Ricoeur's narrative philosophy: A source of inspiration in critical hermeneutic health research.

Patient-centred care has gained ground in health service following a health policy initiative aimed at changing the paternalistic culture towards one with more patient involvement. Development of knowledge relating to people's lived experiences of illness is important in this context. Literature in the field of health science describes methods for exploring what is at stake for people affected by illness, and the French philosopher Paul Ricoeur has been a significant source of inspiration. Especially, Ricoeur's interpretation theory has been construed and applied in different, often schematic, methodological variations, whereas his narrative philosophy is a little used source of inspiration. Health science has been characterized by a biomedical awareness of method and the idea that there is a direct and immediate path to patients' experiences, a viewpoint that can be traced back to Descartes and the philosophy of subjectivism. Opposed to Descartes, Ricoeur says that we are already embedded in a world of traditions and meanings over which we have no control. According to Ricoeur, we leave traces when we express ourselves, and traces are formed by the world of meanings and traditions to which we belong. Often, the sense in the traces is hidden, making it impossible to directly understand individual's experiences. Reflection on an individual's lived experiences must take place via the narratives in which the individual expresses themselves. The centrepiece of Ricoeur's narrative philosophy is the threefold mimesis, which is an approach to understanding the meaning of peoples' lived experiences. The philosophical hermeneutics of Gadamer plays an important role in Ricoeur's theory of interpretation, although he has criticized Gadamer for failing to include one dimension in his philosophy; he finds this dimension in Habermas' ideology critique. Ricoeur's ideology critique is absent in health science research, which is why it has been made a focal point in this article.

The status quo of situation-specific theories.

The purpose of this article is to explore the status quo of situation-specific theories through an integrated literature review on situation-specific theories that have been published since 1999. The literature was searched through multiple databases including PubMed, CINAHL, and PsycINFO and analyzed in terms of purpose of theorizing, types of theorizing, sources of theorizing, and linkages to research or practice. Four themes reflecting the current status of situation-specific theories were extracted: (a) explicitly claimed and not explicitly claimed situation-specific theories; (b) multiple philosophical bases; (c) unique theorizing process; and (d) providing clear directions for nursing interventions but rarely evaluated. Nurses need to continuously make their efforts to develop theoretical bases that could closely link theory, research, and practice in nursing and that could adequately serve new nursing needs and challenges.

Nursing intellectual capital theory: implications for research and practice.

Due to rising costs of healthcare, determining how registered nurses and knowledge resources influence the quality of patient care is critical. Studies that have investigated the relationship between nursing knowledge and outcomes have been plagued with conceptual and methodological issues. This has resulted in limited empirical evidence of the impact of nursing knowledge on patient or organizational outcomes. The nursing intellectual capital theory was developed to assist with this area of inquiry. Nursing intellectual capital theory conceptualizes the sources of nursing knowledge available within an organization and delineates its relationship to patient and organizational outcomes. In this article, we review the nursing intellectual capital theory and discuss its implications for research and practice. We explain why the theory shows promise for guiding research on quality work environments and how it may assist with administrative decision-making related to nursing human resource management and continuing professional development.

Stories and programs of research: revelations about humanbecoming.

In this column, humanbecoming theory will be considered from a concrete perspective using stories about Katie written by Dr. Kristine Florczak. It will also be discussed as it relates to more scholarly endeavors in the form of programs of research conducted by Dr. Steven Baumann and Dr. Thomas Doucet.

Thoughts about nursing science and nursing sciencing on the event of the 25th anniversary of Nursing Science Quarterly.

This paper presents an essay about nursing science and asks readers to consider terminology that will encompass all types of nursing discipline-specific knowledge. The essay was written to acknowledge the 25th anniversary of the founding of Nursing Science Quarterly.

Influencing the future of nursing: an interview with sue hassmiller.

This department highlights nursing leaders who have demonstrated the ability to inspire and lead change. This competency is seen in the ability to develop, structure, and implement organizational, local, national, and international change through strategic vision, risk taking, and effective communication. In this article, the author showcases the work of Susan Hassmiller, PhD, RN, FAAN.

Cuidados enfermeros en Cuidados Paliativos: Análisis, consensos y retos / Nursing care in Palliative Care: analysis, consensuses and challenges

La creciente complejidad de los cuidados que requieren las personas en situación de enfermedad avanzada y al final de vida, y la variabilidad de profesionales sanitarios que intervienen en el proceso asistencial, nos conduce a clarificar el rol profesional enfermero en el equipo multidisciplinar de Cuidados Paliativos (CP). Objetivo: reflexionar sobre la práctica enfermera en CP. Metodología: Técnica del grupo nominal. Se seleccionaron 10 enfermeras con más de 10 años de experiencia profesional en CP. Categorías elegidas para la atención enfermera: Evolución de los cuidados, de la profesión enfermera, funciones y actividades de enfermería, historia de los cuidados paliativos. Conclusiones: Necesidad de definir las competencias enfermeras en CP; Necesidad de contemplar la práctica profesional en el marco de un modelo conceptual y la aplicación del método científico enfermero; Necesidad de avanzar en prácticas reflexivas basadas en evidencias científicas; Iniciar una línea de investigación en competencias enfermeras en CP (AU)

The increasing complexity of care needed by patients with advanced diseases or end-of-life situation, added to variability of health professionals who participate in patient care, make necessary to clarify the specific role of nurses in a interdisciplinary Palliative Care team (PC). Aim: To establish a reflection about the nurse practice in PC. Methodology: Nominal group study. Ten nurses with more than 10 years of experience in PC were selected. The main areas of discussion were: the evolution of care and nursing profession, the general practice of nurses and Palliative Care history. Conclusion: There is the need: a) define nurse's competences in PC; b) describe the professional practice in the frame of a conceptual model and the application of nurse's scientific method; c) advance in a practice based on scientific evidence; d) start a research line about nurse's competences in PC (AU)

Hierarchies of evidence in education.

The trend toward providing evidence-based education has emerged in part from the precedent set by the evidence-based practice movement in medicine. Historically, the medical model specified that evidence should be informed by experimental research. However, more contemporary models draw on a variety of evidence to determine best practices. Quantitative, qualitative, and mixed-methods designs, as well as the incorporation of professional expertise, are recognized as acceptable approaches to interpreting evidence in the educational arena. This article describes an integrated level of evidence model to assist educators in identifying the best evidence to inform teaching and learning practices.

La evolución del pensamiento enfermeroa través de los escritos de Pilar Arcas / Evolution of nursing thinking through the writings of Pilar Arcas

El presente artículo pretende realizar una revisión crítica del pensamientode una enfermera española, Pilar Arcas Ruiz (Granada 1951-1998), queen las últimas dos décadas del siglo XX desarrolló un intenso trabajoconsiderado de gran interés por su contribución al desarrollo de la profesiónenfermera actual. A través de la revisión de varios documentoshemos podido constatar aportaciones de excepcional importancia para eldesarrollo profesional de las enfermeras, como son sus reflexiones sobreel significado de cuidar y la aportación específica de la enfermera a la salud,la defensa de la necesidad de investigar en cuidados, la utilizaciónde metodología en el proceso de atención y la formación superior.Igualmente, este artículo pretende ser un homenaje y un reconocimientoa su trayectoria, además de dejar constancia, en forma de documentoescrito, para las nuevas generaciones de enfermeras (AU)

This article aims to perform a critical review of the thinking of a Spanishnurse, Pilar Arcas Ruiz (Granada, 1951-1998), who, in the last two decadesof the 20th century developed a comprehensive work that is deemedto be of great interest due to its contributions to the development ofthe current nursing profession. By means of the review of several documentswe have been able to find extremely important contributions tothe professional development of nurses, such as her reflections on the meaningof providing care and the specific contribution of nurses to health,the need to carry out research on care, the use of methodology inthe care delivery process and higher training.Likewise, this article aims to be a tribute and recognition of her trajectory,in addition to being a written record for new generations of nurses (AU)

Evolving Grounded Theory Methodology: towards a discursive approach.

Grounded Theory Methodology (GTM) is a widely cited research approach based upon symbolic interaction with a focus on interaction, action and processes. Relatively recently, Discursive Psychology; a language-based interaction research approach also based on symbolic interaction, emerged. At present Discursive Psychology is principally cited in the social sciences literature. Given Discursive Psychology's symbolic interaction foundations, what relevance does this approach have for evolving GTM? A number of methodological challenges were posed by a study looking at humour in Clinical Nurse Specialist-patient interactions. This paper will use the phenomenon of spontaneous humour in healthcare interactions to illustrate the potential for a new form of GTM drawing on discursive approaches; Discursive GTM. First, the challenges presented by a study looking at spontaneous humour in Clinical Nurse Specialist-patient interactions are presented. Second, the research approach adopted to meet these challenges - Discursive GTM (DGTM) - is explicated and the results of the study are outlined. Third, the different GTM approaches and Discursive Psychology are compared and contrasted in relation to the DGTM approach adopted. Finally, the challenges and tensions of using DGTM as well as the opportunities afforded by the use of naturally occurring data are reviewed. The authors contend that a DGTM approach may be appropriate in analyzing certain phenomena. In particular, we highlight the potential contribution of naturally occurring data as an adjunct to researcher-elicited data. Thus, when exploring particular phenomena, a DGTM approach may address the potentially under-developed symbolic interaction tenet of language.

Ricoeur's hermeneutic phenomenology: an implication for nursing research.

Researchers and educators are increasingly implementing qualitative research methods to investigate issues of concern and interest. Hermeneutics has risen as an option for the qualitative research paradigm particularly after the 1970s. The precedence of the sciences that have applied hermeneutics as their approach to investigation is provided with special reference to nursing. In the nursing science, hermeneutics have been used extensively as a qualitative research method to investigate a variety of issues, through the lived experiences of the participants. In this paper, we introduce important aspects of the philosophy of Paul Ricoeur and we discuss the reasons why we have applied this approach in our study titled 'Quality Nursing Care: perspectives of patients with cancer and the nursing response'. The arguments that are presented here can be generalised to fit other areas of Nursing Science. Through this paper our aim is not only to familiarise the reader with Ricoeur's work, but also to arrive at an appreciation of his philosophy as a methodological approach for future nursing research.

Methodological considerations in evaluating eHealth interventions.

Advances in information and communication technologies shape consumers' attitudes towards engagement in their own health and their interface with the health-care system. The use of eHealth tools holds promise for supporting and enabling health behaviour change and the prevention and management of chronic diseases. The authors review issues related to study design, treatment implementation, and outcome measurement in eHealth trials, providing examples from the literature and from their own ongoing studies. Selection of a comparison group and design considerations related to participant preferences are based on the state of the science and current practice in the particular field. Randomized designs allow for control of selection bias and are favoured in both efficacy and effectiveness trials of eHealth interventions. Depending on the choice of comparison groups, eHealth applications must be fairly robust to demonstrate their efficacy above and beyond active controls. Strategies to ensure treatment fidelity and ongoing participant engagement can be challenging and are not always successful. Patient-reported outcomes are common to eHealth studies. Other outcomes, such as the costs associated with new eHealth applications, are equally if not more important for decision-makers. This discussion is intended to inform future trials and thereby serve to advance the science of eHealth.

Stress and coping in nurse managers: two decades of research.

An integrative literature review was undertaken to examine the research related to stress and coping in nurse managers. Key gaps in the literature were identified with implications for research presented.

Nursing scholars appropriating new methods: the use of discourse analysis in scholarly nursing journals 1996-2003.

Nursing scholars appropriate the analysis of discourse. "Discourse analysis" covers a wide spectrum of approaches to analysing meaning and language and there is no widely accepted definition of either a concept or an analysis of discourse. A sample of the discourse analyses indexed in the CINAHL database was analysed in order to identify what notions of discourse and discourse analysis are preferred by nursing scholars. The results showed that nursing scholars prefer approaches to discourse that resemble mainstream qualitative research avoiding social life and interaction. Explanations for these findings are briefly outlined.

Trabajar con método científico / Working with the scientific method

Para mejorar la calidad de la prestación de los cuidados enfermeros, la Dirección de Enfermería del Área 7 de Madrid elaboró un plan de trabajo basado, fundamentalmente, en la implantación progresiva del método científico en el trabajo enfermero habitual. Este estudio (descriptivo transversal) mide el grado de implantación de la metodología tras 18 meses de desarrollo del plan y compara los resultados con los obtenidos en los seis primeros meses. La Dirección de Enfermería había planteado alcanzar, a los 18 meses, un 50 por ciento de cumplimentación completa del proceso enfermero de los usuarios inmovilizados y terminales. El objetivo se ha cumplido en cuanto a la valoración por patrones y registro del diagnóstico enfermero. Hay que mejorar en la cumplimentación del plan de cuidados, así como en el registro de la evaluación (AU)