Effects of Healing Touch on Postsurgical Adult Outpatients.

This prospective pilot study was implemented to determine whether a Healing Touch (HT) treatment postoperatively would have an effect on pain, anxiety, blood pressure, and pulse rate in adult postoperative outpatients. Using a randomized control trial design, participants were assigned to a control or intervention group. The control group received traditional nursing care (TNC), and the intervention group received a HT treatment in addition to TNC. Pre- and postdata collection included measurement of pain, anxiety, blood pressure, and pulse. HT treatment was at least as effective as TNC for reduction in pain and more effective in reducing anxiety. Posttreatment anxiety ratings in the intervention group had a significant decrease (0.55; p = .029), while the reduction in anxiety in the control group was not significant (0.25; p = .22). Neither group showed any difference pre- versus posttreatment in blood pressure or pulse. The intervention group had a decrease in pain rating of 1.0 (p < .001), and the control group had a decrease of 0.64 (p = .02). There was a trend toward a decrease in the use of narcotics with HT. HT is an appropriate modality to decrease anxiety, may be appropriate for pain reduction, and may decrease the amount of narcotics needed postoperatively. Patient comments reflected the relaxing effects of receiving HT. The findings support the use of HT as an effective complementary intervention for surgical outpatients, however additional research is recommended.

Uptake of critical knowledge in nursing practice: lessons learned from a knowledge translation study.

This article is based on a knowledge translation (KT) study of the transition of patients from hospital to home. It focuses on the lessons learned about the challenges of translating research-derived critical knowledge in practice settings. The authors situate the article in current discourses about KT; discuss their understanding of the nature of critical knowledge; and present themes from their body of research, which comprises the knowledge that was translated. The findings have the potential to guide future KT research that focuses on the uptake of critical knowledge in nursing practice.

The advocate-analyst dialectic in critical and postcolonial feminist research: reconciling tensions around scientific integrity.

With increased attentiveness to social justice and the social and economic inequities that shape health, well-being, and health care access, nurse researchers, particularly those positioning their work as emancipatory, negotiate the dialectic of analysis and advocacy. Drawing on postcolonial feminism, we explore this dialectic and associated ramifications for scientific integrity. Staying true to critical foundations shifts the focus from advocacy as "speaking on behalf of" to rigorous reflexive analysis that decenters dominant discourses to open up the possibility for those who have been marginalized to exercise human agency and work alongside researchers toward social justice for all.

Narratives of "dissonance" and "repositioning" through the lens of critical humanism: exploring the influences on immigrants' and refugees' health and well-being.

The focus of this article is on narratives of "starting over," and the embedded processes, conceptualized as "dissonance"--between what people had expected to find in Canada and their actual experiences, and "repositioning"--how they subsequently restructured their lives and redefined their identities. This narrative analysis is one way of illuminating the complex ways in which social support networks influence dissonance and repositioning, and subsequently influence health and well-being.

Inequities in health and healthcare viewed through the ethical lens of critical social justice: contextual knowledge for the global priorities ahead.

The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.

Lesbian, gay, bisexual, and transgender (LGBT) issues in dental school environments: dental student leaders' perceptions.

The objectives of the study reported in this article were to assess dental student leaders' perceptions of educational efforts concerning lesbian, gay, bisexual, and transgender (LGBT) topics and the cultural climate concerning LGBT issues in dental schools in the United States and Canada. In addition, the perceptions of student leaders who self-identified as belonging to the LGBT community and of students with a heterosexual orientation were compared. Data were collected from 113 dental student leaders from twenty-seven dental schools in the United States and three in Canada. Fifty student leaders were females, and sixty-two were males. Only 13.3 percent of the respondents agreed that their dental education prepared them well to treat patients from LGBT backgrounds. The more the student leaders believed that their university has an honest interest in diversity, the better they felt prepared by their dental school program to treat patients from LGBT backgrounds (r=.327; p<.001). The better they felt prepared, the more they perceived the clinic environment as sensitive and affirming for patients with different sexual orientations (r=.464; p<.001). The more they reported that dental schools' administrations create a positive environment for students with LGBT orientations, the more they agreed that persons can feel comfortable regardless of their sexual orientation (r=.585; p<.001). In conclusion, the findings indicate that dental school administrators play an important role in ensuring that future care providers are well prepared to treat patients from LGBT backgrounds and that staff, faculty, students, and patients from these backgrounds are not discriminated against.

Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings.

There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.

Easing the transition between hospital and home: translating knowledge into action.

Knowledge translation is an interactive, dynamic approach to the uptake of evidence-based knowledge. In this article, the authors present a collaborative model for knowledge translation that grew out of a program of research focusing on the experiences of patients from ethnoculturally diverse groups as they were discharged home from hospital. Research findings highlight issues around gaps in the continuity of services and language and communication. The authors discuss a number of knowledge translation initiatives that were developed to address these gaps. Key to the success of this process has been a collaborative relationship between researchers and practitioners that is grounded in the shared goal of knowledge translation to support ethically sound decision-making in the delivery of health-care services.

Health care reform and the paradox of efficiency: "writing in" culture.

Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations.

Knowledge development and evidence-based practice: insights and opportunities from a postcolonial feminist perspective for transformative nursing practice.

Although not without its critics, evidence-based practice is widely espoused as supporting professional nursing practice. Engaging with the evidence-based practice discourse from a vantage point offered by the critical perspectives of postcolonial feminism, the incomplete epistemologies and limitations of the standardization characteristic of the evidences-based movement are analyzed. Critical analysis of evidence is suggested, such that it recognizes the evidence generated from multiple paradigms of inquiry, along with contextual interpretation and application of this evidence. We examine how broader interpretations of evidence might contribute to nursing knowledge development and translation for transformative professional nursing practice, and ultimately to address persistent health disparities within the complex context of healthcare delivery.

Resisting vulnerability: the experiences of families who have kin in hospital-a feminist ethnography.

Health care restructuring, in an effort to control costs, has resulted in marked organizational change with concomitant influences on nursing practice in the hospital and community contexts. Such changes have resulted in increased levels of acuity among patients and shorter hospital stays. As a consequence, families are being asked to assume greater roles in illness care of family members. At the same time societies and therefore patient populations are becoming increasingly culturally and linguistically diverse. Yet, little is known about hospitalization and help-seeking practices of family caregivers in an ethnoculturally diverse context and the nature of support they require from the health care system. This paper addresses this gap in knowledge. Here we draw upon data gathered in two ethnographic studies of illness care and help-seeking practices in an enthoculturally diverse community. Analysis of family data identified 'resisting vulnerability' as a process central to the families' experiences. This paper examines the process of resisting vulnerability and how it was influenced by the practices of health care professionals and structures of the health system. Implications for practice are discussed.

Crafting a praxis-oriented culture concept in the health disciplines: conundrums and possibilities.

'Culture' is a key concept in the social sciences. It also figures prominently in health science discourses. Yet, it is an imprecise and politically charged term. Due to a variety of factors, health care professionals may tend to use notions of culture that can be easily applied. Dangers are posed when using simplified culture concepts, however, because they act as 'interpretive lenses' - lenses that may generate cultural stereotypes, lead health professionals to miss key interactions and processes in the provision of care, and simplify the cultural complexities surrounding the position(s) of both the health care providers and their clients. Two cases of eldercare are analysed to demonstrate the multi-layered intricacies of the concept of culture. The overall point is that 'culture' is a highly complex and dynamic term; the way in which it is conceptualized and used has enormous consequences for health care.

Lessons from a postcolonial-feminist perspective: suffering and a path to healing.

Recent events around the globe reflect the tensions and ethical dilemmas of the postmodern, postcolonial and neocolonial world that have far reaching implications for health, well-being, and human suffering. As we consider what is at stake, and what this means for local lives and human relationships, we need to examine whether the theories we draw on are adequate to further our understanding of health, and the social and material conditions of human suffering. In this paper I begin to explore the question, "Can postcolonial feminist theories provide an inclusive scholarship that would further our understanding of human suffering and open up a path to healing?" At issue here is whether this scholarship adds another dimension to a praxis-oriented nursing science.

Riting" cultural safety within the postcolonial and postnational feminist project: toward new epistemologies of healing.

The concept of cultural safety, developed by indigenous nurses in the postcolonial climate of New Zealand, has not been widely examined in North America. In this article we explicate the theoretical and methodological issues that came to the forefront in our attempts to use this concept in our research with different populations in Canada. We argue that this concept prompts us to "think critically" about ourselves and our patients, and to be mindful of our own sociocultural, economic, and historical location. This critical reflection has implications for how we live, relate to one another, and practice in our various professional disciplines. On the basis of our findings, we discuss how the concept might be rewritten within a critical postcolonial and postnational feminist discourse.

Healthcare restructuring with a view to equity and efficiency: reflections on unintended consequences.

This paper is developed from a research study that examined the hospitalization and helpseeking experiences of diverse ethnocultural populations in the era of healthcare restraint. Interview data were gathered from 60 patients while hospitalized and after their discharge home. Fifty-six healthcare professionals, the majority of whom were nurses caring for these patients while they were in hospital, were also interviewed. The data gathered in this study provides evidence to illustrate how restructuring associated with fiscal restraint designed to enhance efficiencies while ensuring the provision of medically necessary services, has had unintended consequences for some groups of patients and for nurses. These consequences have created a context for inequities in care delivery for those most vulnerable. In this paper we trace the ways in which the changed context of care delivery has exerted its effects on both nurses and patients and illustrate how each has sought to bridge gaps created when organizational supports are lacking. Our study data offer insight into the complexities of the practice setting and difficulties that arise when resources cannot be mobilized to match patients' needs. Our analysis examines how tensions between ideologies of efficiency and accessibility are navigated at the front lines, and draws attention to unintended consequences of the current policy context.

Toward a post-colonial feminist methodology in nursing research: exploring the convergence of post-colonial and black feminist scholarship.

In this paper, Joan M Anderson explores post-colonial feminist scholarship, generated through the convergence of black feminist and post-colonial scholarship, and examines its use as a theory and methodology for nursing scholarship.