Nursing Theory

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both. In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice.

This paper argues that conceiving nursing as a form of praxis, encompasses amongst other things, the critical reflection upon one's nursing practice in order to work out and understand internal and external constructions of personal theories. This reflective examination will demonstrate the implicit knowing that nurses develop as a result of their personal, day to day practice. Highlighting this knowing and incorporating the richness of their practice experience becomes the basis for their own personal nursing praxis.

A study was undertaken on the use of the Nursing Outcomes Classification (NOC) in different practice settings in Israel that included an analysis of problems that can arise in using NOC and a proposed solution. The results indicated four main problems with using the NOC in nursing practice: It is not possible to build from several indicators a weighted index for estimating patient outcomes; some of the indicators are not identical to the clinical guidelines; the grading scales depend largely on subjective judgment; and we question whether an evaluation scale of 5 grades is necessary for such numerical values as vital signs. We suggest dividing the NOC into three main categories (based on original values, objective values as suggested in the clinical guidelines, and values that require the development of quantitative indices) to enable better implementation.

Psychoanalyst Julia Kristeva defines the theoretical concept of abjection as an unconscious defence mechanism used to protect the self against threats to one's subjectivity. Kristeva suggests that the first instance of abjection in an individual's life occurs when the child abjects the mother. However, the instance of abjection addressed within this paper is the reverse of this: the abjection of the child, with a disability, by the parent, and more broadly society. Using the contemporary example of prenatal testing, the authors explore how parents of children with disabilities may be influenced in abjecting the child. The implications of abjection of the child are then used to explore normalization, routinization of care and the development of standardized care practices within health-care. Prenatal screening practices and standardized care permeate medical obstetric care and social discourses regarding pregnancy and childbirth, thereby affecting not only healthcare professionals but also parents in their position as consumers of health-care. In a time when the focus of health-care is increasingly placed on disease prevention and broader medical and social discourses glorify normalcy and consistency, the unconscious abjection of those that do not fit within these standards must be identified and addressed.

New instructional methodologies that foster student inquiry, critical thinking, accountability, group work, and self-mastery skills must be created to meet the challenges of modern community health nursing. Bold steps need to be taken to examine current nursing curricula and institute innovative teaching-learning methods to achieve these outcomes. Designing a unique way of providing clinical practice in community assessment is one step toward achieving these goals. The purpose of this article is to share the development, implementation, and evaluation of the Population Focused Analysis Project (PFAP). This new approach to community assessment for baccalaureate nursing students links theory and clinical practice and provides students with an opportunity to learn about and implement the core functions of public health in relation to a selected population.

hutton a. (2010) How adolescent patients use ward space. Journal of Advanced Nursing 66(8), 1802–1809.hutton a. (2010) How adolescent patients use ward space. Journal of Advanced Nursing 66(8), 1802–1809.AbstractTitle. How adolescent patients use ward space.Aim.  This paper is a report of a study of the use of ward space in a purpose-built adolescent ward and the influence of that space on both adolescent patients and nurses.Background.  A separate ward environment gives adolescent patients opportunities to be with peers, have privacy and independence and be nursed away from younger children. The aim of adolescent wards is to cater for these differences and to set routines around this age group.Methods.  Data were collected between 2002 and 2003 by participant observation and interview. In total 35 observations were undertaken of both adolescents and nursing staff, with associated interviews. A further 17 semi-structured individual nurse and 11 adolescent interviews were conducted, aimed at exploring the use of ward space. Patient demographics, ward policies and patient information sheets were also used.Findings.  Adolescent patients created their own spaces on the ward from personal effects that were of interest to them. These spaces show nurses who they are. Adolescent patients want to be identified as more than ‘just’ a patient when they are in hospital. What the creation of these spaces does is assist the adolescent patient in escaping the homogeneity of the ward by cutting across its activities.Conclusions.  By understanding patients through their self-created spaces, nurses can improve the capacity of adolescents to contribute to their own care, whilst enhancing their care experiences through understanding and collaboration.Title. How adolescent patients use ward space.Aim.  This paper is a report of a study of the use of ward space in a purpose-built adolescent ward and the influence of that space on both adolescent patients and nurses.Background.  A separate ward environment gives adolescent patients opportunities to be with peers, have privacy and independence and be nursed away from younger children. The aim of adolescent wards is to cater for these differences and to set routines around this age group.Methods.  Data were collected between 2002 and 2003 by participant observation and interview. In total 35 observations were undertaken of both adolescents and nursing staff, with associated interviews. A further 17 semi-structured individual nurse and 11 adolescent interviews were conducted, aimed at exploring the use of ward space. Patient demographics, ward policies and patient information sheets were also used.Findings.  Adolescent patients created their own spaces on the ward from personal effects that were of interest to them. These spaces show nurses who they are. Adolescent patients want to be identified as more than ‘just’ a patient when they are in hospital. What the creation of these spaces does is assist the adolescent patient in escaping the homogeneity of the ward by cutting across its activities.Conclusions.  By understanding patients through their self-created spaces, nurses can improve the capacity of adolescents to contribute to their own care, whilst enhancing their care experiences through understanding and collaboration.

Obesity presents a public health challenge and is a serious chronic medical condition, associated with multiple co-morbidities and reduced survivability and longevity. Obesity accounts for about 300,000 deaths each year and is expected to cost the United States healthcare system almost 237 million dollars within the next decade. African American adolescents who retain weight after pregnancy are at the highest risk of becoming obese adults with the potential to develop chronic diseases or serious illnesses. The author explores non-nursing and nursing theories that could guide needed research to help understand the barriers that prevent weight loss and raise the risk of obesity among postpartum adolescents. After the exploration, Orem's self-care theory was selected for the proposed study based on nursing interventions that could facilitate postpartum adolescents' self-care and weight control behaviors.

This paper critiques the conventional concept of ‘insight’ within the mental status assessment, seeking to unseat its taken-for-granted definition and the status it has acquired in research and practice. Drawing on social theory, consumer perspective and interdisciplinary research, the paper focuses on the impact of ‘thin’ biomedical understandings of insight, in disqualifying and demoralizing persons subjected to assessment and at the same time creating punitive scrutineers out of well-intentioned practitioners. Nurses and their mental health colleagues are encouraged to reconsider their reliance on the concept of insight. We entertain the alternative idea that insight is a quality of perception that mental health practitioners can cultivate, to more deeply understand their work, culture and the self.

Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear. The main objective of this theoretical paper is to engage the readers in a theoretical reflection regarding the concepts of abjection and fear since they both apply to the experiences of caring for mentally ill individuals in forensic psychiatric settings. Our contention is with the potential impact of feelings such as disgust, repulsion, and fear on the therapeutic relationship and, more particularly, with the boundaries imposed on this relationship when these feelings are unrecognized by nurses. Acknowledging that patients may evoke feelings of disgust, repulsion, and fear is essential if nurses wish to understand the implications of these emotions in the therapeutic process. In forensic psychiatric settings, caring for so-called "monsters" in the face of abjection and fear is not an easy task to achieve given the lack of theoretical understanding regarding both concepts. Given the actual state of knowledge in forensic nursing, we argue that theoretical (conceptual) analyses, as well as ethical and political discussions, are paramount if we wish to understand the specificities of this complex field of nursing practice.

In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.

The nursing shortage is continuing toward its projected peak in 2010. As a profession we seem unable to devise effective strategies to enhance growth and overcome this looming crisis. By focusing on predictable barriers using methods of reductionism, nurses may have forgotten the biggest barrier: the challenge of creating a holistic professional group presence and inclusive nursing stance. Without first addressing and solving internal paradoxical identity struggles, nursing will continue to try to overcome the multiple internal and external barriers that resulted in the current shortage. This article discusses the group dynamics that have fostered the cyclic loop of nursing shortage situations and explores the reflection and inquiry needed to formulate a cohesive national nursing group posture.