Nursing Inquiry最新文献

The 1991 film The Silence of the Lambs tracks the fictional pursuit of an American serial killer by a Federal Bureau of Investigation trainee, via the assistance of another incarcerated serial killer. It features psychologically disturbing themes, such as corpses, the mutilation of skin and monstrous persons. Incidentally, these are all themes regularly encountered by nurses in their day-to-day practices, including forensic mental health nurses. Despite regular encounters with these themes and phenomena, nurses continue to find them disturbing and troubling, but, at the same time, clinically fascinating. This paper will mobilize Kristeva's poststructuralist, psychoanalytic concept of abjection to relate the encounters in The Silence of the Lambs to those of nurses, to reconceptualize feelings of both disgust and fascination and to consider how vulnerability may benefit nursing practice. Of particular relevance are the breakdown of skin encountered in nursing practice, encounters with corpses and work with forensic patients considered monstrous. The film provides opportunity for nurses to conceptualize abjection in their own practice and to consider how a reconceptualization of boundaries and vulnerability may prove productive.

Shared governance in hospitals promotes the inclusion of nurses' expertise, knowledge and skills in organisational processes, and nurses increasingly fulfil positions in organisational hierarchies. However, incorporating nursing expertise in strategic governance structures might be complicated, as these structures are primarily linked to managerial and biomedical expertise. Drawing on a Foucauldian perspective on knowledge and power, intertwined and embedded in everyday (inter)actions, we study how newly appointed directors of nursing challenge these dominant 'modes of knowing'. By focusing on a (Dutch) healthcare organisation, a large academic medical centre, we gained insight into how the history of director of nursing roles relates to how nursing expertise is valued. We gathered qualitative data (from multiple sources) to get close to the daily practices of these directors. In this way, we were able to highlight three tactics that enable directors to relate to new 'knowledge-power knots': (1) positioning, by creating more unity; (2) profiling, by showing significance and (3) powering, by being alert and intervening. With these tactics, the directors of nursing try to embed themselves and their expertise in hospital governance. This study contributes to an everyday understanding of power and the tactics that directors of nursing employ as an ongoing practice. This provides practical starting points for embedding nursing in governance and decision-making.

This study investigates the role of language in cross-sector collaboration between mental health hospitals and municipalities, focusing on the challenges of maintaining continuity of care and integrating patient-centered approaches. Using Fairclough's framework for critical discourse analysis, we examined focus group interviews with 21 healthcare professionals, including nurses, social workers, and psychiatrists, to identify key themes and patterns in how cross-sector collaboration is discussed. The analysis revealed a dominant medicalized discourse in hospital settings, which often emphasized structured care processes like treatment plans and medication management, overshadowing more flexible, patient-centered approaches common in community-based services. Power dynamics were evident, with hospital professionals frequently positioned as active agents, while patients and community-based workers were portrayed in more passive roles. Although efforts to involve patients in decision-making were noted, these were often controlled by professionals, reflecting a mediated approach to patient empowerment. The findings highlight the cultural and structural divides between hospital and community services and suggest the need for improved communication strategies, integrated care pathways, and a shift toward more inclusive, patient-centered care models. Addressing these discursive barriers is crucial for achieving more effective, integrated, and patient-centered care, ultimately improving outcomes for patients.

The nursing profession has a long history of advocating for social justice and health equity, and both values profoundly infuse nursing ethics, theory, and education. Homecare nursing occurs between the patient's daily life at home and the public health care system. Therefore, homecare nurses ideally possess insight into the living conditions and social determinants of health that their patients experience. This interpretive phenomenological study explores the strategies employed by homecare nurses to fight health inequity and advance social justice. Data were collected through participant observations, situational interviews, and small group interviews with 12 homecare nurses from two municipalities. Three analytical approaches were used: paradigm cases, exemplars, and thematic analysis. The data identified two primary strategies homecare nurses use to circumvent, solve, and mitigate the negative consequences of social determinants of health on patients' care and treatment: "Negotiating practice" and "Aligning practice." "Negotiating practice" ensures that care and treatment are delivered in a way acceptable to all involved. "Aligning practice" ensures cohesion, progression in the treatment and care trajectory, and support for patients and relatives in navigating the system. Both strategies are part of nurses' largely hidden work, reflecting the nursing profession's position as nested between the individual patient and the system.

The global climate crisis is an immediate threat, causing inequitable health impacts across different populations. Climate justice connects the causes and effects of climate change to structural injustices in society. Nurses and community-based organizations (CBOs) partner in promoting justice and health equity. The purpose of this article is to describe how nurses and their CBO partners envision, perceive, and experience climate justice in the communities they serve. Participants were recruited via a screening survey sent to nursing and public health organizations in the United States. This descriptive mixed-methods study utilized participatory photo mapping (i.e., combined participatory photography, community mapping, and interviews) to capture participants' understanding and experiences of climate justice. Recruitment methods identified eight partnerships across six states. Participants depicted how climate injustice is reinforced by colonial severance from Nature. Participants noted that state violence and corporate climate pollution degraded the public's health. Climate justice was described as a long struggle to regain spiritual relationships within Nature, fostering belonging, abundance, and protected communities of care. Planetary health and well-being were central to participants' experiences with climate justice. Future research could explore barriers and facilitators to addressing climate injustice and promoting climate justice in diverse settings.

This paper explores the application of positionality and reflexivity drawing on the experience of a British Minority Ethnic (BME) group senior nurse researching nurses with the same ethnic heritage in an IPA study. It explores how using IPA informed reflexivity and positionality as a researcher who shared the same ethnicity with the research participants. The IPA study allowed for the exploration of Internationally Educated Nurses' (IENs) perspectives on their integration into British healthcare and their navigation of career progression. The central aims of an IPA study are to understand the participant's world, its description, the development of a clear, and open interpretative analysis with a descriptive focus on the social, cultural and theoretical context, and the participant's sense-making of their lived experience. In this paper, we discuss how the lead researcher employed reflexivity, stated his intentionality and positionality in the conduct of the IPA study. This paper discusses some examples of the effects of positionality and reflexivity in the conduct of research by researchers of different racial background, and explicate the influence of personal and professional experiences of a researcher in using reflexivity and positionality to ensure cross-cultural validity and reliability of an IPA research. This paper concludes that appropriate use of reflexivity and positionality in an IPA study may recognise the personal and professional influence of a researcher's experiences on the research process, including their ethnicity.

Hospitals are paying increasing attention to the delivery of humanized care. The purpose of this study was to explore from the nursing perspective what hospital managers might do to facilitate this. A secondary analysis from a primary ethnographic study regarding dignity in nursing practice was conducted. Twenty interviews of internal medicine nurses from four hospitals were analyzed, and three main themes were identified: Management of nursing teams, Management of ethical values, and Management of the context. It is important for institutional values to be closely aligned with those of the nursing profession, and nurse managers play a key role in ensuring that the latter are applied in practice. The proposed actions offer a cost-effective framework through which nurses and managers may promote the delivery of humanized care.

The proliferation of Generative Artificial Intelligence (Generative AI) has led to an increased reliance on AI-generated content for designing and deploying digital health interventions. While generative AI has the potential to facilitate and automate healthcare, there are concerns that AI-generated content and AI-generated health advice could trigger, perpetuate, or exacerbate prior traumatic experiences among vulnerable populations. In this discussion article, I examined how generative-AI-powered digital health interventions could trigger, perpetuate, or exacerbate emotional trauma among vulnerable populations who rely on digital health interventions as complementary or alternative sources of seeking health services or information. I then proposed actionable strategies for mitigating AI-generated trauma in the context of digital health interventions. The arguments raised in this article are expected to shift the focus of AI practitioners against prioritizing dominant narratives in AI algorithms into seriously considering the needs of vulnerable minority groups who are at the greatest risk for trauma but are often invisible in AI data sets, AI algorithms, and their resultant technologies.