Unlicensed uses for medication in a palliative care unit.

The aim of this study was to review the extent of drug use for unlicensed purposes in a palliative care unit. We carried out a prospective study of all patients with advanced malignancy admitted to a 10-bed specialist palliative care unit over a 4-month period. Prescriptions were assessed and compared with licensed prescribing indications. Seventy-six patients were included in the study; 689 prescriptions were made using 84 drugs to treat 34 different symptoms. Fifteen per cent of prescribing events were for unlicensed indications. We conclude that drugs are frequently used in the palliative care setting for purposes unsupported by product licences, although usually backed by literature. These drugs are often prescribed for symptoms which are difficult to control.

Ideological implications of paradigm discourse.

Whilst the notions of paradigm and paradigm shift have become popularized in nursing's scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivation underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.

Abstracting women: essentialism in women's health research.

Women's desire to take control of their own bodies creates a natural affinity between the projects of feminism and women's health research. Feminists have used the categories of woman/women, gender, and sex as foundation terms to designate the subject of feminist theories. Universal categories, which have been exposed as essentialist by postmodern and poststructural critiques, create falsely unified subject positions that fail to account for the diversity of women and also fail to acknowledge the situated interests of the dominant groups whose perspectives they reflect. Because it adopts these same categories, research in women's health is also permeated with this essentialized understanding, whether or not it is overtly feminist. In this paper, we point out the dangers of the unreflective use of woman/women, gender, and sex in women's health research. We conclude, that for political purposes, however, a carefully considered "strategic essentialism" can be warranted in research aimed at improving women's health.

Nursing's metaparadigm concepts: disimpacting the debates.

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing's approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing's health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing's literature, the authors argue for a less extreme and more integrated reference point for nursing's theory and practice.

Nurses' descriptions of caring for culturally diverse clients.

The nursing profession has responded to today's cultural diversity through theory development, association statements, research, and inclusion of cultural content in nursing curricula. This qualitative study was completed to explore whether this increased attention to cultural diversity is resulting in culturally sensitive nursing care. In this preliminary description of cross-cultural care, eight recently graduated nurses were each interviewed twice. Caring for culturally diverse clients is reflected by these participants as complex and challenging, due to the interrelatedness of multiple personal and contextual factors. Nurses' commitment to caring for culturally diverse clients varies, ranging from "resistant" to "generalist" to "impassioned." Contextual factors include the setting of health care, the support of colleagues, the institutional climate, the foundation of education, and the presence of racism. Despite the nursing profession's attention directed toward issues of cultural diversity, it seems that the goal of culturally sensitive care remains a distant ideal.

Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.

Despite nursing's enthusiastic endorsement of the applicability of qualitative research approaches to answering relevant clinical questions, many nurse researchers have been hesitant to depart from traditional qualitative research methods. While various derivations of phenomenology, grounded theory, and ethnography have been popularized within qualitative nursing research, the methodological principles upon which these approaches are based reflect the foundations and objectives of disciplines whose aims are sometimes quite distinct from nursing's domain of inquiry. Thus, as many nurse researchers have discovered, nursing's unique knowledge mandate may not always be well served by strict adherence to traditional methods as the "gold standard" for qualitative nursing research. The authors present the point of view that a non-categorical description, drawing on principles grounded in nursing's epistemological mandate, may be an appropriate methodological alternative for credible research toward the development of nursing science. They propose a coherent set of strategies for conceptual orientation, sampling, data construction, analysis, and reporting by which nurses can use an interpretive descriptive approach to develop knowledge about human health and illness experience phenomena without sacrificing the theoretical or methodological integrity that the traditional qualitative approaches provide.