Nursing Inquiry最新文献

Mass casualty incident simulations shape disaster nursing preparedness. In a mixed-methods analysis, quantitative analysis of 380 student nurses demonstrated significant increases in confidence across all measured domains (p < 0.001). Qualitative hermeneutic analysis of 251 student nurse reflections and 487 volunteer patient actor narratives revealed that readiness and composure, alongside compassionate, respectful, and attentive care, were central to trust-building in disaster response. Together, these findings disrupt the prevailing emphasis on technical mastery in simulation, highlighting that relational competence is not an incidental outcome but a fundamental dimension of preparedness. Policy and practice implications are clear. Disaster nursing curricula should mandate structured opportunities for trust-building, reflection, and ethical dialogue, positioning simulation not only as technical rehearsal but also as the origin of germinating relational courage and humanization in care. The use of volunteer patient actors (cost-effective and accessible) offers a scalable strategy to democratize simulation globally, particularly in resource-limited settings. Educational leaders and policymakers are called to prioritize funding, design, and accreditation standards that integrate relational and ethical competencies alongside technical skill, reframing disaster readiness as an inherently human, ethical, and political practice.

Wars in Ukraine, Sudan and the Middle East highlight that armed conflict is once more a significant geopolitical challenge across the world. An aspect of such wars is the deliberate violation of medical neutrality through the targeting of hospitals and clinical staff, including nurses, in breach of international law. Through a narrative review of documented cases, this article reflects on recurring themes in attacks on medical neutrality during the World Wars that resonate with contemporary wars. Within the current context of international rivalry, it is emphasised that the growing strategic and military significance of healthcare assets increases the likelihood that breaches of medical neutrality will take place in the future. Whilst consistent enforcement of international law, if implemented, may deter such breaches, the current environment of politics and conflict suggests that this is unlikely to happen when the influence of historical precedent is taken into account.

Aggression and violence toward nurses is a growing problem in Canadian emergency departments. Existing literature often examines this issue through an individualistic lens, focusing primarily on individual behaviors of patients and staff, with limited attention to organizational and structural factors contributing to root causes. This paper presents a secondary analysis of a larger data set - including interviews with hospital staff, observational field notes, and open-ended patient survey responses - to explore the structural and contextual factors shaping aggression and violence in emergency departments. Using a structural lens informed by critical theoretical perspectives and guided by interpretive description, the research team conducted a thematic analysis to identify recurrent patterns across the data sources. The analysis reveals how policies, power relations, and institutional norms shape the conditions that give rise to violence, moving beyond individual-level explanations. Three themes were identified: (a) significant stress and frustration is the contextual backdrop, (b) dominant norms and a culture of efficiency in the emergency department create and maintain a stressful environment, and (c) widespread health and social inequities and a lack of community resources exacerbate stress and frustration. This analysis demonstrates that addressing aggression and violence requires multi-pronged strategies that engage with the structural contexts shaping these events.

Nurses are often perceived as dominant figures in patient interactions due to their specialised knowledge and institutional authority, particularly in hospital settings. This article challenges that perspective by examining nurse-patient dynamics in primary care through the lens of reciprocity-a relational concept centred on mutual exchange and interdependence. Drawing on an interpretive case study conducted in Shenzhen, China, involving 18 community nurses and 20 patients with chronic conditions, the study identifies two key dimensions of reciprocity: expertise-trust and social networking. These are supported by three mechanisms: reciprocal recognition as an antecedent, a policy-driven culture of reciprocity and perceived equivalence in interactions. While acknowledging the persistence of asymmetry, we argue that reciprocity fosters more collaborative and responsive exchanges in community settings. This perspective offers a more nuanced and balanced understanding of power in healthcare, re-framing nurse-patient relationships as interdependent rather than unidirectional. Findings highlight the importance of nurse education that integrates relational and technical skills, and of policies that promote community-based care and sustained interactions to build trust and reciprocity-while also advancing theory by framing power as dynamic and negotiated.

In recent years, the growing demands of an aging population and market forces have led to an increase in nursing staff, including nurses and nursing aides. This expansion necessitates the surveillance of nursing activities to ensure the quality and efficiency of care. However, there is still a limited understanding of surveillance dynamics in long-term care (LTC) and their implications. This qualitative study explored the surveillance dynamics affecting nurses and nurse aides in LTC facilities. The research used semi-structured interviews to describe how surveillance affected LTC work and care quality. In total, 14 registered nurses and 18 nurse aides were interviewed. Analysis indicated three themes. Vertical surveillance involves oversight by higher management and families, as well as patient complaints and camera recordings. Horizontal surveillance includes peer monitoring and gossip, creating an informal oversight system. Finally, patients' body surveillance consists of monitoring patient health and hygiene, and nurse aides' compliance with regulations. The study found that these surveillance practices were described as only partly effective. Although they aimed to improve safety and compliance, they often resulted in heightened stress, diminished autonomy, and lower care standards. The results and implications are discussed.

Perioperative nursing is essential to safe surgical systems, yet remains marginal in nursing education and policy, contributing to workforce shortages and inconsistent entry pathways. This study examined how entry to perioperative nursing is represented in Australian policy and experienced by nurses entering the specialty. It focused on how policy, education and organisational conditions shape access, learning and support. An explanatory concurrent mixed methods design, underpinned by a critical realist framework, integrated policy analysis and survey data from 226 perioperative nurses. Findings revealed that relational and structural constraints shaped support, opportunity and recognition in entry to perioperative nursing. Policy analysis showed entry is treated as a local organisational matter rather than a structured specialty transition. Factor analysis identified two constructs: Legitimate Learners and Useful Bodies. Thematic analysis highlighted barriers limiting specialty exposure, access and post-entry support. Across data sources, power asymmetry emerged as a shared mechanism producing ontological insecurity. Structural reform is needed to position perioperative nursing as a supported specialty transition rather than a staffing solution.

The nursing discipline has a rich legacy in understanding disease in human terms. Efforts to strengthen this understanding are reflected in calls for holistic, person-centered care. Person-centered care, however, will remain largely aspirational as long as the biomechanical paradigm of the body that descends from Descartes' thought is privileged in health care. This paradigm treats disease as an anatomic fact while disregarding patients' illness experiences. The biomechanical body speaks in the scientific language of disease via lab values, vital signs, radiographic studies, algorithms, guidelines, and "care bundles" while the lived body, as described by Merleau-Ponty, expresses the patient's experience of illness. We describe the philosophical origins of the biomechanical and lived body paradigms; illustrate both paradigms by referring to the medical and nursing care of a patient with ovarian cancer; and identify forces that privilege the biomechanical body in contemporary health care. While we applaud efforts to strengthen patient-centered care by melding conceptions of the medicalized and lived bodies in nursing education and clinical practice, we fear that these efforts will gain little purchase in corporate health care systems that closely align with the Cartesian paradigm of the body.

Amid global instability and increasing political resistance to diversity and equity initiatives, nursing education faces growing pressure to either uphold or retreat from its ethical commitments. This paper presents a justice-oriented curricular model that responds to these challenges by redesigning a senior-level undergraduate course, Nursing in the Community, through the lens of equity-centered pedagogy. Guided by the LIGHT-Liberatory Learning, Inquiry, Global Awareness, Health Equity, and Transformation-framework, the course was restructured using principles of Writing Across the Curriculum (WAC), critical pedagogy, and community-based experiential learning. A thematic analysis was conducted on 86 student assignments, including reflections, policy briefs, and group community assessments. Findings indicate significant student growth in structural understanding, policy literacy, cultural humility, and clinical reasoning informed by social determinants of health. Students demonstrated the ability to recognize systemic barriers such as racism, poverty, and environmental injustice and to articulate advocacy strategies at both individual and policy levels. This case study provides evidence that justice-driven pedagogies can foster transformative learning and professional identity development while offering nursing educators a replicable model for embedding equity and civic engagement into curricula amid political and systemic constraints.

Professional identity formation is a pivotal element of nursing education shaped by educational structures and by the roles of clinical supervisors and educators. This qualitative study examines how these stakeholders perceive their role in supporting nursing students' professional identity development and the conditions that influence this process. The empirical material was generated from six focus groups with clinical supervisors from somatic, psychiatric, and home care settings, and educators from diverse teams at a university college. Drawing on critical psychological practice research, the analysis centers on participants' interpretations, their reasons for acting as they do, and the broader societal and institutional conditions framing their practice. Three themes emerged: challenges arising from dual roles, perceived student vulnerability and its impact on the learning process, and a constructed distinction between professionalism and personality in identity formation. The findings illustrate the complex dynamics that, according to participants, shape nursing students' professional identity and highlight the importance of moving beyond explanations of individual shortcomings toward an understanding of challenges as embedded in everyday educational practices. This perspective emphasizes the need for structural changes that foster collaborative and reflective practices and better support students, clinical supervisors, and educators in navigating the complexities of nursing education.