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This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse–patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge. [ABSTRACT FROM AUTHOR]

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. [ABSTRACT FROM AUTHOR]

The global COVID‐19 pandemic challenged the world—how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person‐centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID‐19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic. [ABSTRACT FROM AUTHOR]

Artificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision‐making. The boundaries between human‐ and nonhuman‐driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision‐making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed. [ABSTRACT FROM AUTHOR]

Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro‐level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide‐reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well‐being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level. [ABSTRACT FROM AUTHOR]

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person‐centred practice (PCP). Although the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient‐centred care. [ABSTRACT FROM AUTHOR]

Positioning the individual at the centre of care (person‐centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long‐standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well‐being of the individuals utilising the services. [ABSTRACT FROM AUTHOR]

Changes in healthcare organizations are inevitable and occurring at unprecedented rates. Such changes greatly impact nurses and their work, yet these experiences are rarely explored. Organizational change discourses remain grounded in perspectives that explore and explain systems, often not the people within them. Change processes in healthcare organizations informed by such organizational discourses validate only certain perspectives and forms of knowledge. This fosters exclusionary practices, limiting the capacity of certain individuals or groups of individuals to effectively contribute to change discourses and processes. The reliance on mainstream organizational discourses in healthcare organizations has left little room for the exploration of diverse perspectives on the subject of organizational change, particularly those of nurses. Michel Foucault's work challenges dominant discourse and suggest that strong reliance's on specific discourses effectively disqualify certain forms of knowledge. Foucault's writings on disqualified knowledge and parrhesia (truth telling and frank speech) facilitate the critical exploration of discourses that inform change in healthcare organizations and nurses capacities to contribute to organizational discourses. This paper explores the capacity of nurses to speak their truths within rapidly and continuously changing healthcare organizations when such changes are often driven by discourses not derived from nursing knowledge or experience. [ABSTRACT FROM AUTHOR]

This paper challenges nurses to join together as a collective in order to facilitate ongoing analysis of the issues that arise for nurses and patients when nursing care is harnessed for health care efficiencies. It is a call for nurses to respond with a collective strategy through which we can 'talk back' and 'act back' to the powerful rationality of current thinking and practices. The paper uses examples from an institutional ethnographic (IE) research project to demonstrate how dominant approaches to understanding nursing position nurses to overlook how we activate practices of reform that reorganize how we nurse. The paper then describes two classroom strategies taken from my work with students in undergraduate and graduate programs. The teaching strategies I describe rely on the theoretical framework that underpin the development of an IE analysis. Taken into the classroom (or into other venues of nursing activism) the tools of IE can be adapted to inform a pedagogical approach that supports nurses to develop an alternate analysis to what is happening in our work. [ABSTRACT FROM AUTHOR]

Attempts to 'modernize' the English National Health Service (NHS) have included significant workforce re-design, including the development of new, advanced roles in nursing. There is a wealth of evidence documenting and evaluating such roles in hospital and, to a lesser extent, in community settings. This paper builds on this work, drawing on recent post structural and sociological analyzes to theorize these roles, locating them within broader social and cultural changes taking place in healthcare and exploring how understandings of new roles in community nursing are in the process of being constructed. Building on a literature review, the paper draws out what an analysis of new advanced nursing roles in the community reveals about competing conceptualizations of the nursing mandate, the ambivalence and ambiguity that practitioners experience in shaping 'new' identities (the shaping of subjectivities), and the often implicit ideological positions that underpin such developments. [ABSTRACT FROM AUTHOR]

This paper offers a critical commentary on the essentialist concept of ethnicity, which, it is argued, underpins the discourse of transcultural health-care. Following a consideration of the difficulties that ensue from the way in which ethnicity has been theorised within transcultural nursing in particular, the paper turns to a consideration of alternative ways of thinking about ethnicity, which have emerged from more recent social anthropology and postmodernism. It addresses the question of how to therorise ethnicity in a way that does not entail its reification as a set of fixed cultural properties, and makes some tentative suggestions for the possibility of a critical culturalist approach to difference and healthcare practice, which must include a consideration of racisms. [ABSTRACT FROM AUTHOR]

The migration of nursing professionals from developing countries such as Zimbabwe to industrialised countries is taking place at an alarming rate, with little signs of slowing down. In Africa, nurses form the backbone of the healthcare delivery system and their migration has a huge negative impact on health service provision. Drawing on evidence from selected health institutions, the paper shows the magnitude of migration of nurses from Zimbabwe. The paper also shows that public to private health sector migration of nurses is occurring at a significant rate. The effects of such movements are examined in detail. For instance, at the health institution level, nurse migration has led to staff shortages, and health institutions located in the disadvantaged areas have been the worst affected. The paper calls for the adoption of an integrated approach in managing and addressing the concerns of the nursing professionals. [ABSTRACT FROM AUTHOR]

SAVAGE J. Nursing Inquiry 2004; 11: 25–34 Researching emotion: the need for coherence between focus, theory and methodology There is a longstanding awareness of the significance of emotion in nursing and yet it remains one of the more elusive areas of practice. Surprisingly, there has been little discussion in the nursing literature of how the phenomenon of emotion might be understood or studied. This paper gives an overview of theoretical and methodological approaches to emotion, and how the researcher's emotions may inform the research process. In addition, it draws on ethnographic research exploring the role of emotion in the practice and clinical supervision of a group of psychosexual nurses undergoing Balint seminar training to help highlight some of the inherent problems of researching emotion. The paper argues that these sorts of problems may be avoided or reduced by ensuring coherence between the research focus, the way emotion is theorised, and the methodological approach of the study. [ABSTRACT FROM AUTHOR]

This paper presents a discourse analysis of publications of the Christian Reformed Church regarding its Rehoboth Mission near Gallup, New Mexico, among the Navajo. All issues of The Banner, Acts of Synod of the Christian Reformed Church, the Rehoboth Hospital Bulletin, and the Annual Report of the Rehoboth Mission from 1880 to the present were reviewed for references to health-care at Rehoboth from 1903 to 1943. Four religiously framed discourses were identified: discourses justifying provision of health-care at the mission, discourses of the Navajos as immature and potentially dangerous, needing to be civilized, discourses of cleanliness, and discourses of calling. This paper adds to a growing body of knowledge about religious frames within which nurses have practiced in North America. [ABSTRACT FROM AUTHOR]

Nursing as normative praxisThe purpose of this paper is twofold. First, it introduces a variety of concepts of ‘praxis’, and argues in support of those which reflect the normative dimension of the critical social perspective. This begins with the Aristotelian concept, and moves through a variety of sources, including Hannah Arendt and Paulo Freire, but focuses primarily, and uniquely in the nursing literature, upon the work of the Yugoslavian ‘praxis Marxists’. Second, specific ways of conceiving nursing as praxis are outlined, including political, aesthetic and ethical forms which have immediate import for nurses. The paper concludes with brief suggestions as to how these ways of conceiving praxis may be used by nurses to develop a more intimate and productive understanding of their own practices. [ABSTRACT FROM AUTHOR]

The social production of an enterprise clinic: nurses, clinical pathway guidelines and contemporary healthcare practices In this paper I critically engage with the forming of contemporary nursing practice with/in an ‘enterprise clinic’ in order to discuss the practical potential of developing a mode of reflective practice that is a critical ontology of self. Critical engagement in the paper is secured through a ‘troubling’ of the relationship between the contemporary practices of both the self and governance, without the reduction of one to the other. The paper draws on my doctoral study in which I combined the techniques of ethnography and discourse analysis in order to critically examine registered nurses’ employment of clinical pathway guidelines through an analysis of the political technologies through which that engagement was constituted. This critical purchase was applied because of the influence of the contemporary ‘problematisation’ of healthcare provision in western society on the formation and deployment of the professional identities of nurses. [ABSTRACT FROM AUTHOR]

Recently, patient safety has gained popularity in the nursing literature. While this topic is used extensively and has been analyzed thoroughly, some of the concepts upon which it relies, such as risk, have remained undertheorized. In fact, despite its considerable use, the term 'risk' has been largely assumed to be inherently neutral DL meaning that its definition and discovery is seen as objective and impartial, and that risk avoidance is natural and logical. Such an oversight in evaluation requires that the concept of risk be thoroughly analyzed as it relates to nursing practices, particularly in relation to those practices surrounding bio-political nursing care, such as public health, as well as other more trendy nursing topics, such as patient safety. Thus, this paper applies the Evolutionary Model of concept analysis to explore 'risk', and expose it as one mechanism of maintaining prescribed/ proscribed social practices. Thereby, an analysis of risk results in the definitions and roles of the discipline and profession of nursing expanding from solely being dedicated to patient care, to include, in addition, its functions as a governmental body that unwittingly maintains hegemonic infrastructures. [ABSTRACT FROM AUTHOR]

This paper is a review of the experiences gained whilst working with the 'expertise in practice project'. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice-based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners' concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient-participants' role as a sophisticated evaluator of health-care. As a result, we present a case for transformational qualitative research. Such research is values-driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its 'ends' (i.e. research products) but also, intentionally, through its 'means' (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self-reflection) to examine and critique their personal values. [ABSTRACT FROM AUTHOR]

The past decade has seen the gradual emergence of what might be called a postmodern perspective on nursing research. However, the development of a coherent postmodern critique of the modernist position has been hampered by some misunderstandings and misrepresentations of postmodern epistemology by a number of writers, leading to a fractured and distorted view of postmodern nursing research. This paper seeks to distinguish between judgemental relativist and epistemic relativist or ironist positions, and regards the latter as offering the most coherent critique of modernist/(post)positivist nursing research. The writings of poststructuralist philosophers, including Barthes, Lyotard, Derrida, Foucault and Rorty are examined, and a number of criteria for a postmodern ironist concept of research validity or trustworthiness are suggested. Whilst these writers reject the idea of Method as a guarantee of valid research, they nevertheless believe that value judgements can and must be made, and turn to notions of ironism, différance, and the differend. Ultimately, the postmodern ironist reader of the research report must make a judgement without criteria, based on her own practical wisdom or ‘prudence’. [ABSTRACT FROM AUTHOR]

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses’ experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary. [ABSTRACT FROM AUTHOR]

This paper attempts to uncover some of the factors that may have influenced the choice of model for the systematic training of nurses in Denmark. From a historical analysis of selected historical literature, nursing magazines, and archival documents, three themes emerge: the interest from (and of) the medical profession, the strategy on nurse training of the Danish Nurses' Organization, and the societal context of the time. Despite there being a Deaconess Institution in Copenhagen from 1863, it was ultimately the Nightingale model that formed the basis for the training programme. Findings suggest that the Nightingale influence within the medical establishment and among leaders in Danish nursing played a vital role in this choice. As well, the Danish Nurses' Organization actively promoted their preferred 3-year training model, which had strong similarities to the Nightingale model. Changes in family and social life after the 1864 defeat in the Prussian war fostered a growing demand for the liberalization of women's rights and a need for increased professionalization in the nursing and caring function. [ABSTRACT FROM AUTHOR]

The use of virtual environments for the provision of health-care is on the increase, and with each new development brings debates about their impact on care, nursing and nursing practice. Such environments offer opportunities for extending care and improvements in communication. Others believe these developments threaten aspects of nursing they hold sacrosanct. This paper explores the development of an assemblage of computer networks, databases, information systems, software programs and management systems that together work to manage health-care in Australia, namely casemix. We contend that spatial theories on network society show how this assemblage co-ordinates and operates to manage care. We discuss how this assemblage affects care and suggest that changes in organisation may be a part of the shift in how bodily organisation occurs more generally, but more specifically in health-care. We also suggest how nurses are enrolled in and by such networks, leading to transformation in nurses’ practices. Finally, we argue that using spatial forms of analysis allows an interpretation of such assemblages that may account for their strengths and their shortcomings. [ABSTRACT FROM AUTHOR]

Within the broader agenda of adherence research, health beliefs have been identified as being significant predictors of adherence. Specifically, perceived threat as a health belief has received considerable attention in compliance and adherence research from multiple perspectives in multiple patient populations. The purpose of this paper is to analyze the concept of perceived threat as it relates to treatment adherence through a series of perspectives: conceptual, methodological, and empirical. Analysis of the literature reveals that there is lack of consistency in operationalization of perceived threat as it relates to treatment adherence. Perceived threat is most commonly cited in studies that focus on health beliefs or utilize a stress and coping paradigm. Instruments have been developed with items that measure perceived threat. Measures of threat occur primarily through uni-dimensional measures that do not reflect the inter-relatedness of the threat experience to personal and contextual factors. Future research examining perceived threat from a cognitive appraisal perspective, where both primary and secondary appraisals can be examined, may provide additional insight into factors affecting treatment adherence. [ABSTRACT FROM AUTHOR]

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind--body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. [ABSTRACT FROM AUTHOR]

SHANNON V and FRENCH S. Nursing Inquiry 2005; 12: 231–239 The impact of the re-engineered world of health-care in Canada on nursing and patient outcomes The healthcare environment is knowledge driven and knowledge and human resource dependent. Despite the paucity of evidence on which to shape and evaluate organizational change, health-care in Canada has undergone many changes in the last 15 years. In the pursuit of enhanced productivity, healthcare administrators have turned to industrial and engineering models. Using available Canadian research and policy reports, and where necessary, American literature, this paper describes the impact of re-engineering on nursing and on the relationship between nursing and patient outcomes. It also identifies emerging trends and ways forward. [ABSTRACT FROM AUTHOR]

GOBBI M. Nursing Inquiry 2005; 12: 117 –125 Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi-Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the‘shards and fragments’ of the situation-at-hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi-Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. [ABSTRACT FROM AUTHOR]

LARSEN A-C. Nursing Inquiry 2005; 12: 135–143 In the public interest: autonomy and resistance to methods of standardising nurses’ advice and practices from a health call centre in Perth, Western Australia The history of nursing is replete with examples of nurses battling for autonomy over their education, knowledge and work practices. The latest battleground is HealthDirect, Australia's first medial call centre, where nurses are required to meet externally imposed clinical standards while satisfying legal and financial obligations. These objectives are arguably achieved when nurses assess callers’ health problems via computerised algorithms that determine an appropriate plan of action. That way, nurses’ subjective responses to callers are ruled out. To ensure nurses comply with the standard processes, calls are monitored randomly and surreptitiously in formal and informal ways. This paper explores how nurses respond to standard procedures and surveillance, in order to argue that nurses’ input partially drives reform processes. Nurses continue to seek autonomy over the advice they give and how their work is evaluated but are constrained by structural power relations. [ABSTRACT FROM AUTHOR]

HEARTFIELD M.Nursing Inquiry2005;12: 21–26Regulating hospital use: length of stay, beds and whiteboardsThis paper presents part of a larger study of contemporary nursing practice and the rationalisation of hospital length of stay. Informed by Michel Foucault's work on governmentality, length of hospital stay and the re-engineering of surgical services are examined, not in terms of numerical representations of hospital use, but as part of social and political processes through which certain concepts are made susceptible to measurement and practices are organised. Using data generated through fieldwork in a hospital surgical division this analysis offers understandings of how social practices around length of hospital stay are translated and how they pattern contemporary hospital nursing practice. Nursing practice is explored through the reconstitution of hospital beds and the demands of local administration of hospital length of stay. [ABSTRACT FROM AUTHOR]

PARKER JM.Nursing Inquiry2004;11: 210 –217Nursing on the medical wardThis paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses.I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse–patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses’ relationships with patients and the complex dimensions of their medical nursing role. [ABSTRACT FROM AUTHOR]

WALMSLEY J. Nursing Inquiry 2004; 11: 54–64 Involving users with learning difficulties in health improvement: Lessons from inclusive learning disability research In this paper the author considers the lessons to be drawn from what is termed ‘inclusive’ learning disability research for user involvement around health improvement. Inclusive learning disability research refers to research where people with learning difficulties (intellectual disability) are involved as active participants, as opposed to passive subjects. There is by now a considerable body of such research, developed over the past 25 years. From the review, the author draws attention to areas which can inform practice in involvement of users in a way that adds value. [ABSTRACT FROM AUTHOR]

This paper argues for a broadening of the way evidence is developed and used in health-care. It contends that the current political and policy imperatives and the evidence-based practice movement are in direct tension with the other major ideological movements that promote patient-centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be alleviated by embracing a broader definition of what counts as evidence and by focusing more on patient-centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses' response to patient experiences can improve the evidence base for nursing. [ABSTRACT FROM AUTHOR]

In this paper it is argued that the way in which ageing is portrayed is culturally constructed and historically located. The terminology used to describe older people becomes part of nursing taxonomy but the issue that it is a cultural construct remains hidden. Nurses use histories and records as a means of communication about the condition of the client or patient. The notes mediate the way in which the patient comes to be known as an individual in need of services and help define the way in which nursing care is undertaken. Nursing notes help construct the ‘manageable’ patient. Noncompliance disrupts this notion of the manageable patient and it challenges medical and nursing dominance of the body. However, noncompliance then becomes reinterpreted as ‘risk’, which has the effect of extending the clinical gaze from the confines of the body to extra-corporeal spaces. Older people, because of their corporeality, can subvert and resist this clinical gaze. [ABSTRACT FROM AUTHOR]

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providers and organisers of patient care and are better able to articulate and develop this aspect of nursing practice. [ABSTRACT FROM AUTHOR]

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re‐centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value‐laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy. [ABSTRACT FROM AUTHOR]