Search

Nursing on paper: therapeutic letters in nursing practice This paper offers a selected piece of interpretive research extracted from the context of a larger research study. The hermeneutic research inquiry described in this paper involved the examination of the nursing and family therapy intervention of therapeutic letters. It incorporated the textual interpretation of 11 therapeutic letters, clinical sessions with three families, clinical team discussions, and research interviews with four family members and three nurse clinicians who participated in the writing of the letters. This particular paper extracts segments of the research related to the letters received by two participants, as well as some general findings, with a focus on the possibilities and influences of therapeutic letters in nursing practice. The findings of this research offer suggestions, not as a template, but as an inspiration and evocation to write therapeutic letters that address the obligation of meeting people experiencing illness at the point of their suffering, with words and questions that invite relationship, reflection, and are large enough to sustain a meeting.

Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians and patients alike. Understanding the complex and multi-faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end-of-life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada.

Phenomenology is one of the most popular qualitative research methodologies used in nursing research. Although interpretive phenomenology is often a logical choice to address the concerns of nursing, the vast number of methods of phenomenology means choosing an appropriate method can be daunting, especially for novice researchers. It is critical that nurse researchers select a phenomenological method that fits the research problem and the skill and world view of the researcher; doing so will result in a research experience that resonates with and excites the researcher. The interpretive phenomenological methodologies of Benner, Munhall, and Conroy each offer unique methods of phenomenological inquiry. However, to date, we are not aware of any literature that explores and compares the methodological approaches of these nurses. In this paper, the origins and influence of phenomenology as both a philosophy and methodology on nurse researchers will be explored, followed by a critical analysis and comparison of these three nurses. By highlighting the distinctive differences and attributes of each method, this paper provides an analysis and comparison of the approaches of these prominent nurses. In doing so, we aim to aid the researcher in their methodological selection, thereby resulting in a successful and rewarding research endeavor.

Transfers of critically ill neonates are frequent phenomena. Even though parents’ participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents’ experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents’ experiences of neonatal transfer. Through deconstruction and reflections of theories, methods and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical and methodological issues of qualitative studies concerning parents’ experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar and threatening experience for the parents; they were losing familiar context, were separated from their neonate and could feel their parenthood disrupted. We identified ‘wavering and wandering’ as a metaphoric representation of the parents’ experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and points at the value of meta-theory and meta-method analyses. Transfers of critically ill neonates are frequent phenomena. Even though parents’ par-ticipation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents’ experiences of neo-natal transfer is lacking. This paper describes a meta- study addressing qualitative re-search about parents’ experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological is-sues of qualitative studies concerning parents’ experiences of neonatal transfer over the course of this meta- study (2000–2017). Meta- theory and meta- method analyses showed that caring, transition, and family- centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta- data- analysis showed that transfer was a scary, un-familiar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified ‘wavering and wandering’ as a metaphoric representation of the parents’ experiences. The findings add knowledge about meta- study as an approach for com-prehensive qualitative research and point at the value of meta- theory and meta- method analyses.

The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in this emerging area of research. Systematic searches in reference databases and in citation indexes identified 12 articles that included analyses of the social and linguistic features of records and recording. Two reviewers extracted data using established criteria for the evaluation of qualitative research papers. A common characteristic of nursing records was the economical use of language with local meanings that conveyed little information to the uninitiated reader. Records were dominated by technocratic-medical discourse focused on patients' bodies, and they depicted only very limited aspects of nursing practice. Nurses made moral evaluations in their categorisation of patients, which reflected detailed surveillance of patients' disturbing behaviour. The text analysis methods were rarely transparent in the articles, which could suggest research quality problems. For most articles, the significance of the findings was substantiated more by theoretical readings of the institutional settings than by the analysis of textual data. More probing empirical research of nurses' records and a wider range of theoretical perspectives has the potential to expose the situated meanings of nursing work in healthcare organisations. © 2015 John Wiley & Sons Ltd.

Photovoice is a powerful method that is gaining momentum in nursing research. As a relatively new method in nursing science, the situatedness of photovoice within or alongside various research methodologies in a single study remains in a stage of early development. The purpose of this paper is to discuss the photovoice method as a means to elicit phenomenological data when researching the lived experience. While the foundational bases of phenomenology and photovoice differ substantially, the argument presented in this paper suggests that the photovoice method can be successfully used in phenomenological inquiry provided that significant rigour checks are pursued. This includes reflecting upon the origins and understandings of both methodology and method to promote methodological congruency. Data collection and analysis approaches that contribute to phenomenological inquiry using the photovoice method in addition to rigour and ethical considerations are discussed. The use of data generated from photovoice in phenomenological inquiry may fill a void of understanding furnished by limitations of traditional phenomenological inquiry and of spoken language and can enhance understanding of the lived experience, which may not always be best understood by words alone.

In New Zealand in 2006, a professional photographer undertook a photo essay of residents and staff in an aged care residential setting. The photographer captured the ‘lifeworld’ of the institution through photographing the images of daily life. The resulting photo essay, which included some photographs of older people naked and in semi-dress, was published in New Zealand’s principal nursing journal in May 2006. There ensued an unprecedented reaction that divided New Zealand’s nursing world. In this paper, I explore possible meanings of the ‘photo furore’, through discourse analysis of the numerous letters to the nursing journal editors. These letters reveal reactions and opinions from both ‘sides’– rejection and disapproval, acceptance and approval – as the situation developed into dichotomy. In this paper, the further aim is to address the issue of attitudes and reactions of the exposed ageing body from theoretical perspectives. Results reveal conflicting discourses and attitudes within nursing towards photographs of the ageing body and underlying this, how nurses believe older people should be thought about and cared for. These attitudes are wide-ranging and, on the one hand, include ageism and a desire to protect and supervise older people versus a greater tolerance and acceptance of older people as competent, autonomous beings.

This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions.

This paper is concerned with the ways in which men construct and explain their sexual identity. When attending a genitourinary medicine (GUM) clinic the constraints of the system and the imperatives of the clinical encounter tend to be reductive, reinforcing the dominant constructions of male sexuality and masculinity. Interviews with men recruited as part of a study of the social construction of male sexuality yielded richly textured narratives of sexual experiences and explanations of sexual identity. The paper reports on the ethnographic study and, using extracts from these narratives, will address central themes of: (i) emotional labour of identity formation; (ii) an essentialist view of sexual orientation and corresponding identity; and (iii) role, social fit and the reformulating of the dominant social notions of partnerships within a new geography of desire transgression, "authenticity".

Assessing the vast arena that continues to grow in pursuit of accountability in American hospitals, this paper raises the following question: Is this enterprise geared toward making hospitals better or toward making them only look better? 'Accountability' has become an umbrella concept to signal the need to demonstrate - to others - that performance is being measured and perfected. The author asserts that there is an imperfect fit between health-care and the industrial model being used to measure quality of care due to four problematic issues: the nature of contemporary patient care, the overstating and overselling of accountability proposals, inflated expectations placed upon 'rationalization', and insufficient attention afforded accident and error. The paper concludes with a plea for reconsideration of the tilt toward a business approach to health-care, asking if, in our zeal to hold hospitals accountable, we are measuring what is important or simply making important what we can measure.

This paper aims to highlight the gap in nursing literature of discussion of the definition of human death--to show that nurses should engage in such discussion. For the nursing role in the care of brain dead patients and their relatives may unwittingly promote and foster a definition of human death which is fundamentally flawed. A person can be warm, pink, have an independently beating heart and be breathing, yet still be diagnosed as brainstem dead. Nursing literature which discusses issues surrounding brain death (as opposed to brain death itself), proposes that nurses should suppress any reservations which they may have in accepting that a patient with the characteristics described is dead; and that they should try to allay any reservations which relatives of such dead patients might have. But what if the concept of brainstem death is flawed? Surely, as accountable professionals, nurses should not accept the role just referred to without satisfying themselves that the concept of brainstem death is coherent and robust. This paper tries to show that, on examination, this is not the case. The definition of human death which guides practice in the UK and elsewhere is fundamentally flawed. Instead of suppressing their own intuitions, and the intuitions of patients' relatives in the management of patients diagnosed as brainstem dead, nurses should critically examine the definition of death which currently informs clinical practice. Our conclusion is that this definition is false.

Nurses’ bodywork: is there a body of work? The work that many nurses do involves the use of their own body as one of the tools of their occupation. Being a nurse, in many cases, means controlled, purposeful use of her or his own body oriented to the patient. This paper discusses some of the ways in which nurses’ bodies and the work that those bodies do are represented in professional and academic research accounts and made relevant in literature. Using instances of bodies and bodily activity mentioned in a variety of literature, the paper discusses three categories of accounts of nursing bodywork: those which are problematised and where the nurse's body is seen as a topic for investigation, and those which are unproblematised either explicitly discussing bodily activity (for example, touch) or implicitly dealing with bodywork (for example, taking blood pressure). Four ways in which nurses’ bodies are made relevant in accounts are proposed: relational, corporate, instrumental and human. The paper discusses the prominence (or not) nurses’ bodies are given in professional and academic accounts, as a contribution to preliminary work of generating a topic for investigation and concludes with some suggestions as to how this investigative project might be taken forward, focusing primarily on an examination of methodic practices, or how bodywork is brought off and executed as a skilled but taken-for-granted activity.

CARRYER J. Nursing Inquiry 2001; 8 : 90‐97 Embodied largeness: a significant women’s health issue This paper describes a three-year long research project in which nine large-bodied women have engaged in a prolonged dialogue with the researcher about the experience of being ‘obese’. The study involved an extensive review of the multidisciplinary literature that informs our understandings of body size. The literature review was shared with participants in order to support their critical understanding of their experience. An examination of a wide range of literature pertinent to the area of study reveals widespread acceptance of the notion that to be thin is to be healthy and virtuous, and to be fat is to be unhealthy and morally deficient. The experience of participants raised questions as to how nursing could best provide health-care for large women. According to the literature review, nurses have perpetuated an unhelpful and reductionist approach to their care of large women, in direct contradiction to nursing’s supposed allegiance to a holistic approach to health-care. This paper suggests strategies for an improved response to women who are concerned about their large body size.

This paper examines the various theoretical approaches that have informed both the conceptualizations and the research approaches to investigations of loneliness. A focus on phenomenological and existential perspectives of loneliness can assist in an understanding of what is essentially a subjective distressing experience. The elderly, particularly those residing in nursing homes, are vulnerable to feelings of existential loneliness because following busy lives, often they are left without meaningful roles. Concomitant to this sense of loss of meaning is an alteration in the perception of lived time. It is the purpose of this paper to stimulate research into what is a common but profoundly distressing experience.

This paper reports on the findings of a study that considered how anxiety might function to organise nurses' practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change-of-shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety.

Narrative picturing is a creative interviewing technique that can be applied within qualitative research interviews with the aim of enhancing the 'richness' of narrative data. This paper describes briefly narrative picturing and its theoretical underpinnings. Whilst using this technique within a dedicated study of people with experience of self-cutting, two key factors emerged in relation to advancing the use of narrative picturing. These were overcoming the inhibitions of the person interviewed and the exploration of personal meaning(s) disclosed during narrative picturing, which were commonly found to be particularly abstract or unprocessed. This paper suggests interviewing techniques aimed at overcoming these potential limitations. Once overcome, narrative picturing appeared to support the exploration and narration of more 'in-depth' accounts of lived experience, enhancing understandings of both the person interviewed and the researcher.

This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title ‘nurse’ and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses’ practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses’ own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care.

Following a diagnosis of, and treatment for prostate cancer, there is an expectation that men will cope with, adjust to and accept the psychosocial impact on their lives and relationships. Yet, there is a limited qualitative world literature investigating the psychosocial experience of prostate cancer, and almost no literature exploring how masculinity mediates in such an experience. This paper will suggest that the experience of prostate cancer, the process by which it is investigated, and the way in which it is understood has been shaped by an essentialist interpretation of gender, exemplified by hegemonic masculinity as the archetypal mechanism of male adaptation. In response to this static and limiting view of masculinity, this paper will offer a reframe of hegemonic masculinity. This reframe, being more aligned with common experience, will portray masculinity as a dynamic and contextual construct, better understood as one of a number of cultural reference points around which each man organises and adopts behaviour. It will be suggested that the extant literature, in being organised around hegemonic masculinity, obfuscates the experience of prostate cancer and acts to render covert any collateral masculinities, public or private, that may also be operating.

There is a longstanding awareness of the significance of emotion in nursing and yet it remains one of the more elusive areas of practice. Surprisingly, there has been little discussion in the nursing literature of how the phenomenon of emotion might be understood or studied. This paper gives an overview of theoretical and methodological approaches to emotion, and how the researcher's emotions may inform the research process. In addition, it draws on ethnographic research exploring the role of emotion in the practice and clinical supervision of a group of psychosexual nurses undergoing Balint seminar training to help highlight some of the inherent problems of researching emotion. The paper argues that these sorts of problems may be avoided or reduced by ensuring coherence between the research focus, the way emotion is theorised, and the methodological approach of the study.

Social poetics as research and practice: living in and learning from the process of research This paper is both a report of research work carried out by one author of the paper with the other involved in a supervisory role, and a reflection on methodology that was an emergent property of the research process. The research question arose when professional preunderstandings about schizophrenia as a biological disturbance were bracketed as a Husserlian form of phenomenology was adopted. The initial study focused on the meanings three individuals attached to being diagnosed with a mental illness and being involved in psychiatric treatment systems. The exploration of meanings led to the researcher being guided by one study participant in relation to a suitable framework for making sense of her lived experience of being entangled in psychiatric systems. This involved an appreciation of the poetics of interpersonal interaction that was simultaneously fuelled by the researcher’s reading of social poetics in psychology. Thus, the research became a hermeneutic inquiry, focused upon the text of one participant (Beth)1 and the psychiatric system that she and colleagues encountered. Beth’s psychiatric predicament was described by a loss of ‘self’, psychiatric interrogation, and positive and negative features of immersion in the system. A byproduct of taking a poetic approach was that the participant found the research process therapeutic. Thus, social poetics encouraged a beneficial blurring of the boundaries between research and practice. In both arenas, social poetics can lead to a different level of understanding. This is contradictory to mainstream approaches to research that value objectivity with a strict division between the researcher and the subjects, with the aim of producing scientific knowledge.

This paper explores contradictory understandings of nurse-patient interaction arising through an exploration of 'being authentic' and 'being a chameleon'. The concepts arose during a critical praxis research study exploring nurse-patient relationships in the context of life-threatening or terminal illness. Being authentic can be understood as a dominant view in the nursing literature of the nurse-patient relationship, incorporating the value of being genuine. However, we argue that this concept offers only a partial and inadequate framework from which to understand nurse-patient interaction. The paper argues that nurse-patient relationships develop intersubjectively, with both the nurse and the patient choosing to reveal or conceal aspects of themselves in response to their interactions. Intersubjectivity as a concept provided the nurses in this study with a means for understanding how the nurse and the patient each contribute to interactions; nurse-patient relationships being understood as mutually constructed. These ideas are explored in this paper using examples from the nurses' stories, along with the implications raised for nursing practice.

Mad talk: attending to the language of distress This paper will examine how the narrative of one woman, Madeleine, can be constructed as symptomatic of the diagnosis of schizophrenia, and how it can also be read from other perspectives, particularly a poststructural feminist one. The readings are presented as possibilities for understanding the woman's experiences and the implications of this for mental health nursing practice. A poststructural feminist reading acknowledges the gendered experiences of subjectivity and how those experiences are constructed in language. The purpose of this paper is to identify for mental health nursing practice an approach which recognizes the figurative and literal characteristics of language in order to provide nursing care which positions the individual's experience of mental distress as central. This requires an acknowledgement of Madeleine's path into mental distress rather than simply a categorization of what is observed in a clinical setting. Intervention may need to include a range of strategies: medical and nonmedical, psychotherapeutic and social, physical and environmental. It may also require the provision of sanctuary and security whilst these options are explored.

The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, "reasonableness" remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.

An ethic of caring: conceptual and practical issues The purpose of this paper is to explore the concept of an ethic of care. Caring as a concept has long been associated with nursing, but in more recent times there has been a strong move to promote an ethic of care as a fundamental concept of nursing. Literature and a personal perspective are used to explore the concept of an ethic of care. It is a premise of this paper that care should be taken that an ethic of care, as currently described, does not contribute to nurses' powerlessness in ethical decision-making in the clinical area. Issues that need to be addressed include the inadequate articulation of the concept to inform and guide practice, and also the emotively laden language utilized by some writers. It is concluded that an ethic of care shows promise to advance nursing knowledge and practice and requires increased research and dialogue to clarify the concept.

This paper explores the discursive construction of the category of teacher identified as the 'reluctant instructor'. Data are drawn from my doctoral study, an ethnography of a school of nursing located in the higher education sector in which I was employed. This study explored the question: What shapes nurse educators and what do they, in turn, shape? Participants included nurse educators who taught a pre-registration programme. Data were gathered through interview and observations of classroom teaching. Analysis focused on the discursive constitution of participants' sense of being a nurse educator and on the implications of their ways of 'knowing and doing' for students. The analysis suggests that the dominant subject positions adopted by participants were those of 'academic' and 'victim'. They employed an ideal/real dichotomy to give a sense of coherence to the inconsistencies or contradications that they saw as structuring their daily activities. Being an academic entailed being an educator, specifically a facilitator, as being competent and having some degree of autonomy. However, participants saw the reality of their situation as markedly different from their ideal; as exhibiting traits of the 'outmoded', oppressive, hospital system of nurse training. Within this context most participants positioned themselves as a 'reluctant instructor'. The implications of their practices for the creation of the 'passive student' are suggested in the paper. In this analysis the nurse educator is viewed as implicated in the formation and maintenance of the context in which she or he is located. Such a view challenges the neutrality that is implicated in understandings of the nurse educator that inform nursing texts and that helped constitute participants' sense of self.

Nurse Ratched or 'Big Nurse' in Ken Kesey's counter-culture novel One Flew Over the Cuckoo's Nest is one of popular culture's most arresting and memorable images of the nurse. She is, however, deemed to be remarkable primarily for her malice and authoritarianism. This paper argues that such a purely realist reading fails to fully appreciate the significance of the character of Nurse Ratched. A feminist critique of the novel contends that the importance of 'Big Nurse' is less related to how realistic/unrealistic or good/bad she is as a nurse. Nurse Ratched is important because she exemplifies all that traditional masculinity abhors in women, and particularly in strong women in positions of power and influence. This paper explores the stereotype of 'Big Nurse' and argues that Kesey's vision of her ultimate 'conquest' is not a progressive allegory of 'individual freedom', but a reactionary misogyny which would deny women any function other than that of sexual trophy.

This paper is a critique of some research methods evident in contemporary nursing literature. The arguments derive from critical-feminist, humanist and ethical perspectives. As a consequence of investigating specific aspects of scientific method, an approach to research that is congruent with values intrinsic to an holistic approach to nursing practice is articulated. Such methodologies also render problematic with status quo power relations between nurses and other health professionals, as well as between nurses and patients. The central themes in this paper are: the absence of overt conceptual frameworks; an avoidance of complex social contexts within which research subjects live; an apparent lack of empathy; and an apolitical articulation of research problems and data analyses. All four of these difficulties may be traced to scientific methodology by many researchers. Most nurse researchers may not actually adhere to this technique, but I propose that they have been informed by belief systems associated with scientific methodology and diat these have dire consequences for the discipline of nursing. A key argument is diat the apparent lack of conceptual frameworks in the majority of nursing research is due to the epistemology, which therefore provides a pre-existing, non-declared conceptual framework, that is incorporated into the research by drawing upon scientific mediodology. A further argument is diat scientific, or scientistic, ways of approaching situations are antithetical to nursing values and to constructive social change for the benefit of patients, nursing and nurses.

This paper explores essential characteristics of current nursing practice from the perspectives of clinically experienced registered nurses in various fields of health care in Sweden. Nursing practice has been the subject of much debate in the past and because of its complexity as well as continuous changes in society it is important to continue the debate. A qualitative study, including 16 group interviews with altogether 74 participants, was conducted. Nursing practice was viewed as a multifaceted field. The participants struggled to define nursing but were able to describe it using concrete examples. The analysis, using interpretive description, identified current practice as essentially consisting of: ‘A practice pervaded by comprehensive responsibility’, ‘A practice that recognises a patient's unique needs’, ‘A practice based on multifaceted knowledge’ and ‘A practice that mediates between traditional values and changing demands’. Current nursing practice can be understood as striving to be in close proximity to the patient, but in tension with pervasive requirements and societal changes. Going forward, it is necessary to continue to reflect on and discuss the nature of nursing practice in an interprofessional context. Studies from primary and home care are also needed to broaden the understanding of nursing practice.

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses' use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person-centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses' compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power-laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.

The aim of the research was to analyse the experience of medical volunteers during World War II in the context of nursing history. Oral history data used in the study consisted of 30 interviews with Finnish wartime medical volunteers, known locally as Lottas. Interview data were analysed both thematically and by using the oral history method. Based on the analysis, the Lottas' experiences during wartime nursing became the leitmotif of this study. The main themes consisted of the following: 'taking care of wounded and ill patients', 'taking care of dying and deceased patients', 'taking care of mentally ill and psychoactive substance-addicted patients' and 'confronting ethical and role dilemmas in nursing'. The interview results showed that the Lottas' duties were sometimes more demanding than basic nursing tasks and that their education was not adequate for the challenges that they faced. In this paper, the terms Lotta, medical Lotta or medical volunteer are used interchangeably and refer to people who were assigned to medical volunteer tasks, regardless of whether or not they were trained. It also includes junior members of the organisation who served as medical volunteers as minors, with special permission.

The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care.

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in-depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational 'rule-centred' culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child-centred approach.

Pre-abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre-abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative-discursive lens, the analysis revealed four micro-narratives in which participants appreciated non-directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti-abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client-centred pre-abortion counselling are discussed.

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providers and organisers of patient care and are better able to articulate and develop this aspect of nursing practice.

Self-management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community-based programme that combines a transdiagnostic approach to self-management with mindfulness to enhance psychological coping for older people with long-term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence-based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.