Nursing policy and healthcare reform are focusing on two, interconnected areas: person‐centred care and fundamental care. Each initiative emphasises a positive nurse–patient relationship. For these initiatives to work, nurses require guidance for how they can best develop and maintain relationships with their patients in practice. Although empirical evidence on the nurse–patient relationship is increasing, findings derived from this research are not readily or easily transferable to the complexities and diversities of nursing practice. This study describes a (...) novel methodological approach, called holistic interpretive synthesis (HIS), for interpreting empirical research findings to create practice‐relevant recommendations for nurses. Using HIS, umbrella review findings on the nurse–patient relationship are interpreted through the lens of the Fundamentals of Care Framework. The recommendations for the nurse–patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients to deliver person‐centred fundamental care. Future research should evaluate the validity and impact of these recommendations and test the feasibility of using HIS for other areas of nursing practice and further refine the approach. (shrink)

Background: Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care. Objectives: The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers. Research design: This was a qualitative exploratory study. Data were analyzed (...) using the conventional content analysis method. Participants and research context: Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method. In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection. Ethical considerations: The study was approved by the University’s Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study. Findings: Data from interviews and filed notes were analyzed and classified into three themes: “effective interaction,” “professionalism,” and “continuous comprehensive care.” Discussion and conclusion: Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients’ and family caregivers’ comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics’ standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care. (shrink)

Background Providing quality care is of the fundamental elements of holistic nursing practice, and burnout and moral intelligence of nurses be mentioned as the important factors influencing the quality of nursing care. The present study was conducted to investigate the relationship between moral intelligence, burnout, and the quality of nursing care. Methods This descriptive-correlative study was conducted on 125 nurses working in Sari-based Educational hospitals affiliated to Mazandaran University of Medical Sciences, Iran, between (...) June and August 2020. The sample was selected via random sampling. The data were collected by the Maslach Burnout Inventory, Lennick and Kiel Moral Intelligence Scale, and Quality of Patient Care Scale. The data were analyzed by SPSS-21 and Amos-24. Results A direct and significant relationship was found between the quality of nursing care and moral intelligence ( r = 0.285, p = 0.001). Quality of care had an inverse relationship with subscales of frequency of burnout including emotional exhaustion ( r = −0.369, p < 0.001) and depersonalization ( r = −0.471, p < 0.001) and also, a direct relationship with personal accomplishment ( r = 0.226, p = 0.011). The findings also showed an inverse relationship between quality of care and subscales of the intensity of burnout. Amos software yielded results that demonstrated moral intelligence as a robust mediator between burnout and the quality of care. Conclusion The findings implied the necessity for more attention to moral intelligence as a mediator in order to come up with properly managing the personality traits influencing the nurses’ burnout reduction, which can ultimately lead to improved quality of nursing care. (shrink)

Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in (...) the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit. (shrink)

Background:The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings.Objectives:This study aimed to evaluate Iranian nurses’ perceived professional competence in spiritual care, the relationship between perceived competence and nurses’ personal characteristics, and barriers to provide spiritual care.Research design:A cross-sectional study was conducted in the year 2014.Participants and research context:The study population consisted of nurses working in teaching hospitals in Kashan city. Using a (...) stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses’ competencies in spiritual care.Ethical considerations:A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent.Results:Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses’ overall score of competence in spiritual care and receiving training on spiritual care, nurses’ position, and the ward they worked in.Discussion:Confirming the findings of the international literature, this study puts light on the situation of nurses’ perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context.Conclusion:Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care. (shrink)

Caring is at the core of what nurses and other health professionals do. But caring encompasses more than simply looking after people's physical health needs. People requiring any health service will have psychological needs that affect their feelings, thoughts, and behaviour. Good psychological care can even help improve physical health outcomes. An Introduction to Psychological Care in Nursing and the Health Professions explains and promotes the importance of psychological care for people when they become physically ill, (...) giving a sound theoretical basis to ensure care is evidence-based. It encourages the reader to think about the effects of illness and disability on patients, and to understand what can be done to identify and minimise any difficulties they might be experiencing in these areas. The chapters cover: the meaning and elements of care and holistic care; a model of psychological care in practice; the personal qualities and skills of carers that best underpin psychological care delivery, and how these might be enhanced; the knowledge needed for effective psychological caregiving; psychological care as it might be practised in a range of health care settings. This text contains key learning points, practical activities, reflective exercises and case illustrations. It is ideal for student and practising nurses, and health professionals who would like to improve their care for patients in this essential area. (shrink)

Background:It is stated that high ethical sensitivity positively affects the quality of nursing care. However, the relationship between nursing care quality and ethical sensitivity has not been clearly demonstrated in researches.Aim:This study was carried out to determine the relationship between surgical nurses’ care behaviors and their ethical sensitivity.Method:The sample of this cross-sectional, descriptive-correlational study consists of 308 nurses who worked at the surgical departments in four Turkish hospitals. The data were collected using the “Nurse Description (...) Form” developed by the researcher, “Caring Behaviours Inventory-24” and “Ethical Sensitivity Questionnaire.” Data were evaluated by the Mann Whitney U test, Kruskal Wallis one-way analysis of variance and Spearman correlation analysis.Ethical considerations:The study was approved by the ethics committee. Verbal and written consent was received from the nurses.Results:It was found in the study that nurses’ Caring Behaviours Inventory-24 total score median was 5.25 (4.83–5.58), nurses’ perception level of caring quality was high, median of Ethical Sensitivity Questionnaire total score was 89.00 (75.00–101.00) and nurses’ ethical sensitivity was moderate. A negative significant relation was found between nurses’ Caring Behaviours Inventory-24 total score and Ethical Sensitivity Questionnaire total score (r = -0.162; p = 0.009). A negative relation was also detected between nurses’ working period at the current clinic and providing benefit (r = -0.147; p = 0.012), holistic approach (r = -0.139; p = 0.018) and orientation (r = -0.175; p = 0.003) scores of Ethical Sensitivity Questionnaire sub-scales.Conclusion:Nurses’ perception levels of caring quality were high and their ethical sensitivity levels were moderate. It was found out that nurses’ ethical sensitivity increased together with their perception of caring quality, and as their working period at the current clinic increased, the ethical sensitivity also increased in terms of the sub-scales of providing benefit, holistic approach, and orientation. The factors that adversely affect the quality of nursing care and ethical sensitivity should be examined and attempts should be made to improve the working environment. (shrink)

This article explains the attempts of nurses to practice humanistic, holistic care in line with their professionalizing strategy. Ideally, the intention of nurses is to broaden their concerns beyond the physiological needs of patients, thereby circumventing biomedical control over their work. However, the author argues that resource constraints, and the coalescing of biomedical and managerial definitions of patients, suggest that holistic notions of care are subjected to a new form of calculus and normalizing technology. Critically, nurses (...) are more preoccupied with the day-to-day struggle to free up resources for healthcare, in particular bed spaces, and to pre-empt the problem of bed blocking. Such work suggests that the ‘emptying of beds’ is not just a symbol of accomplishment for nursing work. From the governmentality theory of Foucault, the administration of ‘beds’ has become part of the managerial power/knowledge discourse and an instrument for making nurses toe the financial bottom-line. (shrink)

BackgroundRationing of care in nursing is nurses' inability to complete all care activities for patients because of scarcity in time and resource. Literature suggests that rationing of care is closely related to patient safety and quality of care. The phenomena have been defined and studied from varied perspectives and contexts. A systematic review of studies related to the concept was aimed at identifying and synthesizing the finding.MethodsThe review followed Preferred Reporting Items for Systematic Reviews and (...) Meta‐analysis guidelines, and literature searches were conducted in MEDLINE, CINAHL, PsycInfo, Web of Science and EMBASE databases. Fifty‐seven quantitative studies were included in the review.FindingsThe review observed that nursing activities addressing the emotional, educational, mobility and hygiene needs of the patients were commonly rationed. Antecedents of rationing included resource inadequacy and organizational work environment. Rationing influenced patient satisfaction, mortality and a number of adverse events and was associated with decreased job satisfaction, increased intention to leave and high turnover among nurses.DiscussionsThis review concludes that rationing in nursing is ubiquitous, embedded in the work environment and poses a threat to the professional health and philosophical base of nursing in addition to having serious implications on patients' safety. Strategies to reframe and reconsider organizational traits, and open discussion with other healthcare stakeholders can reduce rationing of nursing care. The review suggests future researchers adopt different methodological layout to study rationing. (shrink)

Employs philosophy to help illuminate the nature of nursing and provide a holistic view of both nursing and persons.

Background: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse–patient relationships. Aim: This study aimed to understand the experience of nurses who cared (...) for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. Research design: A qualitative descriptive study using a phenomenological approach. Participants and research context: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi’s method. Ethical considerations: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Findings Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: the calling must be answered, the calling provoked my feelings, and the calling called out my strengths. Conclusions: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient–nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving. (shrink)

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

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

In this paper, the historical alignment of nursing with divinity‐based perspectives and modern New Age nursing theories are explored. The nature of divinity in nursing is examined, together with the complexities and issues that arise in adopting a spiritual basis for care. The work of the key theorists in this area (Rogers, Newman, Parse, Watson, Dossey) is reconsidered and fundamental epistemological problems inherent in this approach reviewed. Specific concerns with the interpretation of holistic care, (...) adoption of doxastic logic, faith‐based rationales, influence of Caucasian Judeo‐Christian and New Age values, misappropriation of science, use of pseudoscience and development of divinity as social consumer product are discussed. Practical problems with using a spiritual basis in contemporary nursing practice are also explored and the alignment of divinity‐based nursing theories with the modern antiscience movement is examined. Overall, the re‐emergence of divinity‐based nursing and spiritual basis for care may be problematic, and would seem to counter the development of an inclusive profession. Additionally, the alignment of nursing with antiscience movements rejecting biomedicine has significant public health implications. This is argued as a regressive step for the advancement of the profession. (shrink)

This practical guide explores professional values in nursing, helping you to develop safe, compassionate, person-centred and evidence-based practice. The fundamental values of equality, anti-discriminatory practice and caring are discussed throughout. Chapters explore person-centred and holistic nursing care. They discuss working in partnership with people and families and working in partnership within the interprofessional team. The book explores vulnerability and safeguarding, challenging poor practice and promoting best practice. Chapters are mapped to NMC Standards for Pre-registration Nursing (...) Education. Strong evidence base to ensure best practice. Accessible style with features including learning outcomes, key points, summary boxes, case studies, reflection points and questions. Relevant to all fields of nursing, with case studies representing patients across the lifespan and with different healthcare needs. Free online resources include PowerPoints, additional scenarios and questions. Professional Values in Nursing is a valuable resource for all nursing students, helping to embed professional values in your everyday practice. (shrink)

In July 1993, the Scottish Highlands Centre for Human Caring sponsored a conference with the title Exploring the Spirituality in Caring. The papers given at the conference and included in this volume are offered as a contribution to the debate that must take place in nursing and in the wider context of health care provision. Ann Bradshaw's paper puts the debate in context arguing that nursing is fundamentally a loving response to the human being created in the (...) image of God. (shrink)

Spirituality has been a part of nursing for many centuries and represents an essential value for people, including nurses and patients. Cumulative evidence points to the positive contribution of spiritually on health and wellbeing. However, there is little clarity about what spirituality means. The literature reveals that nurses have ascribed a diversity of interpretations to spirituality. However, no studies have investigated how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Therefore, the aim of this (...) study was to uncover how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Twenty registered nurses from a non‐denominational public hospital and a faith‐based private hospital were interviewed about their understanding of spirituality and practice of spiritual care. A critical discourse analysis approach was used in the examination of the interview texts to uncover underlying social and power features. Links were made between the linguistic features the registered nurses used in their interviews and the broader social context of the study. Three discourses emerged from the interview texts. These include constructing spirituality through personal religious beliefs discourse, holistic discourse and empathetic care discourse. The findings of this study have implications for nurse education and policy makers. (shrink)

Netley Hospital played a crucial role in caring for the wounded during the nineteenth century and twentieth century, becoming one of the busiest military hospitals of the time. Simultaneously, Florence Nightingale delved into the concept of health and developed the theoretical basis of nursing. This research aims to describe the experiences related to nursing and patient care described in The Netley British Red Cross Magazine during the First World War. The analysis displays different nurses' roles and the (...) influence of environmental factors in the delivery of the soldiers' care. There are indications that Nightingale's ideas would have infiltrated the nursing practices and other aspects of the soldiers' recovery at Netley. The history of the Netley Red Cross Hospital shows the theoretical and practical advancement of nursing care towards a holistic approach. (shrink)

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health‐centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to (...) integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision‐makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework. (shrink)

The introduction of nurse‐led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call‐centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South (...) Wales, UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call‐centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional ‘hands‐on’ models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries. (shrink)

This paper presents the author's model of humility structures that can be operationalized as behaviours and incorporated into healthcare practice, the Humility in Health Care Model. The Humility in Health Care Model expands and combines the concepts of cultural humility, holistic nursing, servant leadership and the Chinese concept ‘QIAN’. The paper identifies ways to create a regular practice of humility behaviours on the personal/interpersonal, leadership, systems and policy levels. The paper discusses the benefits of operationalizing humility, (...) forces that favour humility and barriers to practicing its behaviours. Suggestions for future research on humility in the healthcare professions are offered. (shrink)

As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often (...) a contentious topic and employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti‐reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology. (shrink)

Now in its sixth edition, this highly popular text covers the range of ethical issues affecting nurses and other healthcare professionals. Authors Simon Robinson and Owen Doody take a holistic and practical approach, focused in the dialogue of ethical decision making and how this connects professional, leadership and governance ethics in the modern healthcare environment. This focuses on the responsibility of professionals and leaders, and the importance of shared responsibility in the practice of healthcare. With a foreword by the (...) eminent medical ethicist Alastair Campbell, the revised edition includes contemporary topics, such as the duty of candour, recent cases, such as the Mid Staffs scandal, and ethical perspectives on vulnerable groups, such as; persons with intellectual/learning disability, dementia and those with an enduring mental illness. It builds on professional identity and personal development as part of ongoing learning, individual and organizational, and provides interactive ways that helps the reader to develop reflective ethical practice. This text aims to enable ethical engagement with the ever changing healthcare environment, and is a must-have for anyone serious about ethics in healthcare. Holistic and practice relevant approach New perspectives on vulnerable groups, such as persons with intellectual/learning disability, dementia and those with an enduring mental illness Descriptive as well as normative ethical theory Promoting dialogue and engagement with practice, practitioners, patients and families Development of professional ethical skills Connecting professional ethics to leadership, governance and social ethics Highly accessible format Case studies/Scenarios presented within chapters and pause for thought exercises to promote dialogue and engagement? Suitable for pre/post registration nurses, students, health care professionals. (shrink)

Background The ambulance service provides emergency care to meet the patient’s medical and nursing needs. Based on professional nursing values, this should be done within a caring relationship with a holistic approach as the opposite would risk suffering related to disengagement from the patient’s emotional and existential needs. However, knowledge is sparse on how ambulance personnel can meet caring needs and avoid suffering, particularly in conjunction with urgent and emergency situations. Aim The aim of the study (...) was to explore ambulance nurses’ experiences of relationships with patients in urgent and emergency situations. Methods Data collection was performed using individual open-ended interviews with six ambulance nurses. The data were analyzed using a thematic analysis. Results Relationships with patients during urgent and emergency assignments emerged as three themes: “ Ambiguous silence,” “ Professional competence” and “ Challenging inadequacy” comprising eight sub-themes in total. The result shows that the ambulance nurses found it difficult to prioritize between medical care and establishing a caring relationship with the patient. However, sometimes a wordless relationship was perceived sufficient and considered a first step towards a verbal relationship. Conclusions Ambulance nurses experience that a caring relationship cannot and does not need to be prioritized in the acute stage. This uncovers a dichotomy approach to medical care versus caring relationships that exclude a holistic approach. Thus, patients’ emotional, existential and physical needs are not considered as equally important. Clinical relevance: It is important to stimulate reflection on core ethical nursing values, in training and simulation exercises among clinically active ambulance nurses. (shrink)

Background:Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care.Objectives:The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and (...) die at home?, and identify gaps in the knowledge.Method:Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings.Results:34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role.Discussion:Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas.Conclusion:It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered. (shrink)

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the (...) article argues, and the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse. (shrink)

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the (...) article argues, and the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse. (shrink)

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real‐life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are (...) described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future. (shrink)

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the (...) use of music within a holistic, caring‐healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music‐based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well‐being of this vulnerable group of older persons. (shrink)

Spirituality has long been considered a dimension of holistic palliative care. However, conceptualizations of spirituality are in transition in the nursing literature. No longer rooted within religion, spirituality is increasingly being defined by the universal search for meaning, connectedness, energy, and transcendence. To be human is to be spiritual. Some have argued that the concept of spirituality in the nursing literature has become so generic that it is no longer meaningful. A conceptualization that attempts to be (...) all‐encompassing of what it means to live a human life has a tendency to render invisible the differences that make life meaningful. For palliative patients in particular, a generic approach may obscure and relativize the important values and beliefs that inform the critical questions that many patients grapple with at end of life. A different approach to conceptualizing spirituality can be achieved through the use of typologies. Rather than obscuring difference, categories are constructed to illuminate how spirituality is understood within a diverse society and how those understandings might influence patient–provider relationships. What follows in this article is a dialogue illustrating one typology of spirituality constructed from a review of selected nursing literature. The hypothetical narrator and three participants, representing the positions of theism, monism, and humanism, discuss their understandings of spirituality and religion, and how those understandings influence the intersections between nursing ontology, epistemology, and spiritual care. (shrink)

Humanism in nursing: the emergence of the lightThis paper examines Western nursing practices by focusing on their spiritual aspect. The transformation of the informal and poorly trained nurse into the trained and uniform persona of the modern nurse is the subject of many nursing histories and part of nursing mythology. Using the work of Michel Foucault and Marcel Mauss, the nursing that preceded the 19th century reformers is re‐examined and continuities between current and quite ancient (...) practices of nursing are explored. The development of practices or technologies for care of the sick originated with the establishment of hospitals in the 4th century as part of pious Christian practice. Current practices of care and the discourse of holistic nursing are argued to have grown from these traditional Christian technologies of care. Humanist or holistic nursing represents the enshrinement of the Christian edios – freed of doctrine; the discourse of caring a redrafted Christian discipline of love. (shrink)

The metaparadigm concept of person as a core emphasis for nursing theorizing has attracted considerable attention in western literature, but has received less attention in the context of eastern philosophical contexts. In this philosophical inquiry, we sought to clarify the concept of what it is to be a human being according to ideas deriving from Islamic tradition, drawing on concept analysis as general approach to advance an understanding of how nursing within an Islamic context might operationalize metaparadigm conceptualization. (...) Specifically, we considered person as human being on the basis of its definition, attributes/characteristics and boundaries to explore the anatomy of the concept in this context. Our analysis revealed that Islamic thought is relevant to two distinct understandings of the holistic concept of human being. Reciprocal interaction worldview organizes the dimensions of being human (cognitive, emotion, social and spiritual) into a whole. Simultaneous action worldview emphasizes that the human is a coherent and unified creature in harmony with the universe. In Islamic thought, these two worldviews are integrated and operate concurrently. Nurse–patient interactions arising from an integrated perspective that aligns both of these worldviews will allow for informed applications of knowledge to practice and enhanced patient care. (shrink)

Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values (...) that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’ drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement palliative care philosophy in practice. (shrink)

Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values (...) that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients’ drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses’ profession in the palliative field and help them implement palliative care philosophy in practice. (shrink)

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health (...) outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. (shrink)

Genetic information and technologies are increasingly important in health care, not only in technologically advanced countries, but world-wide. Several global factors promise to increase future demand for morally conscious genetic health services and research. Although they are the largest professional group delivering health care world-wide, nurses have not taken the lead in meeting this challenge. Insights from feminist analysis help to illuminate some of the social institutions and cultural obstacles that have impeded the integration of genetics technology into (...) the discipline of nursing. An alternative model is suggested - the transdisciplinary model - which was developed initially by a nurse and introduced in the 1970s into the delivery of health care and social services for children with developmental disabilities. This holistic model enables all health care professionals to have an equal voice in determining how genetic health care will be globalized. (shrink)

Undoubtedly, the discipline of nursing has been influenced extensively by both Western and Eastern/Asian philosophies. What remains unknown or, perhaps, poorly articulated is the potential influence of African philosophy on the onto‐epistemology of nursing. As a starting point, this article sought to examine the core claims of African philosophy and how they may offer new meanings to the metaparadigm domains of interest in the discipline of nursing. At the core of African philosophy is the notion of personhood (...) (which is distinguished from what it means to be a human being), community, solidarity, and relationality. A major claim of African philosophy is the notion that ‘a person is a person through persons’ which may mean that nursing will be relevant from the African philosophical perspective if it is able to attain this. Health and illness from the African philosophical perspective are defined relationally which shifts attention from the biomedical framework to holism and relational care. The sick ‘person’ is also distinguished from the sick ‘human being’ which has the potential of leading to exclusion from the African philosophical viewpoint. Put together, the African philosophical stance potentially extends the meaning of the metaparadigm domains of interest to the discipline of nursing which warrants further exploration. (shrink)

This article presents the works of great Polish philosopher, Mieczysław Albert Krąpiec, whose creative output can be applied to professional nursing practice. Krąpiec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Krąpiec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Krąpiec: the theory of the person based (...) on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Krąpiec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all—not only selected—qualitative deficits of characteristics can be defined as holistic care in the nursing profession. (shrink)

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

This article reports on research that examines newly qualified UK nurses’ experiences of implementing their ideals and values in contemporary nursing practice. Findings are presented from questionnaire and interview data from a longitudinal interpretive study of nurses’ trajectories over time. On qualification nurses emerged with a coherent and strong set of espoused ideals around delivering high quality, patient‐centred, holistic and evidence‐based care. These were consistent with the current UK nursing mandate and had been transmitted and reinforced (...) throughout their ‘prequalification’ programmes. The existence of professional and organisational constraints influenced their ability to implement these ideals and values once in practice. Data analysis revealed that within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of ‘burnout’ as a consequence of their ideals and values being thwarted. This led to disillusionment, ‘job‐hopping’ and, in some cases, a decision to leave the profession. These data are explored and discussed to inform the question of whether the current nursing mandate is sustainable. (shrink)

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support (...) for ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

Human Progress is often understood to be a rather natural and obvious truth of human existence. That this is not necessarily so, is indicative of the pervasive social, psychological, and educational inculcation that sustains its ubiquitous acceptance. Moreover, the uncritical and ill‐informed understanding of Progress as an unquestioned expression of human beneficence has serious consequences for those concerned with the health and welfare of people. It is argued in this paper that, much of what we might consider deleterious in the (...) socio‐political milieu that now confronts us is, to a significant extent, a matter of progressive ideological epistemology and its ensuing manner of human institutionalization. Part one contends that the current socio‐political structure of the current postmodern affairs is in reality that of a pervasive postmodern economic ideology. Part two provides a brief overview of the historical and philosophical development of Progress as an idea, including some of the profound effects wrought by it on human affairs in the contemporary world. Finally, Part three presents a discussion of the influential effects of the philosophy of Progress on the epistemology of human health and welfare intervention, specifically that of nursing and its claim to a holistic ethic of Caring. (shrink)

Our aim was to employ a critical analytic lens to explicate the role of nursing research in supporting the notion of caring realities. To do this, we used case exemplars to illustrate the infusion of such discourses. The first exemplar examines the fundamental concept of caring: using Florence Nightingale's Notes on Nursing, the case study surfaces caring as originally grounded in ritualized practice and subsequently describes its transmutation, via competing discourses, to a more holistic concept. It is (...) argued that in the many and varied attempts to define the dynamic concept of care, caring has now become paradoxically, a more fragmented concept despite attempts to render it more holistic and inclusive. In the second exemplar, one of the authors draws on her personal experience of the gap between theory and practice, so pronounced that it pushed the author to revisit the concept of evidence‐based practice and nursing education. In our third and final exemplar, we refer to the absence of knowledge and practice generated through natural enquiry and curiosity, an absence which has led to production of corporate led rhetoric. Drawing together the central arguments of the three exemplars, we reflect on the influential role of nursing research in enabling the deconstruction of taken for granted assumptions such as caring, evidence‐based practice and empowerment; assumptions which have been generated by discourses riddled with confusion and alienation from the reality of practice and the natural spirit of professional enquiry. (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)

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect - the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be fully ethical beings or cannot (...) respect patients’ religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients’ religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed. (shrink)

The need for human touch is universal among critical care patients and is an important component of the nurse–patient relationship. However, multiple barriers to human touch exist in the critical care environment. With little research to guide practice, we argue for the importance of human touch in the provision of holistic nursing care.