Showing papers in "Advances in Nursing Science in 1994"
TL;DR: This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity and the implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.
Abstract: This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity. The seven key properties of marginalization as it applies to the domain of nursing are (1) intermediacy, (2) differentiation, (3) power, (4) secrecy, (5) reflectiveness, (6) voice, and (7) liminality. Through examination of each of these properties, the relationship between marginalization and vulnerability is clarified, and by this means the relevance of marginalization for health is established. The implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.
307 citations
TL;DR: The challenge for nursing will be to sharpen the “gaze of nursing,” which is an antidote to the strictly biomedical understanding of disease.
Abstract: One result of the historical division of labor between nurses and physicians is that nurses became the eyes and ears of the physician, extending their perceptual capabilities across space and time. This “gaze of medicine” has evolved with the rise of technology, hospitals, and the medical profession
147 citations
TL;DR: Interview and observational data obtained from caregiver-care recipient dyads were analyzed in a theory of enrichment that explains how some families use pleasurable or meaningful experiences in their caregiving to frail elders.
Abstract: Interview and observational data obtained from caregiver-care recipient dyads were analyzed in developing a theory of enrichment that explains how some families use pleasurable or meaningful experiences in their caregiving to frail elders. The personal history and frailty trajectory of both caregiver and care recipient, the quality of the dyadic relationship, and the caregiving situation are antecedents to enrichment processes. Core elements influencing the nature of enriching events include acquiring symbolic meaning, performing activity, and fine tuning. Categories of enrichment events are customary routines and innovative routine breakers. Consequences of enrichment are relationship and identity sustenance for both caregiver and care recipient, comfort for the care recipient, and rewards of meaning for the caregiver.
116 citations
TL;DR: A dialectical study was undertaken to identify the distinct conceptions of nursing art that are represented in the nursing literature and revealed five distinct conceptualizations that can be identified as the art of grasping meaning in patient encounters.
Abstract: Literature relevant to the art of nursing is immensely diverse and fragmented. This state is problematic in that progress in understanding nursing art cannot be made until the subject of nursing art is clearly delineated. In light of the need for conceptual clarity regarding nursing art, a dialectical study was undertaken to identify the distinct conceptions of nursing art that are represented in the nursing literature. The examined discourse was that contained in the works of 41 nursing scholars published between 1860 and 1992. The analysis revealed five distinct conceptualizations that can be identified as the art of (1) grasping meaning in patient encounters, (2) establishing a meaningful connection with the patient, (3) skillfully performing nursing activities, (4) rationally determining an appropriate course of nursing action, and (5) morally conducting one's nursing practice.
95 citations
TL;DR: The use of hermeneutic photography as an esthetic technique to enhance data generation is discussed and suggestions for the use of photographs within nursing research are presented.
Abstract: In this article, the use of hermeneutic photography as an esthetic technique to enhance data generation is discussed. When photographs are used as an entree for interviewing participants, they often elicit participants' stories and illustrate themes of experience. A discussion of the uses of hermeneutic photography as a method and suggestions for the use of photographs within nursing research are presented.
81 citations
TL;DR: A study of the strengths and personal resources of women who had overcome homelessness revealed that the experience of homelessness for these women was a temporary state of disruption resulting from an effort to free themselves from conditions associated with despair, such as abuse or addictions, and to search for a better life.
Abstract: A study of the strengths and personal resources of women who had overcome homelessness revealed that the experience of homelessness for these women was a temporary state of disruption resulting from an effort to free themselves from conditions associated with despair, such as abuse or addictions, and to search for a better life. Personal, interpersonal, and transpersonal categories of strengths were identified that enabled these women to move in a positive direction toward health and self-actualization. The synthesizing metaphor “swimming up-stream” describes the stoic determination required to go against the overwhelming negative forces of their environment.
62 citations
TL;DR: A heuristic approach employing Newman's method for pattern identification was used to examine the theory of health as expanding consciousness in persons with human immunodeficiency virus (HIV)/acquired immunodficiency syndrome (AIDS).
Abstract: A heuristic approach employing Newman's method for pattern identification was used to examine the theory of health as expanding consciousness in persons with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Themes derived from the interview of nine gay men portrayed a pattern of alienation during childhood, followed by a breaking away from family, and progressing to cycles of aloneness and searching. Recognition of HIV/AIDS in their lives brought them to a turning point of more meaningful connectedness. This pattern is viewed as expanding consciousness and possibly a phenomenon of cultural evolution.
61 citations
TL;DR: Information processing and nursing process components related to problem identification and problem solving serve as a framework for the integration of the two domains of clinical reasoning.
Abstract: Literature on clinical judgment is discussed as a background for proposing an integrated model of diagnostic-therapeutic and ethical reasoning. Information processing and nursing process components related to problem identification and problem solving serve as a framework for the integration of the two domains of clinical reasoning. Discussion focuses on the integration of process components, identification of areas of research, and the use of the model in education and practice.
54 citations
TL;DR: An ethnography was conducted to describe rural home care for frail older adults from the perspective of those delivering and receiving services, a major theme identified was “Circles of Care.”
Abstract: Rural dwelling, frail older adults are a vulnerable population owing to the complexity of health problems superimposed upon limited health care resources. Home care facilitates managing complex health needs and is congruent with rural valued independence. An ethnography was conducted to describe rural home care for frail older adults from the perspective of those delivering and receiving services. A major theme identified was "Circles of Care." Grounded in rural culture, the circles assisted the system of formal care to work in harmony with informal care, maintaining independence for vulnerable rural elderly and their families.
51 citations
TL;DR: The development of reflective practice and resulting narratives from a critical perspective are described as a way of creating a pathway between the two worlds of nursing and honoring scholarship in all the ways nursing is known and practiced.
Abstract: The carrier bag theory of nursing practice is a reinterpretation of how nursing is known and practiced that explicitly acknowledges and values nursing's oral and experiential traditions. An assumption of this work is that the region of experience that is nursing has been effectively divided into two worlds--academia and the world of practice. This has resulted in a theory-practice gap and an elite class-working class gap, as well as a gap between epistemes, or "knowing that" versus "knowing how." This article describes the development of reflective practice and resulting narratives from a critical perspective as a way of creating a pathway between the two worlds of nursing and honoring scholarship in all the ways nursing is known and practiced.
45 citations
TL;DR: This qualitative study investigated cultural beliefs, coping strategies, and management of family stress among Cambodian refugee women living in the inner-city environment to develop the theoretical base for developing culturally sensitive nursing intervention strategies with this high risk population.
Abstract: This qualitative research examines the cultural beliefs coping strategies and management of family stress among Cambodian refugee women living in the American inner city particularly in California and Massachusetts. Data from 120 subjects were obtained through focused and open-ended interviews. The study showed that headache (74%) and somatic chest complaints (55%) were the two most culturally recognized stressful behavior among the study population. Perceived causes of stress include haunting memories of the Khmer Rouge regime and financial difficulties. Moreover avoidance of sad thoughts and of being alone was the most common of the cultural coping strategies. Management of stress within the family was through an avoidance strategy either nonconfrontation or withdrawal. In addition 82% of the cohort in Long Beach California claimed that violence in the home is managed by talking softly to the person concerned. There is a need for further study to develop the theoretical basis for developing intervention strategies with this high-risk population.
TL;DR: Path analyses results indicate that variables explain variance in caregiver and patient quality of life, patient condition, and technological side effects and have implications for home care practice.
Abstract: Caregiver-care-receiver interactions unique to this model of caregiving effectiveness were tested longitudinally in a randomly drawn national sample of 111 caregivers Path analyses results indicate that variables explain variance in caregiver and patient quality of life, patient condition, and technological side effects These findings extend nursing knowledge related to caregiving motivation-to-help and mutual interactions and thus have implications for home care practice Effective family caregiving of loved ones dependent on technology for survival can result in enhanced patient condition, return to work, normalization of family life, and for society a reduction in health care costs
TL;DR: Qualitative analysis of interviews with a purposive sample of family caregivers indicated that caregivers of stroke survivors practice situational vigilance for the stroke survivors, create solutions for problems associated with functional losses of a stroke, construct the reality of recovery for themselves and the stroke survivor, and seek to find personal meaning in the caregiving experience.
Abstract: Development of home health care programs for family caregivers is predicated on an understanding of problems caregivers encounter and ways in which they manage those problems. This article describes home care management strategies of family caregivers of stroke survivors. Qualitative analysis of interviews with a purposive sample of family caregivers indicated that caregivers of stroke survivors practice situational vigilance for the stroke survivor, create solutions for problems associated with functional losses of a stroke, construct the reality of recovery for themselves and the stroke survivor, and seek to find personal meaning in the caregiving experience. Implications for practice and future research are proposed.
TL;DR: Until this relationship between economic impoverishment and health is better understood, development of effective strategies to improve health for the economically disadvantaged will be problematic.
Abstract: Although economic impoverishment has long been recognized as a health risk, it has not generally been targeted as a modifiable risk factor. A number of methodologic and conceptual issues have impeded and obscured explanation of the nature and characteristics of the relationship between socioeconomic status and health. Further investigation is needed to address directional effects, confounding factors, and measurement difficulties. Conceptual representations of the links between economic impoverishment and health need to be clarified and expanded. Until this relationship is better understood, development of effective strategies to improve health for the economically disadvantaged will be problematic.
TL;DR: A new leadership paradigm, connective leadership, is proposed to address the problems of the past and facilitate the collaboration and synergism needed in the reformed health care environment of the future.
Abstract: Health care reform, layoffs, and hospital closures have created substantial stress for both nursing leadership and nursing staff. History suggests that nursing staff and leaders have not felt closely aligned and mutually supportive. An environment that provides a means for renewal of caregivers and administrators is needed to sustain caring practice. A new leadership paradigm, connective leadership, is proposed to address the problems of the past. Connective leaders, by empowering staff at all levels, facilitate the collaboration and synergism needed in the reformed health care environment of the future.
TL;DR: An educational approach to promoting more esthetic and less instrumental thinking and understanding enables nuses to gain a deeper understanding of the lived experiences of suffering, chronic pain, miscarriage, and disability through engaging with the art of Mexican painter Frida Kahlo.
Abstract: That nursing is an art as well as a science is in danger of becoming a cliche unless attempts are made to reverse the marginalization and exclusion of arts and humanities within nursing. An educational approach to promoting more esthetic and less instrumental thinking and understanding is described.
TL;DR: A phenomenologic study of the lived experience of seven older widows who were living alone at home and the participants articulated the risks they experienced and described the ways in which they attempted to reduce these risks.
Abstract: While scholars and practitioners often use the concept of "risk" in relation to older persons who live at home, there has been limited exploration of risk from the perspective of older persons themselves. During a phenomenologic study of the lived experience of seven older widows who were living alone at home, the participants articulated the risks they experienced and described the ways in which they attempted to reduce these risks. The results have meaningful implications for home care providers and policy makers.
TL;DR: Chunking theory, network theory, and schema theory are described as they relate to the development of expertise as characteristics of expertise are described.
Abstract: This article analyzes the concept of expertise. Expertise can have varied definitions, and different theories can be used to explain how individuals become experts. Chunking theory, network theory, and schema theory are described as they relate to the development of expertise. Intuition and expertise are two concepts that are closely related, and this association is clear as characteristics of expertise are described. This article concludes with a presentation of clinical exemplars that serve as model cases to illustrate dimensions of expertise.
TL;DR: The writing process offers a valuable medium for informing estheticKnowing in nursing and composition theories and research are used to identify ways in which writing can shape esthetic knowing.
Abstract: The writing process offers a valuable medium for informing esthetic knowing in nursing. First, characteristics of esthetic patterns of knowing in nursing are described. Esthetic knowing in world literature is then illustrated through the writings of Proust. Next, composition theories and research are used to identify ways in which writing can shape esthetic knowing. Finally, the author presents implications for the use of writing to foster esthetic patterns of knowing in nursing.
TL;DR: To determine how one specific at-risk population problematizes alcohol use and responds to alcohol-related difficulties, findings from an ethnographic interview study of lesbians recovering from alcohol problems were used to develop a theoretical model of problematization.
Abstract: To determine how one specific at-risk population problematizes alcohol use and responds to alcohol-related difficulties, findings from an ethnographic interview study of lesbians recovering from alcohol problems were used to develop a theoretical model of problematization. Problematization consists of two phases: recognition and response. Recognition involves problem indicators varying by type (cumulative vs immediate) and source (personal vs environmental). Movement from recognition to response is hindered by perceptual and environmental constraints. Response consists of interrelated processes of construction, interaction, action, and validation. On the basis of validation, problems are reconstructed and new problems are recognized as the cycle continues.
TL;DR: Community-based experiences in which nursing students learn about people and their health in the context of home and community offer the best promise for students to learn the complex human dynamics of real life and develop the holistic perspective required for independent nursing practice.
Abstract: Nursing has been viewed as a service for people wherever they may be--a service, grounded in scientific knowledge, that transcends setting. Yet nursing education has been overwhelmed by hospital institutions for the past 50 years, its attention diverted to medical entities and institutional trends, with fragmentation and depersonalization of general health care as well as nursing care as the result. Nursing theory-based practice is not feasible in institutions where medical orders overshadow all other disciplines. Community-based experiences in which nursing students learn about people and their health in the context of home and community offer the best promise for students to learn the complex human dynamics of real life and develop the holistic perspective required for independent nursing practice. The time has passed for nursing education to focus on the fraction of the population in hospitals while slighting knowledge about health as it is lived every day. Priority content for all nursing students should be a portable nursing theorybase that can be taken anywhere, focusing on health promotion, healthy environments, and quality of life.
TL;DR: This article examines theoretical, empirical, and practical issues relating to the development of automated nursing clinical databases that will foster safe, effective practice and further nursing's knowledgebase.
Abstract: Automated clinical databases are crucial to the future of nursing but presently are not meeting the needs of clinicians, administrators, educators, or researchers. This article examines theoretical, empirical, and practical issues relating to the development of automated nursing clinical databases that will foster safe, effective practice and further nursing's knowledgebase. A series of key questions are identified relevant to each issue. These issues must be resolved if nurses are to take full advantage of the possibilities inherent in the evolving information technology.
TL;DR: The lived experiences of three women from Brazil, Egypt, and Colombia who are in low-income, devalued, but important jobs are presented through their voices and highlight nursing's mission in dealing with the marginalized client as a human being whose context is historical and sociocultural.
Abstract: The first purpose of this article is to argue the significance of using international and culturally diverse exemplars in developing nursing knowledge. The second is to identify some urgent priorities in the development of nursing knowledge, particularly as related to women's health. The lived experiences of three women from Brazil, Egypt, and Colombia who are in low-income, devalued, but important jobs are presented through their voices. These storied accounts highlight nursing's mission in dealing with the marginalized client as a human being whose context is historical and sociocultural. The implications for knowledge development as driven by international exemplars, diverse experiences, and narration of stories are discussed.
TL;DR: The analogy of a tapestry is used to explore artistic nursing activities and a sensitive awareness of the total context of the person being cared for enables the nurse to creatively use approaches and activities that match and balance the person's values, needs, and interests.
Abstract: The analogy of a tapestry is used to explore artistic nursing activities. The warp is composed of acontextual knowledge and skills, available resources, and agency policies. The weft is the creative pattern of care. A sensitive awareness of the total context of the person being cared for enables the nurse to creatively use approaches and activities that match and balance the person's values, needs, and interests. An example of how the weft was developed for one client is described.
TL;DR: A conceptual model outlines the current health-related risks for women with serious mental illness and use of a feminist perspective challenges the underlying assumptions and opens new arenas for research and practice.
Abstract: Women with serious mental illness are a population at risk because of their invisibility. A comprehensive and critical literature review documents the issues and gaps in this aspect of the health care environment for women. A conceptual model outlines the current health-related risks for women with serious mental illness. Use of a feminist perspective challenges the underlying assumptions and opens new arenas for research and practice. The speculative, theoretical context thus created encourages and supports the questioning process that is the precursor to change.
TL;DR: Data analysis indicated an association between the use of base rate information and education and experience and methods to increase awareness ofbase rate information, thereby improving diagnostic precision and ultimately enhancing patient outcomes.
Abstract: This survey examined home health nurses' use of base rate data when diagnosing and explored the influence of education and experience on the use of base rate data. The relationships between education and experience and normatively appropriate diagnoses were also examined. Two hundred and fourteen nurses completed the Clinical Inference Vignettes, which included four diagnostic problems relevant to home health care nursing. Data analysis indicated an association between the use of base rate information and education and experience. Education and experience also influenced normatively correct responses. Recommendations include methods to increase awareness of base rate information, thereby improving diagnostic precision and ultimately enhancing patient outcomes.
TL;DR: Einstein's Dreams is a fictional account of the various timeworlds Einstein imagined in his early theorizing Possible futures for nursing are examined from the perspective of these various timeeworlds, in relation to present concerns for nursing's viability and evolution.
Abstract: Einstein's Dreams is a fictional account of the various timeworlds Einstein imagined in his early theorizing. Possible futures for nursing are examined from the perspective of these various timeworlds, in relation to present concerns for nursing's viability and evolution. These concerns include distance from the heart of nursing, unarticulated working conceptions of nursing, and methods of inquiry and practice that are not congruent with nursing's values. Time warp conditions frame the analysis of the impact of these concerns, and new visions are offered.
TL;DR: Evidence of caring was found in all the paintings, some of which were painted during the Holocaust, and the paintings and the joumaling process are described.
Abstract: In this article the author, through a process of contemplation, sought to put into words the inner feelings and experiences of caring depicted in six works of art. The questions the author explored were, Is the language of caring present in all environments? Are there similarities or dissimilarities? Evidence of caring was found in all the paintings, some of which were painted during the Holocaust. The paintings and the journaling process are described.