Geographical thinking in nursing inquiry, part two: performance, possibility, and non-representational theory.

Part one in this two paper series reviewed the nature of geographical thinking in nursing research thus far. The current paper builds on it by looking forwards and providing a particular vision for future research. It argues that it is time to once again look to the parent discipline of human geography for inspiration, specifically to its turn towards non-representational theory, involving an emphasis on life that onflows prior to meaning, significance, and full cognition; on life's 'taking-place'. The paper introduces this way of viewing and animating the world. Some potential connections to nursing research and practice are suggested, as are some specific avenues for future inquiry. Explained is how, through non-representational theory, nursing might be re-imagined as something that reveals space-time.

Geographical thinking in nursing inquiry, part one: locations, contents, meanings.

Spatial thought is undergoing somewhat of a renaissance in nursing. Building on a long disciplinary tradition of conceptualizing and studying 'nursing environment', the past twenty years has witnessing the establishment and refinement of explicitly geographical nursing research. This article - part one in a series of two - reviews the perspectives taken to date, ranging from historical precedent in classical nursing theory through to positivistic spatial science, political economy, and social constructivism in contemporary inquiry. This discussion sets up part two, which considers the potential of non-representational theory for framing future studies.

An 'all-world ageing' perspective and its wider ethics of care: An empirical illustration.

Recent commentaries have proposed 'all-world ageing' as a new perspective for social scientific ageing research. It is based on the theoretical observation that the ageing process involves all forms of entities co-ageing relationally with each other, and with their surrounds. Its disciplinary implications hence being that what we categorize as ageing in social scientific ageing research should not be limited to human bodies, and that ageing non-humans should be brought under its purview. To empirically illustrate these theoretical and disciplinary assertions, and explore their implications, the current paper reports a study of how people co-age with non-humans they interact with in their daily lives. Sixteen people aged 66-90 were interviewed, ten of them also being observed at those times. The findings show some intricate and diverse relations that involve their co-ageing with varied biological entities and nature surrounds (such as plants, domestic animals and green spaces) and varied non-biological entities and non-nature surrounds (such as materials, technologies, accommodations, organizations and infrastructures). Meanwhile, important crosscutting themes - including lifespan, function and aesthetics - emerge as objectives of care, valued and exercised in broad terms. This empirical reconnaissance shows the potential for an all-world ageing perspective to engage diverse societal challenges and inform diverse areas of practice as part of a wider ethics of care. From it, a number of important considerations and undertakings arise for future scholarship.

The transition from acute care to home: a review of issues in discharge teaching and a framework for better practice.

Patients are often sent home with complex discharge plans that can become overwhelming and difficult to follow. By contrast, implementing effective teaching at the time of discharge can lead to a decrease in the rate of hospital readmissions and mortality for patients post discharge (Koelling, Johnson, Cody, & Aaronson, 2005). Unfortunately, many of the discharge teaching practices and programs used in health care settings have been criticized as being ineffective. Ensuring that patients are prepared for the transition from hospital to home after a cardiac event will require a fundamental shift in how teaching is performed in acute care settings. In this paper, the authors identify and examine models and concepts relevant to improving the process of providing discharge education in acute care settings. This includes attention to adult education, self-management and patient-centred care. A practical framework was developed: Important Elements of Effective Discharge Teaching. This framework can be used by frontline staff to initiate realistic practice change and promote the use of evidence-based strategies related to discharge teaching in acute care settings. The Important Elements of Effective Discharge Teaching framework provides health care practitioners with a tool to evaluate and reflect on their current professional practice and provides examples of teaching strategies that are based on best evidence. Nurses can incorporate elements of this framework while providing health teaching to patients after a cardiac event.

Friendly Visiting Programs for Older People Experiencing Social Isolation: A Realist Review of what Works, for whom, and under what Conditions.

Many social interventions have been developed with the hopes of reducing and preventing social isolation among older people (e.g., recreation, arts-based programs and social prescription). Friendly visiting programs, also known as befriending schemes, have been a mainstay in this area for decades and are largely thought to be effective at reconnecting older people (≥ 60 years of age) experiencing isolation. Research and evaluations have yet to determine, however, how and why these programs may be most successful, and under what conditions. This article presents the findings of a realist synthesis aimed at identifying the critical mechanisms and contextual factors that lead to successful outcomes in friendly visiting programs. Seven studies are synthesized to inform a friendly visiting program theory accounting for key mechanisms (e.g., provision of informal support) and underlying contexts (e.g., training of volunteers) that can be used to inform future programs. Recommendations for future research are also presented.

Re-imagining world: From human health in the world to 'all-world health'.

This article explores the concept of 'world' as it frequently appears across health studies; specifically largely humanistic and phenomenological variations in use of 'the world' and 'lifeworld' are considered as they have helped cast knowledge on health and care. Looking forward, it is argued that world might be reimagined post-humanistically and post-phenomenologically as a vital emergent material entity and property. This is a reimagination that pays dividends by drawing attention to all-world processes and productions, hence to 'all-world health'. On one level, all-world health involves consideration of the healths of all the world's material and biological entities (all parts of the world). On another level, all-world health involves understanding what an entity gains from its total surround as it moves through life (all parts of its world). Together these levels provide a more processual, relational and holistic understanding of health than that provided by traditional notions of human health states, determinants or meanings, and even by some environmental (ist) ideas on health. All-world health arguably provides a vision of interrelatedness on which greater unity, cooperation and care might be built.

Living with embodied vibrations: Sensory experiences following a traumatic brain injury.

Based on autoethnography, this article adopts a (neuro)phenomenological lens to explore sensory experiences following a traumatic brain injury (TBI). Although focussing particularly on pain, vision, hearing, and somatic experiences connected with sleep, we also touch on how these are interwoven with other symptoms associated with TBIs. We use these experiences to enliven, and thereby enrich, clinical constructions and understandings of 'sensitivity' to light and to noise, as well as 'sleep disturbance'. We conclude with a discussion of how these sensory experiences can be understood in relation to embodied dynamics of vibration, oscillation, and (stochastic) resonance. The article closes with the suggestion that an embodied, sensorial, and phenomenologically informed analysis of the experiences of people with TBIs, particularly in relation, for example, to embodied sensations and perceptions of vibration, might provide novel insights for research and clinical practice.

'Whole onflow', the productive event: an articulation through health.

In this paper we develop an understanding of 'whole onflow'. Extending philosopher Ralph Pred's original descriptions in materialist directions consistent with posthumanist and non-representational theory, we treat whole onflow as the progressing moment ever-materializing; as a never-ending more-than-human event happening everywhere that is existed in, registered, malleable and productive. In particular, using examples in health, we describe whole onflow's core qualities that lend it, as a vital forceful becoming, its productive capacities. We argue that whole onflow offers compelling ways of understanding the processual origins of health and many productions besides in all their diversity. Moreover, we argue that it offers ways of understanding how humans figure as part of the Universe's becoming.

Spinning, hurting, still, afraid: Living life spaces with Type I Chiari Malformation.

Human geography's varied engagement with the brain has involved considerations of the way people know and respond to their environments, and their place-based experiences with emotions, mental illnesses and disorders, intellectual disabilities and particular neurological conditions. This paper argues however that this scholarship could be augmented by, and existing expertise be directed towards, considering physical brain abnormalities and injuries. As a case in point it considers the spatial experience of living with Type 1 Chiari Malformation. Through interviews with four sufferers, the research articulates three domains that they have had to re-negotiate - home space, social space and medical space - emphasizing supportive and challenging aspects of each, as well as meaningful and affective qualities to encounters. The paper concludes with some pointers towards the future study of physical brain abnormalities and injuries and the kinds of knowledge it might create to increase awareness and inform care.

Matter beginning to matter: On posthumanist understandings of the vital emergence of health.

In recent years much health research across the social sciences and humanities has undergone a noticeable, albeit by no means cohesive or comprehensive, 'turn' towards a posthumanist theoretical orientation. This paper reviews the radical ideas about health's emergence that have accompanied this turn, noting the core processes that are understood to always be in play. In particular, while acknowledging that not all humanistic ideas have been rejected in this work, it describes how some have been reworked and extended in 'other-than-fully conscious' and 'more-than-human' terms. The paper assesses and synthesizes this diverse literature, emphasising the novel understandings of corporeality, materiality, assemblage, relationality, vitality and affect that have become distinctive features of it.

'Hopeful adaptation' in health geographies: Seeking health and wellbeing in times of adversity.

Living with adversity can create wide-ranging challenges for people's health and wellbeing. This adversity may arise through personal embodied difference (e.g. acquiring a brain injury or losing mobility in older age) as well as wider structural relations that shape a person's capacity to adapt. A number of dichotomies have dominated our understanding of how people engage with health and wellbeing practices in their lives, from classifying behaviours as harmful/health-enabling, to understanding the self as being defined before/after illness. This paper critically interrogates a number of these dichotomies and proposes the concept of 'hopeful adaptation' to understand the myriad, often non-linear ways that people seek and find health and wellbeing in spite of adversity. We highlight the transformative potential in these adaptive practices, rather than solely focusing on how people persist and absorb adversity. The paper outlines an agenda for a health geography of hopeful adaptation, introducing a collection of papers that examine varied forms of adaptation in people's everyday struggles to find health and wellbeing whilst living with and challenging adversity.

Clinical geography: nursing practice and the (re)making of institutional space.

AIM: To present a geographical study that highlights the wide ranging spatial features of nursing agency. In turn, illustrate the further potential for geographical research to describe, support, challenge and guide clinical practice - particularly with regard to those 'everyday' activities and actions undertaken on a frequent basis. BACKGROUND: To provide a focus, and to anchor the study in existing clinical knowledge and debates, the role of nursing in the (re)making of institutional experiences and life is specifically explored. METHODS: In-depth semi-structured interviews were conducted with 15 nurses working in Buckinghamshire and West London, UK. The following specialties were represented: acute care including emergency (n = 3), midwifery (n = 3), children's nursing (n = 2), elderly care (n = 1), rehabilitation (n = 2), mental health (n = 3) and palliative care (n = 1). RESULTS: Nurses claimed to actively manipulate, normalize and recreate clinical spaces as part of their everyday therapeutic practice. Specifically, the range of agency employed by them falls under the following six categories: adjusting social composition; introducing 'normal' activities; providing private spaces; seeking private spaces; explaining clinical spaces; spaces for personal escape and wellbeing. IMPLICATIONS FOR NURSING MANAGEMENT: It is recommended that nurse leaders - including researchers, managers and clinical educators - explore geography as a source of social scientific evidence that sheds light on the complex nature of everyday professional practice. In this regard, some important disciplinary and structural issues are noted.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Designing a better place for patients: professional struggles surrounding satellite and mobile dialysis units.

The professional claims and struggles involved in the design of non-traditional health care places are rarely problematized in applied health research, perhaps because they tend to fade away once the new design is implemented. This paper offers insights into such professional tensions and their impact on health care delivery by examining the design of two dialysis service delivery models in Quebec, Canada. The satellite units were hosted in two small hospitals and staffed by recently trained nurses. The mobile unit was a bus fitted to accommodate five dialysis stations. It was staffed by experienced nurses and travelled back and forth between a university teaching hospital and two sites. In both projects, nephrologists supervised from a distance via a videoconferencing system. In this paper, we draw mainly from interviews with managers (mostly nurses) and physicians (n=18), and from on-site observations. Nephrologists, medical internists, and managers all supported the goal of providing "closer-to-patient" services. However, they held varying opinions on how to best materialize this goal. By comparing two models involving different clinical and spatial logics, we underscore the ways in which the design of non-traditional health care places opens up space for the re-negotiation of clinical norms. Instead of relatively straightforward conflicts between professions, we observed subtle but inexorable tensions within and beyond professional groups, who sought to measure up to "ideal standards" while acknowledging the contingencies of health care places.

Geographical Gerontology: the constitution of a discipline.

Health and healthcare have always been central considerations in geographical gerontology. This paper reviews progress in this part of the field over the past decade (1995-2006) and also looks to the future. It demonstrates how geographical gerontology is currently constituted of multiple fields of empirical interest studied by multiple academic disciplines. Specifically, the continuation and development of traditional perspectives on older population health--in terms of dynamics, distributions and movements--are traced, as well as emerging post-modern perspectives and qualitative approaches that sensitively investigate the complex relationships between older people and the varied places within which they live and are cared for. Mirroring theoretical developments and diversity in the social sciences, the future research challenges that lie ahead will involve the articulation of varied and often hidden cultural practices and social processes, and hitherto taken-for-granted--as well as new--social and spatial relations, between older people, health and place. If however geographical gerontology is to meet these challenges most effectively, there has to be greater collaboration and communication within and between its constituent disciplines and diverse empirical areas. This will help it become recognized to a greater degree as a distinct discipline.

Enhancing chronic disease management: a review of key issues and strategies.

This paper highlights three selected issues and potential strategies towards meeting chronic disease management needs. First, the orientation of the biomedical science model often gives insufficient attention to chronic health care needs. A second issue is that the use of complementary and alternative medicine (CAM) may offer for some an opportunity to enhance their chronic disease management efforts. A third issue is that our understanding of this potential is limited, as many who use CAM do not disclose such use. With reference to proposed solutions/strategies, first, an improved focus to respect patient/client values and goals may encourage people to disclose their use of CAM. Second, a community-based participatory approach shows promise in enhancing communication plus helps integrate CAM within new models of chronic disease management. Lastly, those in public health could help facilitate such an approach plus be a monitor of CAM practices. Overall, this review provides a springboard for further research and practice in CAM and the management of chronic diseases.

Professional roles and communications in clinical placements: a qualitative study of nursing students' perceptions and some models for practice.

BACKGROUND: Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these 'remote' settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment. OBJECTIVE: In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization. METHODS: Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England. FINDINGS: The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes. CONCLUSIONS: Clinical placements are designed to provide practical learning through a 'slice of practice life'. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice.

Geography: research and teaching in nurse education.

This paper outlines how geography might be integrated into nurse education. At one level, researching nurse education geographically could add to the current academic understanding of the many transitional places that make educational experiences and influence outcomes. At another level, as part of a nursing curriculum, teaching geographical concepts and issues to students might provide them with unique insights into core subjects.

Encouraging additional research capacity as an intellectual enterprise: extending Ernst's engagement.

In volume 11, issue 3, Ernst wrote an opinion piece on the funding of centres of excellence. Whilst I agree with his argument, this response outlines a necessary, fundamental and complementary approach to building research capacity.

Extending the field of play: Revealing the dynamics between sports, health and place.

Although the sub-discipline of sports geography has a long fifty-year history it has been, at best, a sporadic endeavor. Whilst clearly indicating the fundamental geographical qualities of sports, it has never really taking off to the extent that arguably it should have given sport's social profile and importance. In way of a solution this paper presents triple tracks, or ways forward, that might circumvent this academic shortfall and cover some of the missed ground. First, pursuing the health component of sport far more thoroughly and in its very broadest sense, including its public health adoption and specific wellbeing, fitness and aesthetic features. Second, defining sport broadly beyond elite forms to include a wide-range of physical and lifestyle activities that possess elements of personal or interpersonal competition. Third, complementing sports geography by developing 'spatial sports studies' as a more expansive interdisciplinary field of inquiry spanning the health and social sciences. Indeed, these tracks potentially unearth substantial new research capacity by together considering the dynamics between sports, health and place.