Nursing Inquiry最新文献

This study examines current assumptions of digital transformation research in the perinatal context and constructs a nursing model through a critical interpretive synthesis. Perinatal digital transformation research is discussed and found to be lacking grounding in nursing concepts; nursing theory was integrated by examining data through the lenses of Woman- and Family-Centered Care (Person-centered Perinatal Care) and by applying Donabedian's Frame of quality assurance into the conceptual matrix. Here, iterative data collection occurred, initially through a scoping review examining the nature and range of perinatal digital health systems. Purposive sampling of empirical studies was conducted to saturate the data pool with all four attributes of patient engagement (access, personalization, therapeutic alliance, and commitment). Participatory action theory supported an abductive stage of analysis and informed pragmatic construction of the model. The model encompasses: (1) person-centered intervention mapping; (2) integration of process evaluation through stakeholder and user consultation; and (3) co-creation during real-life testing. The steps of the model are constructed to align with best practices in participatory action research, while holding nursing models as the foundational theoretical basis. This grounding in nursing theory will support a nursing lens for future action research related to the development of perinatal digital health systems.

Midwifery philosophy views childbearing as primarily normal, indicative of a woman's overall health. Midwifery practice focuses on supporting the human-to-human relationship between the midwife and the woman holding primacy. Despite the traditional focus on wellness, maternity care in today's risk averse world is increasingly complex. Technology has been increasingly implemented into maternity care to detect complications early and reduce harm. The Maternity Early Warning Tool is a technological innovation in this regard. Actor-network theory (ANT) offers a framework for analysing the connections between human actors (women, fetuses, and midwives) and nonhuman actors (machines, tools, and policies) within healthcare. This paper through drawing on the tenets of ANT, particularly in understanding the adoption of Maternity Early Warning Tools in midwifery practice, examines and explores the implications of integrating these tools in relation to midwifery practice. ANT also guides thoughtful considerations regarding the potential trajectory of Artificial Intelligence in midwifery, specifically regarding how these technological advancements alter midwifery practice by creating new hybrid assemblages and fluid identities. This discussion of subversive elements enhances understanding of the implications of Maternity Early Warning Tools on contemporary midwifery practice.

The growing demand for research that is culturally sensitive and contextually relevant is leading to a greater acceptance of indigenous paradigms. Despite this, African philosophy, with its rich cultural and ethical dimensions, is still developing as a field. This paper delves into the philosophical concepts of Ubuntu, Ukama and Consciencism, exploring the ontology, epistemology, axiology and methodology of indigenous African philosophy. It highlights the importance of relationships, community, interconnectedness and a holistic understanding of human existence and experiences. Indigenous African philosophy presents itself as an alternative framework for addressing health and social issues through co-creation, active participation and empowerment. Ontologically, it focuses on relativism and individuals defined by their social and relational contexts. Epistemologically, it values the social construction of knowledge, which should be shared for the benefit of others. Relational ethics are central to African axiology. Together, the ontological, epistemological and axiological basis of African philosophy form a unique paradigm that emphasize community and examine phenomena in both physical and spiritual contexts to achieve a comprehensive understanding.

This review aimed to map the existing research and methodologies used and identify themes of power distance in healthcare. A systematic search for original studies was conducted in May 2023 in accordance with the Joanna Briggs Institute's guidelines for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were used for reporting. A total of 30 studies were included, and all were published between 2004 and 2022. Power distance as a moderator was evident in the research, influencing the relation between other variables. Three distinct themes of power distance in healthcare were identified: interpersonal, intrapersonal and cultural aspects of power distance. These themes illustrate the multilevel effects of power distance in healthcare. Based on current evidence, power distance is an impactful phenomenon in healthcare. Power distance has diverse direct and indirect impacts and is a valuable framework for describing healthcare's complex social inequalities. Power distance was directly linked with hierarchy and associated with a lack of collegiality. Awareness and understanding of power distance are valuable for healthcare leadership and research, aiding in the comprehension of employee outcomes, expectations and subtle cultural differences, though further research on power distance in healthcare is needed.

Empirical evidence on the Fundamentals of Care framework and its relevance to practice is increasing. However, there is a need to understand the evidence in practice and determine how best to evaluate caring activities. This exploratory study aimed to understand current nursing practice with the Fundamentals of Care framework, how nurses understand the framework, and what is essential to patients receiving care. The objectives were (1) to observe nurses in practice and record nurse-patient interactions against the Fundamentals of Care framework dimensions, (2) to probe the nurse's understanding of the framework, (3) to explore what is important to patients when receiving care from nurses, (4) to explore the nurse's and patient's understanding of culture and spirituality, and (5) to identify the barriers and facilitators to delivering integrated care. The study identified four key findings: (1) nurse-patient interactions centred around completing tasks and the physical aspects of care, (2) there are crucial gaps in nurses' ability to connect with their patients and establish a good nurse-patient relationship, (3) integrated fundamental care was not evident in the behaviours and narratives of the nurses, and (4) the context in which care is delivered significantly impacts how nurses work particularly the challenges of using technology and electronic records. Healthcare organisations and nursing leaders need to consider the implications of nurses prioritising the organisation's efficiency-driven requirements over establishing a therapeutic relationship and integrating the patient's care needs. More work is required to support nurses in delivering integrated fundamental care.

The need for nurses to be political is as great as ever, however, nursing has a complicated relationship with politics and political action. This paper examines the impact of a sequential simulation learning activity that sought to transform students' values and attitudes towards political action in addressing Planetary Health issues. Adult and adult mental health nursing students from two British universities participated in the Political Action Sequential Simulation which had three scenarios related to either water or air pollution. Scenario one was clinical, while scenarios two and three were community- and policy-based, respectively. We used a pre-post design to gauge attitudes and values both before and after the intervention. Outcomes measures included Nurse Professional Value Scale-3, Political Efficacy - Short Scale, Perceived Political Self-Efficacy Scale - Short Form, Social Justice Scale and Internal Environmental Locus of Control scale. Of the 256 students who undertook the activity, 75 completed both pre and post-measures. Significant shifts across all scales except the social justice scale were found, meaning that students' attitudes towards political action, their beliefs in their ability to take political action, and in particular, action related to the environment shifted significantly after the sequential simulation. We discuss these results in the context of the broader literature, reflect on some of the reasons why these shifts occurred and consider the implications for nursing education and practice.

Research is needed to better understand how public health nurses (PHNs) contribute to promoting health equity in communities. Our study aimed to fill this gap by exploring what activities PHNs describe they undertake in advancing health equity as well as examining their skills, proficiencies, and training needs specific to health equity work. We collected qualitative data via interviews with 18 PHNs across the US and developed major themes using a thematic analysis approach. We also analyzed quantitative survey data to compare health equity competencies among PHNs versus non-PHNs in local health departments. Most participants identified as female (N = 15); years of experience as a PHN ranged from 1 to 37. Participants described four major themes related to their health equity work: foundational elements of health equity work, components of health equity work, how nurses are equipped to do health equity work, and barriers to engaging in health equity work, which included a need for a more diverse PHN workforce and the opportunity to practice at the top of their scope. Quantitative analyses highlighted PHNs confidence in addressing core health equity concepts, such as the social determinants of health. Findings provide a deeper understanding of how PHNs contribute to advancing health equity, underscoring the value they bring to public health and demonstrating ways that health equity is at the core of what they do. Further work is needed to address barriers, including establishing recruitment pathways for those from diverse backgrounds to facilitate growth of this valuable sector of the public health workforce.

Conflicts can arise when a medical team declares a patient brain dead, especially in Lebanon, where families may be reluctant to accept the diagnosis for religious or cultural reasons. Families sometimes withhold consent for organ donation until they can reconcile their beliefs with their concerns. This manuscript examines these challenges through the eyes of an ICU nurse, who described what happened when a 22-year-old woman was declared brain dead. The nurse explains how she helped the patient's family overcome their objections to organ donation despite some nurses exacerbating the situation by arguing with the family about the patient's care. I use Stein's theory of empathy and Castoriadis' concepts of radical imagination and social imagery to interpret the conflict that emerged due to Lebanese law, which permits families to veto organ donation and prohibits the withdrawal of life support unless requested by the patient's next of kin or legally authorized representative. The case study highlights the importance of trust, compassion, and kindness in helping families resolve organ donation conflicts. ICU nurses who earn families' trust can help them make informed decisions about organ donation without compromising their religious and cultural beliefs. This approach improves outcomes for waitlisted organ recipients. Resolving conflicts requires nurses to stay true to their values and accept responsibility. While the case study focuses on Lebanon, creative nursing practices have the potential to address brain death and after-death care disputes in other jurisdictions.

Nursing research has commonly taken a problem-based approach to research design seeking to ground research endeavour within the phenomena with which nursing is occupied. The aim of this paper is to explore an alternative of using philosophical imperative as a research driver, considering both the appropriateness and implications of this approach for nursing. Jamesian pragmatism, with its emphasis on plural, fluid ontology and evolving knowledge, aligns with nursing and is one philosophical imperative which has much to the profession. The paper offers an exemplar of research into family members' experience of the diminishing drinking of a dying relative, which was undertaken within, and from, a pragmatic imperative. Research driven by philosophical imperative has consequences. The philosophical imperative will likely to be pervasive across the research, influencing research topic, conceptualisation, design, delivery and utilisation, bringing both advantages and constraints.

This study explores the experiences of undergraduate nursing students learning about transgender and gender diverse (TGD) health. We discuss nursing education's perpetuation of discrimination and erasure of TGD people and upholding of gender norms (cisnorms) is not sufficiently preparing students to care for TGD patients. Further, this rampant cisnormativity harms TGD nursing students. This interpretive description drew on queer theory and Hafferty's three levels of curriculum and engaged 18 undergraduate nursing students in initial and 13 in follow-up focus groups or interviews. Three key themes included (1) cisnormativity is perpetuated in nursing education through pervasive power and norms across the three levels of curriculum; (2) "The Trans Problem": Transgender and gender diverse people are othered in nursing education; and (3) Welcoming the other: Individual educators who welcome and affirm TGD people are crucial. Critical recommendations from students to advance gender inclusive and affirming practices are provided, including normalizing gender diversity in formal nursing education, the importance of accountability and representation in schools of nursing, and the need for nursing governing bodies to disrupt cisnormativity.