Guardians of humanity? The challenges of nursing practice in the digital age.

Digital technologies have become a crucial factor in nursing. Given the fact that many tasks could also be done by robots or AI systems, the place for the nurse in this scenario is unclear. In what way and to what extent will the implementation of ever more sophisticated technology affect nursing practice? It is the aim of this paper to analyse the potential challenges of nursing practice in the digital age. The analysis is conducted through the lens of new materialism, a set of theoretical models that understand the relationship between humans and technology as dynamic and performative. According to this view, there is no prefixed essence of technology. Rather, the meaning of technology is enacted in concrete practice. The analysis shows that in past debates on technology use in nursing, the nurses' role has been defined as guardians of humanity, defending the patient against the dehumanizing effects of technology. This role has been transferred to the digital age, where it is the duty of nurses to cushion the negative effects of digital technology. As an alternative to this outdated role, nurses should be included in processes of technology design and policymaking. Enabling nursing professionals to shape the circumstances of a digitally enhanced holistic practice may empower their status within the healthcare system and also benefit the patient by contributing to a more person-centred care.

Albert Mieczyslaw Krapiec's theory of the person for professional nursing practice.

This article presents the works of great Polish philosopher, Mieczyslaw Albert Krapiec, whose creative output can be applied to professional nursing practice. Krapiec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Krapiec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Krapiec: the theory of the person based on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Krapiec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all-not only selected-qualitative deficits of characteristics can be defined as holistic care in the nursing profession.

Finding the fundamental needs behind resistance to care: Using the Fundamentals of Care Practice Process.

A person living with Alzheimer's disease (PA) can experience difficulty during bodily care and therefore may show resistance to care behaviours (RTCBs). Nurses must take a clinical approach to planning care that meets the person's needs. Therefore, it is necessary to identify training strategies for bedside nurses and nursing students. AIMS AND OBJECTIVES: To describe and discuss how the FOC practice process (FOC-PP) can help nurses understand PAs who show RTCBs during bodily care. BACKGROUND: Resistance to care behaviour phenomenon and the importance of bodily care as fundamental care are described. The FOC-PP enables nurses to apply the FOC framework in their practice. DESIGN: This discursive paper is based on the literature of the FOC framework and PP. METHOD: A clinical scenario that develops through the five stages of the FOC-PP. RESULTS: The scenario centres on Mrs. Emily Morgan, 81, who lives in a nursing home and is not receiving the bodily care that she needs. Camille, a nursing student, and her supervisor Florence collaborate with Mrs. Morgan's family to improve the quality of her care. Three particular aspects of nursing practice based on the FOC-PP are described: the critical thinking process, relational process and pedagogical process. CONCLUSION: The FOC-PP promotes holistic care centred on the person and his or her needs and encourages the nurse to use his or her skills and knowledge. All these dimensions are fundamental for high-quality nursing care. RELEVANCE TO CLINICAL PRACTICE: Mrs. Morgan's scenario enables us to perceive that the FOC-PP is very useful for nursing students and bedside nurses. However, given the amount of specific and diverse knowledge required by the FOC-PP, it is necessary to identify avenues for teaching them. Using clinical scenarios could facilitate the integration of the FOC-PP, with taking into account the specific characteristics of individual clients.

Perinatal hospice care in the opinion of nurses and midwives.

OBJECTIVES: Perinatal medicine is a relatively new, dynamically developing branch of medicine. Its main purpose is taking care of a woman in the pre-conception period, pregnancy and delivery, as well as taking care of a newborn baby. The main aim of the study was to assess the state of knowledge and opinion on hospice perinatal care of professionally active nurses and midwives. MATERIAL AND METHODS: An original and anonymous questionnaire containing 30 questions was used for the study. 572 nurses and midwives from the Silesian Voivodeship took part in the study. The obtained data were analyzed. RESULTS: Only 31.6% of respondents defined the level of their knowledge of pregnancy and neonatal care as high. 12.8% of respondents were able to indicate the definition of perinatal care and accurately determine its goals. The women participating in the study were in favor of enclosing the information about not attempting resuscitation (DNAR) in medical record of children with incurable disease diagnosed in fetal life (99.3%). CONCLUSIONS: The study showed deficits in practical and theoretical knowledge of nurses and midwives in the area of hospice perinatal care. Lack of proper preparation is also one of the most frequently mentioned difficulties in taking care of a child and family with poor prognosis.

Integrating spiritual care into nursing education and practice: Strategies utilizing Open Journey Theory.

Throughout nursing, spirituality is a recognized domain of patient care, but nurses feel ill prepared by their nursing education to provide care that is spiritual in nature to patients and their families. Incorporating spiritual care into nursing curricula is challenging in light of the amount of topics for healthcare learning. Open Journey Theory is based on the merging of two grounded theories, one teaching and one learning theory, and is the suggested framework for integrating spirituality and spiritual care across all levels of nursing education. Specially chosen readings (books, articles), activities (role-plays, discussion groups), and assignments (journaling, writing papers, giving reports) can be integrated into already existing courses. By utilizing the three stages of preparing, connecting, and reflecting to frame student learning, nurse educators can introduce and build on spiritual concepts from the simple to the complex over the course of the entire nursing program.

A matrix for the qualitative evaluation of nursing tasks.

AIMS: To formulate a model for patient-nurse interaction; to compile a comprehensive list of nursing tasks on hospital wards; and to construct a nursing tasks demand matrix. BACKGROUND: The physical demands associated with nursing profession are of growing interest among researchers. Yet, it is the complexity of nursing tasks that defines the demands of ward nurses' role. This study explores nursing tasks, based on patient-nurse interaction on hospital wards. METHODS: Extant literature was reviewed to formulate a patient-nurse interaction model. Twenty ward nurses were interviewed to compile a list of nursing tasks. These nursing tasks were mapped against the patient-nurse interaction model. RESULTS: A patient-nurse interaction model was created, consisting of: (1) patient care, (2) patient surveillance and (3) patient support. Twenty-three nursing tasks were identified. The nursing tasks demand matrix was constructed. CONCLUSIONS: Ward managers may use a nursing tasks demand matrix to determine the demands of nursing tasks on ward nurses. IMPLICATIONS FOR NURSING MANAGEMENT: While many studies have explored either the physical or the psychosocial aspects of nursing tasks separately, this study suggests that the physicality of nursing tasks must be evaluated in tandem with their complexity. Ward managers may take a holistic approach to nursing tasks evaluation by using a nursing tasks demand matrix.

¿Cómo ayuda la aplicación del proceso enfermero a las mujeres con diagnóstico ansiedad? / How can the application of the nursing process help to women with anxiety nursing diagnosis?

Objetivo: Evaluar las intervenciones grupales de enfermería en mujeres con diagnóstico enfermero ansiedad mediante el resultado NOC autocontrol de la ansiedad. Material y método: Estudio pre-experimental del tipo pretest-postest de un solo grupo realizado en un Centro de Salud Mental de la Región de Murcia a un grupo de 12 mujeres en edad adulta que presentan el diagnóstico enfermero ansiedad. Se realizó a cada paciente la valoración de enfermería por Patrones Funcionales de Salud (PFS) antes y después de la asistencia a las 8 sesiones de intervenciones enfermeras grupales. Al comenzar y al finalizar el grupo, se cumplimentó el criterio de resultado NOC autocontrol de la ansiedad. Las intervenciones enfermeras fueron a) disminución de la ansiedad (5820), terapia de relajación simple (6040), educación sanitaria (5510), enseñanza grupo (5604) y grupo de apoyo (5430). Se tomó como variable independiente las intervenciones enfermeras y como variable dependiente las puntuaciones del resultado NOC, empleándose como instrumento de evaluación. Resultados: El análisis del resultado NOC autocontrol de la ansiedad nos muestra diferencias significativas. Antes de las intervenciones, la media presenta el valor 22.5 y tras las mismas de 37.8 con una desviación típica de 3.22 y 7.11 respectivamente. La mediana antes y después de las intervenciones corresponde con los valores 21 y 37.5. El parámetro del test de los rangos de Wilcoxon corresponde con un valor de Z igual a -2.98 con una p igual a 0.003. Conclusiones: El estado, conducta y percepciones de las pacientes del grupo medido con el resultado autocontrol de la ansiedad, mejora tras recibir las intervenciones enfermeras. La puntuación global de los indicadores empleados en este resultado ha sido apropiada como medida de los efectos de las intervenciones (AU)

Purpose: To evaluate nursing group interventions in women with anxiety nursing diagnosis by self NOC result of anxiety. Methodology: Pre-experimental pretest-posttest study composed by a single group of twelve women in a Mental Health Center of the Region of Murcia. The participants were a group of women in adulthood presenting the nursing diagnosis anxiety. Each patient received 8 group nursing interventions. Before and after the group intervention, a nursing outcome criteria is filled for each patient. The following nursing interventions were used: Anxiety reduction (5820), simple relaxation therapy (6040), health education (5510), group education (5604) and support group (5430). The independent variable was nursing interventions and the dependent variable was NOC punctuations, being used as an assessment tool. Results: The analysis of the NOC result anxiety self-control shows significant differences. Before the intervention, the mean was 22.5 and 37.8 after it with standard deviations of 3.22 and 7.11 for each one. The median was 21 before interventions and 37.5 after them. The Wilcoxon test shows a Z value of -2.98 with p 0.003. Conclusion: The state, behaviour and perception of patients improve with nursing interventions received. The global punctuation of used clinical indicators is a good tool to measure nursing intervention effects (AU)

NURSING EMERGING. ANA Nursing: Scope and Standards of Practice, (2015) 3rd Edition.

AHNA Past-President Carla Mariano recently had the privilege of serving on the American Nurses Association's (ANA) Nursing Scope and Standards Revision Workgroup. Representing the specialty practice of holistic nursing, Carla's presence within this workgroup contributed greatly to the inclusion of holistic principles and values throughout the new 2015 Nursing: Scope and Standards of Practice, 3rd edition, the foundational document that informs and guides professional nursing practice within the United States. This is a significant step forward for holistic nursing and an indicator of our growing influence as specialty practice.

Evaluation of the case method in nursing education.

The case based learning (CBL) is a problem-based learning which engaging students and presenting them with learning-related and cognitive challenges. The purpose of the study was to elucidate nursing students experiences of the CBL as an educational tool in order to find out if it supports their learning. Qualitative content analysis was used and performed on the statements from nursing students' course evaluations. Students perceived the CBL as an approach combining theory with practice which provides an overview of upcoming profession. Students gain adequate knowledge about patient care in reality and thereby enabling them to obtain a holistic understanding of patients health problems. Reflections related to case seminars widen students perspectives, improve their capacity for cooperation and help them to achieve long-lasting knowledge. This learning method offers nursing students an opportunity to enhance their judgement and critical thinking skills by applying theory in practice. Students gain adequate knowledge about patient care which may benefit patient care due to students acting professionally in their future role.

Caring for children in pediatric intensive care units: an observation study focusing on nurses' concerns.

Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses' concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing--here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children's needs unmet; parent-oriented nursing care--here, the nursing care emphasizes the parents' needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation--here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.

Protocolo de actuación ENLACE-PREALT / Care protocol ENLACE-PREALT

El programa de preparación al alta (PREALT) del CatSalut, dirigido a los pacientes que postalta hospitalaria precisan atención domiciliaria en 24-48 h por Atención Primaria, es un instrumento que mejora la coordinación entre los distintos niveles asistenciales. Se percibió la necesidad de ampliarlo con el concepto de ENLACE: garantizar visita a domicilio o en el centro de salud en menos de cinco días naturales, para dar continuidad asistencial a todos los pacientes que postalta hospitalaria requieran continuidad de cuidados.Al mismo tiempo se perfiló con la bidireccionalidad, que permite el flujo de información entre Atención Primaria (AP) y especializada en ambos sentidos. Entre 2007-2008 las enfermerasde enlace de AP valoraron 1.282 pacientes. 298 pacientes precisaron PREALT y 570 ENLACE. Se encuestaron 202 personas que valoraron con una media de 9,3 (en una escala de de 0 a 10) este proyecto de coordinación. La valoración holística y el seguimiento querealiza la enfermera de enlace de AP con perspectiva primarista al paciente ingresado en el hospital, aporta un valor añadido tanto alequipo de Atención Primaria como al paciente y fomenta su autonomía (AU)

The preparation program on discharge (PREALT-Preparation on Discharge)from the CatSalut (Catalan Health Service) is aimed at patients that are discharged from the hospital and who need domiciliary primary care for 24-48 hours after leaving the hospital. The program is a tool that improves coordination among the different healthcare levels. A need to extend the program was detected and the concept of LIAISON nursing was included in the program: ensuring follow up visits at home or at the primary care centre in less than five natural days to provide continuity of care to all those patients who following their hospital discharge are in need of care.The program was simultaneously designed using the bi-directionality allowed by the flow of information between Primary Care (PC)and Specialised Care in both directions. Between 2007-2008, PCliaison nurses assessed 1.282 patients. 298 required PREALT and 570LIAISON. 202 subjects were interviewed regarding the above mentioned coordination project with a mean of 9,3 (on a scale from de0 to 10). The holistic assessment and the follow up carried out by the PC liaison nurse with a primarist perspective on the hospitalised patient provides an added value both to the primary care teamand to the patient promoting his or her self-autonomy (AU)

Los modelos conceptuales, una estrategia de poder con implicaciones profesionales / Conceptual models; a power strategy with professional implications

Los modelos conceptuales y las teorías de enfermería son considerados por algunos autores como patrones que guían el pensamiento sobre cómo ser enfermera y hacer enfermería. Algunos autores defienden que sin el uso de los modelos enfermeros, difícilmente se podrá perfeccionar la disciplina y la práctica enfermera, e incluso transformar la identidad profesional vinculada a la sumisión, obediencia y humildad. La finalidad de este artículo no es discutir sobre la verdad o falsedad, la utilidad o no de los modelos conceptuales enfermeros, sino analizar desde una perspectiva postestructuralista su uso como una estrategia de poder ejercido por las enfermeras fundamentalmente, a partir de los años setenta en España y las implicaciones profesionales, no intencionadas de su adopción para la profesión. La base de este análisis la constituyen parte de los resultados obtenidos en la tesis doctoral de la autora, en la que analizó los procesos de continuidad y transformación que han constituido la identidad profesional de las enfermeras en España entre 1956 y 1976. Se destacan algunas consecuencias políticas y sociales de articular la práctica de las enfermeras, alrededor de los discursos holísticos, humanistas, moralistas transmitidos por los modelos enfermeros, en ocasiones confrontados a los discursos biopatológicos, técnicos y clínicos (AU)

Conceptual models and nursing theories are considered by some authors as standards that guide the thinking on how to be a nurse and practice nursing. Some authors defend that without the use of nursing models it could be difficult to improve the discipline and nursing practice, and even to transform a professional identity linked to submission, obedience and humility. The purpose of this article is not to argue about the truth or falseness, the usefulness, or not, of conceptual nursing models, but to analyse, from a post-structuralist perspective, their use as a power strategy exercised mainly by nurses since the 1970's in Spain and the unintentional professional implications of their adoption by the nursing profession. The basis of this analysis is from the results obtained in the PhD thesis of the author, in which it analysed the processes of continuity and transformation which constituted the professional identity of nurses in Spain between 1956 and 1976. Some political and social consequences are highlighted on nursing practices, on the holistic, humanist and moralist discourses transmitted by nursing models, on occasions compared with bio-pathological, technical and clinical discourses (AU)

Cultural competence and holistic practice: implications for nursing education, practice, and research.

Western society is becoming increasingly diverse in its cultural, ethnic, linguistic, and religious composition and this has implications for nursing education, practice, and research. Although the healthcare setting is becoming increasingly multicultural, nurses often lack "cultural competence." Incorporating cultural competence in nursing curricula, organizational policy, and research programs will help prepare nurses for multicultural practice environments.

[Comment about the policy statement of the MDS. A position statement of the assessment group of the University Witten/Herdecke with regard to nursing documentation]. / Kommentar zur Grundsatzstellungnahme "Pflegeprozess und Dokumentation" des MDS. Positionspapier der Assessmentgruppe, Universität Witten/Herdecke, zur Pflegedokumentation.

In 2005 the Medical Advisory Service of Social Health Insurance (MDS) in Germany published a policy statement with regard to the nursing process and documentation. According to the intention of the association, this statement should be considered as recommendations which are able to improve nursing practice and to contribute to streamlining of bureaucracy in nursing care. Recognising the broad impact of this publication on nursing institutions, a working group on nursing assessment of the University Witten/Herdecke conducted a critical review of the statement. Significant criteria for evaluation were the primary role of nursing documentation, quality requirements for the documentation as well as recent scientific results concerning the implementation of nursing process and assessment-based nursing diagnoses. The review revealed that the statement lacks of a clear rationale and its content appears to be merely research-based. Therefore it has to be questioned if the publication will accomplish the claimed effects. In fact, future quality criteria for health care are to be developed independently on the basis of scientific results and in consideration of the experiences of all concerned social groups.

Revisiting the evaluation of clinical practice.

The evaluation of patient care is an ongoing process that is aimed at improving clinical outcomes, as well as advancing clinical practice. However, a number of elements need to be taken into account when evaluating clinical practice, including social, structural and process factors. Consideration of these factors, together with comprehensive and holistic assessment, clinical expertise, reflective thinking, and valid and reliable instrumentation, will allow practitioners to better evaluate clinical care, and in effect, improve client outcomes.