Nursing Inquiry最新文献

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.

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.

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.

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.

Toxic workplace environments, especially those involving gaslighting, are known to contribute to stress and excessive work habits, such as workaholism, which may hinder a nurse's agility-an essential skill in adapting to fast-paced healthcare environments. However, the interplay between workplace gaslighting, workaholism, and agility in nursing remains underexplored. This study aims to investigate the relationship between workplace gaslighting, workaholism, and agility among nurses, focusing on how gaslighting moderates this relationship. This study is a multicenter cross-sectional that was conducted among 594 full-time nurses from three major hospitals in Egypt. Data were collected using the Gaslighting at Work Questionnaire, Workforce Agility Scale, and Bergen Work Addiction Scale. Correlation and regression analyses were performed to test the study hypotheses. Results revealed that nurses reported moderate levels of workaholism, workplace gaslighting, and agility. Significant negative correlations were found between agility and both workplace gaslighting and workaholism. Gaslighting negatively moderated the relationship between workaholism and agility, exacerbating the impact of workaholism on nurses' ability to remain agile. The findings indicate that toxic workplace behaviors, such as gaslighting and workaholism, undermine nurses' agility. Regulatory safeguards are necessary to protect nurses from such environments, ensuring both their well-being and the quality of healthcare services. These findings call for the development of national standards and policies to address workplace mental health and ensure accountability in healthcare settings.

In many countries, such as Canada, the USA, England, and Australia, to graduate from a regulated profession such as nursing, students must complete a set of work-integrated learning (WIL) hours and demonstrate their ability to safely perform physical skills and apply knowledge in relation to professional standards. For a disabled nursing student (DNS) undergoing training in higher education institutions (HEI), securing proper accommodations to participate effectively in WIL experiences has been difficult due to concerns related to risks to self and patient safety. This study used critical discourse analysis to investigate the framing of risk and safety in association with providing DNS with accommodation in WIL. Our data were collected from an intensive codesign (group-based discussion) session with participants (n = 16), including clinicians and DNS, from four institutions (two WIL-sites and two HEI organizations). Using an iterative thematic approach based on Foucauldian framework, our analysis revealed three ways in which health professionals discursively framed risk and safety: (a) beliefs that a lack of disclosure by disabled students decreases patient safety and indicates poor self-reflection, (b) concerns that accommodating students poses a risk to institutions offering WIL experiences and to the relationships between HEI and institutions offering WIL-sites, and (c) a framing which challenges the dominant discourse by thinking about safety and risk more expansively. Our findings suggest the first two of these framings are ableist and function to enact barriers to access for DNSs in WIL, whereas the third framing serves the goal of inclusion. Recommendations to address the current ableist discourse within the Canadian nursing context are provided, which may also be applicable across other regulated health professions.