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Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. [ABSTRACT FROM AUTHOR]

The occurrence of poor patient care is emerging as one of the most significant, challenging, and critical issues confronting contemporary nursing and those responsible for the provision of health care more generally. Indeed, as a consequence of the increased recognition of the manner in which nurses can be implicated in the occurrence of poor patient care, there has been sustained critical debate that seeks to understand how such healthcare failings can occur and, in particular, why nurses seemingly fail to intervene, raise concerns, and effectively respond to prevent the occurrence and continuation of such poor patient care. In seeking to contribute to this critical discussion, and in contrast to those 'situational explanations' that maintain that the failure to raise concerns is a consequence of the contextual factors and challenging conditions to which nurses can be subject in the clinical setting, this paper will provide a resolutely philosophical analysis of that failure. In particular, it will draw upon the work of Jean-Paul Sartre-the French philosopher generally regarded as one of the most influential thinkers of the twentieth century-in order to propose that his work can be productively recontextualized to provide a detailed, challenging, and provocative critical analysis of the occurrence and continuation of poor patient care and the role of individual nurse practitioners in such healthcare failings. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between temporal continuity in nursing and temporal features of sickness. It is based on phenomenological and hermeneutical philosophy, empirical studies of sickness time, and the nursing theories of Nightingale, of Benner and of Benner and Wrubel. In the first part, temporal continuity is defined as distinct from interpersonal continuity.Tensions between temporal continuity and discontinuity are discussed in the contexts of care management, of conceptualisations of disease and of time itself. Temporal limitations to the methodological concept of situation are discussed.The main part of this paper explores nurses' possibilities to relate to their patients' time, and how temporal features of sickness may warrant temporal continuity of nursing. Three temporal characteristics of sickness are discussed: the immediacy of patients' suffering, the basic continuity of life through sickness and health care, and the indeterminism and precariousness of sickness.The timing of nursing acts is discussed.The paper explores how sickness is both part of the continuity of life, and threatens this continuity. It concludes that this tension is implicitly recognised in the temporal continuity of nursing, which allows for discontinuous and continuous aspects of sickness time. Nurses accordingly perceive the sick person's time at several levels of temporality, and distinguish highly complex temporal processes in their patients' trajectory.Temporal continuity provides the time, flexibility, and closeness for nurses to perceive and act into time dimensions of individual sickness. The paper shows that temporal continuity of nursing is grounded in temporal characteristics of severe sickness. It suggests that temporal continuity is an important theoretical concept in nursing. [ABSTRACT FROM AUTHOR]

The issue of power has become increasingly important within psychiatry, psychotherapy and mental health nursing generally. This paper will suggest that the work of Michel Foucault, the French philosopher and historian, has much to contribute to the discussion about the nature, existence and exercise of power within contemporary mental health care. As well as examining his original and challenging account of power, Foucault's emphasis on the intimate relationship between power and knowledge will be explored within the context of psychiatry and mental health nursing. This is to say that the paper will investigate Foucault's account of how power and knowledge are central to the process by which human beings are‘made subjects’ and therefore how‘psychiatric identities’ are produced. In doing so, it will be suggested that Foucault's work can not only make a valuable contribution to contemporary discussions about power and knowledge, but can also provide a significant critique and reconceptualization of the theoretical foundations and associated diagnostic and therapeutic practices of psychiatry and mental health nursing. [ABSTRACT FROM AUTHOR]

Abstract This paper outlines the background and significance of philosophy of technology as a focus of inquiry emerging within nursing scholarship and research. The thesis of the paper is that philosophy of technology and nursing is fundamental to discipline development and our role in enhancing health care. It is argued that we must further our responsibility and interest in critiquing current and future health care systems through philosophical inquiry into the experience, meaning and implications of technology. This paper locates nurses as important contributors to the use and integration of health care technology and identifies nursing as a discipline that can provide specific insights into the health experience(s) of individuals, cultures and societies. Nurses are encouraged to undertake further examination of epistemological, ontological and ethical challenges to arise from technology as a focus of philosophical inquiry. The advancement of philosophy of technology and nursing will make a profound contribution to inquiry into the experience of technology, the needs of humanity and the development of appropriate health care. [ABSTRACT FROM AUTHOR]

Abstract Phronesis, a popular Aristotelian concept that emphasizes deliberation and moral action, should replace the phrase ‘research-based practice’ as the guiding light for nursing practice. Knowledge from research is still essential, of course, but is insufficient by itself for practice. In this paper, the author describes assumptions behind the apparent superiority of research-based knowledge, and offers a critique of this position. One critique is that by automatically accepting the superiority of research-based knowledge other types of knowledge (e.g. intuitive, ethical, personal) are devalued. A second critique is that undeliberated, indiscriminate use of research findings may lead to inappropriate nursing practice. Phronesis is then described, and its application to nursing. For example, phronesis requires that the context of the situation be considered very carefully before acting. Aristotle stated that the goal of personal phronesis is to reach eudaimonia, or genuine happiness or ‘human flourishing’. Infusing nursing practice with phronesis means that an anthropomorphized discipline's eudaimonia would be the eudaimonia of patients. That is, nursing practice would be guided by a desire for patients' genuine happiness or human flourishing. The final section of the paper offers rebuttals to potential criticisms. [ABSTRACT FROM AUTHOR]

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. [ABSTRACT FROM AUTHOR]

Theoretic interest in the nature of events and event identity is apparent across a wide range of fields. However, this interest has not yet made itself known in nursing. In this paper, it is asserted that nurse theoreticians and researchers should consider the problematic of events and event identity. It is suggested that engagement with these issues is important because the manner in which this component of explanation is integrated into argument has concrete implications for our understanding of healthcare practice. Indeed, refusal to engage with such issues may jeopardize explanatory coherence. [ABSTRACT FROM AUTHOR]

Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever-changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a ‘sound’ philosophy of nursing that will ‘accommodate diversity in nursing thought’. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be ‘sound’ in the sense that Kikuchi and Simmons use this term. In place of their call for ‘truth and unity in nursing thought’. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying ‘plausible narrative of progress’. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice. [ABSTRACT FROM AUTHOR]

The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier’s requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and ‘trust pretenders’ on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. [ABSTRACT FROM AUTHOR]

Most of the literature on teaching within nursing education presents teaching and learning strategies as unproblematic and widely generalized across contexts, content, learners, and educators. We argue that to be truly effective, teaching strategies must be harmonious with instructor’s beliefs, intentions, and actions. In this paper, we introduce the notion of a plurality of effective teaching based on five different ‘perspectives on teaching’– each composed of different beliefs, intentions, actions, and strategies and illustrated by cases from nursing education. We propose that this foundational conceptualization provides a base from which nurse educators can (1) communicate across differences of philosophical perspective and intent; and (2) critically reflect on their educational practices. [ABSTRACT FROM AUTHOR]

In this paper I explore the possibilities of nursing as safeguarding through a phenomenological description of a small sculpture by the German artist Käthe Kollwitz. My discussion will be grounded in Heidegger's understanding of technicity as a pervasive systematizing and aggressive challenging-out. The method is grounded in Merleau-Ponty's and Heidegger's contention that strong artworks are truth-disclosing and show up our precognitive contact with the world. Bringing nursing concerns to an encounter with single strong artworks can help us cultivate a more receptive openness to our patients. [ABSTRACT FROM AUTHOR]

The word ‘empowerment’ has become a popular term, widely used as an important claim, also within the health services. In this paper the concept's philosophical roots are traced from Freire and his ‘Pedagogy of the Oppressed’ to the philosophical thoughts of Hegel, Habermas, and Sartre. An understanding of the concept, as a way to facilitate coping and well-being in patients through reflection and dialogue, emerges. Within an empowerment strategy the important claim on the nurse and the patient will be to reveal the patient's own resources and limitations in times with sickness and reduced functionality to promote the patient's choice to act and cope. From this point of view an education-programme for the frail elderly is outlined. If the nurse wants to empower the elderly patient she has to be willing to be educated through the dialogue with the patient, and to look for the patient's own meaning of being frail and elderly. The coping and self-care solutions for the patient may then even be different from the preferences of the nurse, and this does not mean that the empowerment strategy is a failure or that the patient then has to continue without the assistance from the nurse. Within an empowerment strategy, in the Freirerian sense, the important thing is that both the patient and the nurse together critically reflect on the meanings of the sickness so that the patient can be able to make his own conscious choices. [ABSTRACT FROM AUTHOR]

Phenomenology has proved to be a popular methodology for nursing research. I argue, however, that phenomenological nursing research could be strengthened by greater attention to its philosophical underpinnings. Many research reports devote more page space to procedure than to the philosophy that purportedly guided it. The philosophy of Maurice Merleau-Ponty is an excellent fit for nursing, although his work has received less attention than that of Husserl and Heidegger. In this paper, I examine the life and thought of Merleau-Ponty, with emphasis on concepts, such as perception, intentionality and embodiment, which have particular relevance to the discipline of nursing. [ABSTRACT FROM AUTHOR]

The paper explores consequences of applying the view that illness is negative first-person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness – patients’ experiences like the state of being in pain – and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse–patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice. [ABSTRACT FROM AUTHOR]

From the perspectives of both an espoused core underlying value of nursing, and of public policy, the patient's voice should be central to our understanding of patient/client need, appropriate care and intervention. However, accessing and hearing the patient's voice is fraught with difficulty. Edwards (2001) reminds us that our raison d' être as nurses is human vulnerability; a vulnerability sometimes brought into sharp focus because of illness or disease. However, when people are at their most vulnerable, they are often least able to identify, or indeed to express, their need - beyond the completely obvious. This paper provides a short descriptive record of one patient's experience of nursing care. This description is placed within the context of moral arguments about the nature of nursing and the impact this may have on decision-making regarding the appropriate distribution of nursing time. One of our most acute deficits in knowledge, regarding nursing in the UK and Ireland, is a lack of knowledge of the day-to-day activities judgements, decisions and interventions of staff nurses at the sharp edge of patient care delivery. We also have little understanding of how, or indeed whether, staff nurses identify or articulate these activities, judgements, decisions and interventions as having a moral dimension that is rooted in respect for the needs and perceptions of the individual patient. Recent empirical work suggests that a substantial proportion of nursing time is spent in prioritizing and delegating care. We have little idea of the impact of prioritization and delegation on the quality of patient care, as perceived by the recipients of that care, our patients. It is urgent that these deficits in our knowledge and understanding are addressed.This is the case both from the perspective of providing high standards of patient care and from the point of view of linking perceptions of the moral dimension of nursing practice, organizational structure, manpower planning, nursing decisions and interventions, to patient outcomes. [ABSTRACT FROM AUTHOR]

Person-centredness is common speak in nursing and health care literature. Increasingly there is an expectation that practitioners adopt person-centred principles in their practice and organizations are expected to respect the values of the service user. However, in the research methodology literature, there is little explicit attention paid to the concept of person-centredness in research practice. Instead, there continues to be a reliance on traditional `ethical principles' to guide effectiveness in research work. This paper argues that the principles of person-centredness that are espoused in nursing practice should also underpin nursing and health care research. A framework for person-centred research is proposed and issues concerning its implementation in practice are discussed. [ABSTRACT FROM AUTHOR]

The nursing profession has a responsibility to ensure that nursing goals and perspectives as these have developed over time remain the focus of its work. Explored in this paper is the potential problem for the nursing profession of recognizing both the promises and pitfalls of informational technologies so as to use them wisely in behalf of ethical patient care. We make a normative claim that maintaining a critical stance toward the use of informational technologies in practice and in influencing the thought patterns of the younger generations of nurses is a moral imperative of the discipline, because without this practice can become subverted from professional goals in various ways. We use a synthesized concept we call "intentional authenticity" derived from the writing of Heidegger and Feminist care ethics to provide a foundation for the development of nurses who understand the importance of the nurse‐patient relationship and how the unthoughtful use of informational and other technologies can militate against effective or good nursing care. [ABSTRACT FROM AUTHOR]

Nursing, with its socially embedded theory and practice, inevitably operates in the realm of power and politics. One of these political sites is that of religion, which to varying degrees continues to shape beliefs about health and illness, the delivery of healthcare services and the nurse–patient encounter. In this paper, I attempt to complicate nursing's views on religion and politics in healthcare, with the intent of thinking critically and philosophically about questions that arise at the intersection of religion, politics and nursing/healthcare. These questions include the following: What is the domain of religion and politics? How (non)religious are the contemporary societies in which nurses practice? What are the variations and implications of secularism? How is religion entangled with other intersecting social relations of power? How does a political reading of religion and politics matter to the concerns of nursing? [ABSTRACT FROM AUTHOR]