A critical analysis of online nursing education: balancing optimistic and cautionary perspectives.

The landscape of nursing education has been transformed by increasing student demand for online programs coupled with strong institutional directives to deliver nursing courses through distributed learning. The authors present a qualitative research design informed by philosophical hermeneutics in which 30 undergraduate and graduate nursing students discuss their experiences of the influence of peer dynamics on online learning. The findings include issues related to time, demands of online participation, experiences of conflict, and the development of skills in the online environment. Theoretical matters of curriculum such as instrumentality and tensionality are examined, generating both optimistic and cautionary possibilities for online learning. Online nursing students could benefit from a period of face-to-face orientation with a focus on building intellectual and social communities, limited class size, and opportunities to connect learners.

Bringing ourselves into view: disclosure as epistemological and ontological production of a lesbian subject.

Using Gadamerian hermeneutics as a methodology and feminist philosophical thought as an analytical framework, this study explores understandings of experiences of disclosure of sexual orientation for older 'lesbian' women. The study draws on an interpretative inquiry in which participants theoretically align with sexual identity categories with both an ontological and an epistemological purpose and later move away from or even disassociate from the 'category' (of lesbian). Reflecting on these interpretations, that of the epistemological and the ontological production of a subject, we ask: What does it mean then to say I am a lesbian? This is where a tension exists: how is it that in spite of the incongruencies of what constitutes a lesbian, and the apparent ambiguity of people to name themselves, we continue to act (as health care providers and researchers) as if the category itself is meaningful and stable? A feminist lens provides an inroad to consider sexuality as practices, rather than as fixed identity; practices that are constituted within the discursive, social and material realities of a life as well as within political and ideological systems in which one resides.

Dialectic of the university: a critique of instrumental reason in graduate nursing education.

Our analysis in this paper unfolds on two levels: a critique of the 'realities' of graduate nursing education and an argument to sustain its 'ideals'. We open for discussion an aspect of graduate nursing education dominated by instrumental reason, namely the research industry, using an internal critique approach developed by Max Horkheimer and Theodor Adorno of the Early Frankfurt School. As we explain, internal critique arises out of, and relies on, the mismatch between goals, or 'ideals', and existing realities. Thinking about 'ideals' of the academy, we draw on Hans-Georg Gadamer's view of the university as a place to think freely, creatively, and critically. The contemporary realities of the university, on the other hand, that emphasize the market values of the research industry forcefully shape nursing academic scholarship in a particular direction. In our attempt to recognize and disrupt the forces of the research industry with its instrumental reason, we consider Judith Butler's writings on how norms operate in society. We show that our growing involvement in the research industry makes it very difficult to disentangle ourselves from that situation. The values of the research industry actually suppress the very ideals of education and scholarship that we would like to uphold. As a contra-force, the internal critique of the 'existing realities' in the graduate nursing education unmasks the tyranny of the research industry and makes visible the importance of sustaining the higher goals and ideals in nursing scholarship.

Where is nursing in the electronic health care record?

The authors explore the possibilities for documenting professional nursing practice in an electronic health record. Recognizing that there are a variety of approaches to electronic documentation, the intent of this discussion is to generate a general rather than a particular approach to this issue. Nurses themselves must determine the ways in which professional nursing care will be captured in the electronic systems used in their facilities. Questions that arise from nursing include: How can nurses balance generalized care and protocol management with the need for documentation of each individual's nursing needs and particular experiences? How can the goals of nursing care be incorporated into the record? How can nursing actions/interventions be clearly communicated to all members of the health care team? In what ways can an electronic record document collaboration with the client to determine individualized outcomes of care and treatment? In considering these questions a number of issues arise: the selection of standardized languages to be used in the records, the title of the record, the tension between coding and text, the accessibility and transferability of the record, the ability to retrieve data on nursing outcomes through data mining techniques, ownership of the record, and privacy/security of the information stored. Although the paper will make no attempt to answer these questions it will draw on relevant journal articles to provide a context for this pivotal change in that way we account for health care practice.

From Braxton Hicks to preterm labour: the constitution of risk in pregnancy.

With the recent introduction of preterm birth prevention programs there has been a shift in our understanding of what the presence of contractions during pregnancy means and a reconstituting of risk in ways that position increasing numbers of women at risk for preterm birth. This paper highlights the findings of a study exploring the influences of risk discourses on women's experiences of preterm labour. The primary goals of this institutional ethnographic study were to describe the effects of societal discourses, institutional structures, and nursing work processes on the everyday lives of childbearing women experiencing preterm labour. The findings suggest that risk discourses exert social control over pregnant women and result in fear, guilt, feelings of being judged or punished, and an overwhelming sense of personal responsibility for preventing preterm birth. The study also exposes ways in which biomedical constructions of risk and preterm labour affect the organization of health services, including nursing practice.

The meaning of the nurse's presence during childbirth.

OBJECTIVE: The purpose of this exploratory study was to develop new understandings of what it means to women in labor for a nurse to be present during childbirth. DESIGN: Hermeneutic inquiry was used to explore the phenomenon of nursing presence during childbirth. The purpose of questioning in hermeneutic phenomenology is to stimulate thoughtful reflection and deeper exploration of the subject's experiences. PARTICIPANTS/ SETTING: Six women from an urban center in Canada volunteered to share their experiences of childbirth through conversations with the research team. DATA ANALYSIS: Audio-taped, transcribed interviews were analyzed along with the reflections of the research team. RESULTS: Women attribute multiple meanings to the care provided by intrapartum nurses. However, what stood out in these women's accounts was that a nurse's presence was the way in which a nurse was "there" for them and was a very important part of their childbirth experience. CONCLUSIONS: Women's experiences of a nurse's presence cannot be understood apart from the institutional structures and work processes that shape their experiences. Further research is needed to explicate how hospital procedures, administrative structures, and medical practices enable or constrain the presence of the intrapartum nurse.

Contemplating the fit and utility of nursing theory and nursing scholarship informed by the social sciences and humanities.

In this article, authors contend that a lack of familiarity with philosophical thinking undermines the ability of students and subsequently practicing nurses to theorize for themselves. Engagement with philosophical ideas propels nurses well beyond the unthinking "application" of extant theory, to theorizing, that is, using theoretical formulations to engage with the significant phenomena we encounter in the world of human health. The authors present a framework to guide philosophical interrogation of knowledge, with a focus on the utility of both disciplinary knowledge and knowledge from the social sciences and humanities.

The limitations of partial citizenship: health care institutions underpinned with heteronormative ideals.

Tensions between apparent rights of lesbian, gay, bisexual, transgender, or queer/questioning people and the continued prevalence of heteronormative health care practice emerged in research with older women who self-identified as lesbian. Having already faced considerable exclusionary institutional practices in their lives, these women expressed anticipatory dread of the erasure of their lives in residential or long-term care. Drawing on the framework of sexual citizenship, this article critiques the disjuncture between the legal reality and the lived reality of LGBTQ people and suggests that social or political rights of full citizenship remain tenuous or absent in residential care settings. Authors present an alternative approach to human health experience.

Integrating experiential learning into a double degree masters program in nursing and health informatics.

In Canada there are few nurses who have advanced practice competencies in nursing informatics. This is a significant issue for regional health authorities, governments and electronic health record vendors in Canada who are implementing electronic health records. Few Schools of Nursing provide formalized opportunities for nurses to develop informatics competencies. Many of these opportunities take the form of post-baccalaureate certificate programs or individual undergraduate or graduate level courses in nursing. The purpose of this paper will be to: (1) describe the health and human resource issues in this area in Canada, (2) provide a brief overview of the design and development of a new, innovative double degree program at the intersection of nursing and health informatics that interleaves cooperative learning, (3) describe the integration of cooperative learning into this new program, and (4) outline the lessons learned in integrating cooperative education into such a graduate program.

Dilemmas, tetralemmas, reimagining the electronic health record.

With the transition from paper-based to computer-based records, nursing practice shifts to computerized documentation of care in the electronic health record (EHR). Viewed not only as an electronic document, but as an instrument of modern economic and technological ideology that serves organizational goals of cost-efficiency, the EHR can be perceived as creating a dilemma for a patient-centered nursing practice. Viewing the EHR as relying solely on the use of standardized languages begets a number of questions and furthers the dilemma for nurses. Through a discussion that draws on the Indian tradition of the tetralemma, authors transcend the EHR/nursing dilemma.

Cultivating a worldly repose: the contribution of Sally Gadow's work to interpretive inquiry.

This paper discusses the contribution that the work of Sally Gadow makes to understandings of interpretive inquiry and it's potential to inform and influence nursing practice, research, and education. The discussion draws on several of Gadow's published works that make explicit her understandings of what it means to be interpretive, to be open to multiple truths, to hear multiple voices, to have a history, to be experienced, and to recognize agency in language. Situating this discussion of Gadow's contribution in opposition to a metaphysics of genius is intended to move our understanding of particular work past the subjectivity that produced it, past the subjectivized responses to the work, past the reporting on myself - my thoughts, my perspectives, my experiences - to explore, to see the worthwhileness or even the possibilities of exploring the work itself and the worlds it evokes. This paper is a deliberate attempt to disrupt the call to the author to save us from the task of interpreting the questions that the work itself places us under. Gadow's work itself points us away from a valorization of the voice of the author of the work, a single voice, and towards a cultivation of a worldly repose where each interpretive account points us to some longstanding whole to which the work belongs and from which it gains its sense and significance.