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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]

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]

Aim: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID‐19. Background: COVID‐19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. Methods: A scoping review was conducted and reported using the PRISMA‐ScR checklist. Electronic databases were searched for peer‐reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID‐19 and involved advanced practice nurses. Results: Fifty‐one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. Conclusion: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID‐19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence‐informed and patient‐centered care. Implications for practice: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID‐19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. Implication for policy: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed. [ABSTRACT FROM AUTHOR]

The development of advanced practice nursing has evolved globally over the past decades and has become an important component in the contemporary healthcare system. The term 'advanced practice nurse' is used to refer to nurses practising at a higher level than traditional nurses and is defined as a registered nurse who has acquired the expert knowledge base, complex decision‐making skills and clinical competencies for expanded practice. In 2003, Singapore embarked on the development of advanced practice nurses as an initiative to improve the nursing professional image, retain excellent clinical nurses and fill the gaps in the provision of healthcare services for the ageing population. This paper documents Singapore's journey of advanced practice nursing development and shares our unique learning experience in the aspects of education, certification, registration and scope of practice. [ABSTRACT FROM AUTHOR]

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]

Purpose: The aim of this study was a clinical validation of the NANDA‐I nursing diagnosis "Impaired Resilience (00210)" in people under fertility treatment and determination of the sensitivity, specificity, and predictive value of the defining characteristics. Methods: A cross‐sectional study was conducted between September 2019 and June 2020. A total of 104 patients were recruited through fertility‐related websites, and they answered an online questionnaire after giving informed consent. The Rasch model was used for statistical analysis. The study was approved by the Ethics Committee. Findings: The "Impaired Resilience (00210)" had a prevalence of 15.4% in the sample, and seven defining characteristics confirmed as representative are "decreased interest in vocational activities," "depression," "impaired health status," "ineffective coping strategies," "low self‐esteem," "renewed elevation of distress," and "social isolation." No item showed differential item functioning. "Renewed elevation of distress" and "low self‐esteem" were the most sensitive defining characteristics and had the highest negative predictive value. "Shame" was the most specific one. Conclusions: The nursing diagnosis "Impaired Resilience (00210)" was validated, and results may improve its accuracy in people going through fertility treatment. Implications for nursing practice: This paper contributes by raising knowledge regarding NANDA‐I nursing diagnosis and enhancing the quality of nurses' critical judgment and clinical reasoning. A more effective assessment will allow early recognition of patients struggling with adversity during fertility treatment and enhance a nursing resilience approach in the reproductive field. [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]

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty‐two nurses were recruited from one Australian forensic mental health service. Data were collected using semi‐structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high‐risk patient cohort. [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]

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research. [ABSTRACT FROM AUTHOR]

kearney p.m. & pryor j. (2004) Journal of Advanced Nursing 46(2), 162–170 The International Classification of Functioning, Disability and Health (ICF) and nursing Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care. The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing. The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing. The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses’ thinking and practice by increasing awareness of the social, political and cultural dimensions of disability. [ABSTRACT FROM AUTHOR]

arbon p. (2004) Journal of Clinical Nursing 13, 150–157 Understanding experience in nursing This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses. [ABSTRACT FROM AUTHOR]

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings. [ABSTRACT FROM AUTHOR]

Aim. This paper reports on the second phase of a national study in Wales. The research aimed to assess the level of Welsh language awareness amongst healthcare professionals across Wales, and to identify the factors that enhance language choice within service delivery. Background. The literature suggests that language sensitive healthcare practice is central to ensuring high quality care. However, it is evident that language barriers continue to compromise the quality of care within nursing and other health services. One issue that has received little attention is the level of language awareness that healthcare professionals currently demonstrate. Furthermore the factors that influence language choice for bilingual/multilingual speakers are not well explored in the literature. Methods. The study involved semi-structured interviews with a range of healthcare professionals in acute and community settings across Wales. Using a systematic sampling matrix, a purposeful sample of 83 professionals was selected to participate. Twenty-seven of the respondents were nurses, health visitors and midwives. The interviews focussed on the factors that facilitate or impede language sensitive healthcare practice. All interviews were audiotaped and, using a framework analysis approach, conceptual codes were developed and defined and categories and sub-categories were constructed to create thematic charts. Findings. Three main themes were identified: care enhancement, which focussed on the process and outcome of offering language choice to bilingual patients; organizational issues, which reflected issues relating to the infrastructure of service provision; and training implications, which focused on Welsh language learning in health care. Conclusions. Complex dynamics of language use are in operation within bilingual healthcare settings and organizational as well as individual factors are important in facilitating appropriate language use. Many of the issues highlighted are not peculiar to the Welsh context, but apply to healthcare settings across the world, where other minority languages are in use. [ABSTRACT FROM AUTHOR]

Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps. First, the concept of practice based on Taylor's and MacIntyre's philosophical definitions of the term is described. Secondly, numerous notions of caring are presented; the call from some nurse researchers for quantification of the concept and why this is problematic is discussed; and an exposition of caring from a phenomenological perspective is provided. Finally, the notions of practice and caring are joined, and the concept of a caring practice is presented. Nursing as a public caring practice is illustrated with examples from an interpretive phenomenological study. In conclusion, it is claimed that a phenomenological view of caring combined with a comprehensive definition of practice is well suited to nursing, and allows for a description of nurses’ caring practices from both a nursing and patient perspective. [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]

Routine‘outcome measurement’ is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed,in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways. [ABSTRACT FROM AUTHOR]

BACKGROUND: The concept of reflection is propounded in the literature as an epistemology for practice that enables practitioners to solve their daily problematic situations through conscious thought processes which eventually leads to practice-based knowledge. Hence, reflection became a central tenet of both theory development and educational provision in nursing. Furthermore, this centrality of reflection was reinforced by statutory nursing bodies and service providers by adopting it as the means for carrying out adequate professional practice. Although this may be the case, issues of implementation of reflection within the daily reality of practitioners are frequently overlooked within the literature. Moreover, little consideration appears to be given on the impact that the organizational culture and the politics of power may exert on the implementation of reflective practices within daily ward reality. AIMS: This paper explores how reflection is viewed by nurses within their daily reality in the medical wards, examines the relationships between the organizational culture of these wards and the practitioners and investigates whether reflective methods of practice were being implemented when the study was conducted. METHODS: An interpretative ethnographical methodology was implemented and the data collecting methods used were observation, interviews and qualitative content analysis with a group of 16 practising nurses from four medical wards of one NHS Trust in England. Two interviews were conducted with each nurse within 3-week intervals. The content of these interviews evolved from the analysis of episodes of practice observed when the nurses were giving nursing care. These data were supplemented by narratives from the nurses' in the form of written reflective accounts that were analysed via qualitative content analysis techniques. FINDINGS: Four themes were generated: (i) relationships between nurses and doctors; (ii) relationships between nurses and managers; (iii) nursing practice; and (iv) nurses' input in the outcome of a clinical situation. CONCLUSIONS: The concept of reflection appears to be invalidated by the organizational hierarchy of the wards on the basis of a power struggle game. The ward structure portrays reflection as an abnormal method of practice and knowledge development. This belittlement of reflection does not mirror the practitioners' reality. Instead, it is an intelligent and intentional act on behalf of the dominant professional groups in the wards to create an illusionary picture of ward reality to allow them to survey and define nursing practice and thus maintain and remain in power. This is explicated by using Foucault's analysis and critical social theory framework. Hence, reflective processes are constrained by this covert power game; reflection, where used, is confined to nurses' personal time and space. RELEVANCE TO CLINICAL PRACTICE: The realization of this covert power game by individual clinical nurses can become the incipient point for formally using reflective methods in the practice setting. [ABSTRACT FROM AUTHOR]

Nursing Clinical Development Units have become popular as a framework for the facilitation of the professional development of nursing and to contribute to improved outcomes for consumers of health care services. An exploratory evaluation of the Nursing Clinical Development Unit program implemented by the Centre for Psychiatric Nursing Research and Practice was undertaken using a qualitative approach. This paper focuses on the findings relating to outcomes. A number of positive outcomes were identified including: changes within nursing practices; the development of more positive attitudes by nurses,a greater focus on research utilization and evidence-based practice; and an increase in professional development activities,including conference presen­tations. Despite these positive findings,the need for more structured evaluation and an increased emphasis on dissemination of findings was identified. [ABSTRACT FROM AUTHOR]

clouder l. & sellars j. (2004) Journal of Advanced Nursing 46(3), 262–269 Reflective practice and clinical supervision: an interprofessional perspective In the United Kingdom, the drive to encourage reflective practice through clinical supervision, as a means of ensuring quality of provision in nursing and other health care professions, is now well-embedded, not only in policy but also in practice. However, debate and critique of these concepts is limited. The aim of this paper is to draw on research, conducted with undergraduate occupational therapy students and qualified physiotherapists, in order to contribute to the debate about the functions of clinical supervision and reflective practice in nursing and other health care professions. Upholding the notion that clinical supervision has the potential to constitute a form of surveillance, we counter the assumption that it is inevitably confessional in nature. A social constructionist perspective is used to illustrate how clinical supervision might involve a complex interplay of factors that dispel notions of predictability, control and rationality. Despite acknowledging tensions, we argue that clinical supervision is both necessary and beneficial. It can be advantageous to individual practitioners and professional groups in enhancing practice and accountability, and promoting professional development. [ABSTRACT FROM AUTHOR]

carter h., macleod r., brander p. & mcpherson k. (2004) Journal of Advanced Nursing 45(6), 611–620 Living with a terminal illness: patients’ priorities Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill. The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives. Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory. Over 30 categories were identified and collated into five inter-related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on ‘life and living’ in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, ‘taking charge’, concerned with people's levels of life engagement, was integrally connected to all other themes. The findings suggest that the way in which health professionals manage patients’ involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional ‘expert-defined’ outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented. [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]