Towards ethical inquiry in the economic evaluation of nursing practice.

Economic evaluation is a critical tool for nursing and health care. The authors claim that economic inquiry needs to be supported by expertise in ethical inquiry, that the nursing profession needs to examine values concurrently with economics. Drawing on 2 ethnographic studies of nursing practice, the authors illustrate nurses' invisible work, their invisible triaging of clients, and the invisible costs to nurses and clients. They argue that invisible work, triage, and costs are embedded in a number of values, and that if nursing is to respond to the consequences of health reform, it must examine the values inherent in economic measurement and subsequent health-policy decisions; what is invisible may go "uncounted" unless economic evaluation is informed by ethical inquiry. The authors conclude by suggesting that economic and ethical inquiry be integrated in order to foster a system that is more humane as well as more effective and efficient for all those involved in health-care delivery.

Abuse obscured: an ethnographic account of emergency nursing in relation to violence against women.

Violence against women is a significant health issue in Canada and around the globe, yet the health-care response has been inadequate. While various reasons for this inadequacy have been suggested, little systematic research has been undertaken. This ethnographic study of 2 hospital emergency units was conducted to describe nursing practice in relation to violence against women. Participant observation and interviews with 25 healthcare providers and 5 patients in the 2 units were complemented by interviews with 5 nurses from other emergency units. The findings illustrate that abuse is obscured and practice shaped by stereotypical thinking and a focus on physical problems and rapid patient processing. Perceptions of patient deservedness influenced care that ranged from "doing nothing" to actively offering the patient choices. This description provides a basis for designing meaningful education for nurses and systemic changes that will foster more effective practice.

The tyranny of feminist methodology in women's health research.

Awareness of the insufficient degree to which mainstream research has created useful knowledge about women's health has drawn many researchers to feminist methodologies. Such approaches tend to privilege qualitative designs, emancipatory objectives, and cooperative strategies. They challenge the notions of expert power, the appropriation of voice, and ownership of the research products. By uncovering the extent to which power inequities are embedded in our research traditions, including such issues as who conducts research, which questions are studied, and how they are studied, feminist critique can be a powerful tool toward stronger research with more socially relevant findings. However, taken to extremes, feminist methodological requirements can immobilize and discourage active inquiry. In this paper, we articulate major directives of a feminist stance, explain the extremes at which they become problematic, and propose responsive options for women's health researchers. We intend such analysis to overcome divisiveness and promote inclusiveness without sacrificing excellence in research and action.

Disparagement of the nursing process: the new dogma?

The nursing process has achieved predominance, if not pre-eminence, in nursing. Concurrent with critical scholarly evaluation of the philosophical foundations of nursing, vigorous critiques of the nursing process have emerged. The critiques are wide-ranging and varied, and question the philosophical commitments, stage of development, components, focus and consequences of using the nursing process. However, the arguments are marred by dualistic dichotomous thinking and a lack of definitional clarity. The critiques fail to discriminate between questions arising from the administrative implementation of the nursing process and questions regarding its theoretical value. Clarification of the definition, description and purpose of the nursing process is essential to rigorous critique and to further development. Given the pervasive use of the nursing process and the need for process theory in nursing, it seems most productive to develop the nursing process more fully and in congruence with contemporary philosophies of nursing.

Theorizing oppression: implications for nursing research on violence against women.

The way in which oppression is theorized is critical to nursing research in general and nursing research on violence against women in particular. Violence is not just the aberrant behaviour of some men, or a simple issue of gender oppression; rather, it is a complex, pervasive social problem that arises from and is sustained by multiple sites of oppression, including race, class, and gender. Conceptualizations of violence that neglect analyses of power, oppression, agency, and resistance may serve to support and sustain violence; thus their use in nursing research can align nursing with structures that perpetuate violence and oppression. Theories of violence that are informed by complex analyses of power and oppression focus inquiry on the social causes of violence; require analysis of racism, sexism, and classism; and establish, as a goal of research, the countering of oppression by individuals, institutions, and the state. Analyzing oppression as simultaneity guides nursing research into violence against women toward social change, is applicable beyond the issue of violence, and can help nursing contribute to the eradication of the social causes of health problems.

Factors affecting acute-care nurses' use of research findings.

This study describes staff nurses' perceptions of hospital support for research and their expectations for research; and relationships between organizational factors, individual factors, and staff nurses' use of research. These factors were compared for groups of nurses by education level and hospital size. Stratified random sampling of 450 nurses was obtained from a provincial nurses' association. The mailed survey was completed by 183 nurses. Use of specific research findings was related to organizational factors and was congruent with earlier studies. Nurses' perceptions of their general use of research were related to individual characteristics such as interest in research and expectations to use research, which scored high regardless of educational level. Nurses' perceptions of organizational support and expectations differed significantly according to hospital size. This study suggests that the organizational context is influential, but nurses' value of, interest in, and expectations to use research may mediate this influence. Enhancing research-based practice will require attention to the organizational context of practice.

Hospitals and the educational institution: an innovative partnership for nursing specialty education.

Rapid technological and economic change require that educational institutions respond efficiently and effectively to the needs of the health care industry. Nurses demand education that is accessible, affordable, and relevant, and demand recognition for educational achievement in terms of credentials and financial rewards. This article describes a partnership between British Columbia Institute of Technology (which is driven by and responds to industry) and The School of Health Science (which prepares nurses for specialty practice). The partnership permits a proactive relationship that utilizes the best qualities of both the health care and educational institutions. Although this alliance has been used extensively to prepare nurses for specialty areas, this partnership model could be implemented by a variety of institutions to meet educational needs in many health care professions.