities to examine how practitioners adjudicate them, and (3)explanations of how and why they decide to act "in their particular lived situations." In contrast to the ontological approach, I like Jorgensen's epistemological approach to the investigation of theory and practice. It offers another perspective in addition to the influence that ontological theories can have in guiding music education practice.My view of the ideal relationship between theory and practice is one that acknowledges the differences between the two concepts, but allows for a variety of relationships between the two. It is one that recognizes that theory should influence practice and that practice should influence theory in an ongoing and continuous reciprocal exchange. It entails being sensitive to a variety of theories and particular practices, and being skilled at being able to pick which particular theory or theories best explains the practice observed.In addition to the concepts of dichotomy, polarity, fusion, and dialectic, another possible concept of the relationship between theory and practice might be based upon Michael Lewis, Margaret Sullivan, and Linda Michalson's view [End Page 103] of the "cognitive-emotional fugue."1 This perspective has the advantage of being very flexible. The authors describe emotion and cognition as being neither separate nor independent processes. "Rather both are elements of a continuous, inseparable stream of behavior like the parts of a fugue in which the theme is often lost... (shrink)