ANGUS J, HODNETT E and O’BRIEN-PALLAS L. Nursing Inquiry 2003; 10: 218–228Implementing evidence-based nursing practice: a tale of two intrapartum nursing unitsDespite concerns that the rise of evidence-based practice threatens to transform nursing practice into a performative exercise disciplined by scientific knowledge, others have found that scientific knowledge is by no means the preeminent source of knowledge within the dynamic settings of health-care. We argue that the contexts within which evidence-based innovations are implemented are as influential (...) in the outcomes as the individual practitioners who attempt these changes. A focused ethnography was done in follow-up to an earlier trial that evaluated the effectiveness of a marketing strategy to encourage the adoption of evidence-based intrapartum nursing practice. Bourdieu's (1990, 1991) concepts of habitus, capital and social field were used in our refinement of the analysis of the ethnographic findings. Nursing leadership, interprofessional struggle with physicians, the characteristics of the community and the physical environment were prominent issues at all of the sites. Detailed descriptions of the sociohistorical context and of the experiences at two sites are presented to illustrate the complexities encountered when implementing innovations. (shrink)

Toward evidence‐based policy decisions: a case study of nursing health human resources in Ontario, CanadaThis paper reflects how health services research ‘evidence’ was used to influence decisions in the province of Ontario, Canada. The process involved interaction among a variety of stakeholders and decision‐makers with researchers to reduce uncertainty and to substantiate emerging service provision issues in the province. The issues presented here focus specifically on an analysis of the nursing situation completed in 1998 for the Minister (...) of Health’s Nursing Task Force, which examined key issues in service delivery. The issues were: restructured work environments; nurse supply and declining enrollments; labour trends and utilization of the nursing workforce; patient acuity and complexity of work environments and the influence on workload; and the paucity of reliable and valid data bases for analysis of nursing’s contribution to the health system. Ontarians can be confident that the Task Force recommendations were born from solid research‐based evidence and now the challenge becomes to monitor the implementation of these resolutions over time. (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and (...) the other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

Governing nursing conduct: the rise of evidence‐based practice Drawing on the Foucauldian concept of ‘governmentality’ to analyse the evidence‐based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of (...) nursing work through evidence‐based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence‐based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence‐based nurse requires the modern nurse to develop new skills and attitudes. Evidence‐based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level. (shrink)

Background: The relationship between the nurse and the patient is understood as fundamental in nursing care. However, numerous challenges can be related to the provision of relationship-based nursing care. Challenges exist when nurses do not respond adequately to the patient’s appeal for help. Moreover, challenges arising in the nurse–patient relationship can be understood as more destructive demands from the patient to the nurse, thus begging inquiry into such a relationship. Research question: The overall aim is to explore and (...) argue the relevance of problematizing destructive demands evident within relationship-based nursing care. Research design: This theoretical article explores destructive demands based on the phenomenological philosophy of the Danish theologian and philosopher Knud E. Løgstrup and provides examples of nurses’ experiences in everyday nursing care. The examples are drawn from a Norwegian empirical study based on a hermeneutical research design. Participants and research context: Data consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions. Ethical consideration: The original empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the participants. Findings: Two themes are described: strong impressions formed in meetings with patients and persistent concern over the burden of work and ability to endure. Discussion: Destructive demands related to relationship-based nursing care are discussed along two lines, first, by further elucidating nurses’ everyday experiences connected to destructive demands and, second, by highlighting the significance of including destructive demands within the relationship-based nursing care. Conclusion: Including destructive demands related to relationship-based nursing care is of particular significance in enabling the proposition that radical, one-sided demands are based on relationality, reciprocity and thereby expectations of life. In short, both the nurse and the patient are human beings in need of love and goodness. (shrink)

The deconstructing angel: nursing, reflection and evidence‐based practice This paper explores Jacques Derrida's strategy of deconstruction as a way of understanding and critiquing nursing theory and practice. Deconstruction has its origins in philosophy, but I argue that it is useful and relevant as a way of challenging the dominant paradigm of any discipline, including nursing. Because deconstruction is notoriously difficult to define, I offer a number of examples of deconstruction in action. In particular, I focus on (...) three critiques of reflective practice by the meta‐narrative of evidence‐based practice (EBP) and attempt to show how those critiques can be directed back at EBP itself. I conclude with the observation that EBP is open to many of the criticisms that it directs at other discourses, including problems of a lack of empirical evidence, of distortions due to memory, and of falsification of the ‘facts’. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of (...) thought and scientific integrity through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP (...) generates the controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)

Recognising relationships: reflections on evidence‐based practice This paper argues for a broadening of the way evidence is developed and used in health‐care. It contends that the current political and policy imperatives and the evidence‐based practice movement are in direct tension with the other major ideological movements that promote patient‐centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be (...) alleviated by embracing a broader definition of what counts as evidence and by focusing more on patient‐centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses’ response to patient experiences can improve the evidence base for nursing. (shrink)

NAIRN S. Nursing Inquiry 2012; 19: 6–17 A critical realist approach to knowledge: implications for evidence‐based practice in and beyond nursingThis paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter‐related. On one side, there is the view that all (...) healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge. (shrink)

This paper puts forward the argument that there are various, competing, and antithetical evidence‐based practice (EBP) definitions and acknowledges that the different EBP definitions are based on different epistemological perspectives. However, this is not enough to understand the way in which nurse professionals choose between the various EBP formations and consequently facilitate them in choosing the most appropriate for their needs. Therefore, the current article goes beyond and behind the various EBP epistemologies to identify how individuals choose an epistemology, (...) which consequently will assist our understanding as to how an individual chooses a specific EBP formation. Individuals choose an epistemology on the mere belief that the specific epistemology offers the ideals or ideas of best explaining or interpreting daily reality. These ideals or ideas are termed by science, history, and politics as ideology. Similarly, individual practitioners choose or should choose between the different EBP formations based on their own personal ideology. Consequently, this article proceeds to analyse the various ideologies behind different EBP definitions as to conclude that there are two broad ideologies that inform the various EBP formations, namely the ideology of truth and the ideology of individual emancipation. These two ideologies are analysed and their connections to the various EBP formations are depicted. Eventually, the article concludes that the in‐depth, critical, and intentional analysis by individual nurses of their own ideology will allow them to choose the EBP formation that is most appropriate and fitting for them, and their specific situation. Hence, the conscious analysis of individual ideology becomes the criterion for choosing between competing EBP formations and allows for best evidence to be implemented in practice. Therefore, the best way to teach EBP courses is by facilitating students to analyse their own ideology. (shrink)

Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence‐based fast‐track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients’ individual perspectives in an evidence‐based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence‐based recommendations, (...) which specify a set of rules that the patient must follow rigorously. The other is a course of democratization based on patients’ involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence‐based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence‐based medicine are being lost in the transformation into the current evidence‐based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence‐based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’. (shrink)

This paper aims to queer evidence‐based practice by troubling the concepts of evidence, knowledge and mental illness. The evidence‐based narrative that emerged within biomedicine has dominated health care. The biomedical notion of ‘evidence’ has been critiqued extensively and is seen as exclusive and limiting, and even though the social constructionist paradigm attempts to challenge the authority of biomedicine to legitimate what constitutes acceptable evidence or knowledge for those experiencing mental illness, biomedical notions of evidence appear to remain relatively (...) intact. Queer theory offers theoretical tools to disrupt biomedical norms and challenges biomedical normativity to indicate how marginalisation occurs when normative truths about mental health classify those who differ from the norm as ‘ill’ or ‘disordered’. Queer theory's emphasis on normativity serves the political aim to subvert marginalisation and bring about radical social and material change. Reference will be made to mental health subjects within each discourse by indicating how the body acts as a vehicle for knowing. Deleuzian notions of the rhizome are used as metaphor to suggest a relational approach to knowledge that does away with either/or positions in either biomedical, or queer knowledge to arrive at a both/and position where the biomedical, constructionist and queer are interrelated and entangled in needing the other for their own evolution. However, queer does not ask for assimilation but celebrates difference by remaining outside to disrupt that which is easily overlooked, assumed to be natural or represented as the norm. The task of queer knowledge is to do justice to the lives lived in the name of evidence‐based practice and demands that we consider the relations of power where knowledge is produced. This pursuit creates different knowledge spaces where we identify new intersections that allow for socially just understandings of knowing or evidence to emerge. (shrink)

In bringing together this special edition we wish to contribute to a conversation concerning the meaning of 'evidence-based practice'. We are nurses and phenomenological researchers interested in lifeworld approaches and in the many ways of knowing that are relevant to everyday caring practice. In the context of the ever-increasing specialisation of knowledge, we wish to widen the embrace of current notions of evidence and point to ways of knowing that are inclusive of the 'head, hand and heart'. This wider embrace (...) of evidence does not excessively exclude kinds of knowledge that include the aesthetic, empathic, embodied and relational dimensions of understanding. (shrink)

PORTER S and O’HALLORAN P. Nursing Inquiry 2012; 19: 18–28 The use and limitation of realistic evaluation as a tool for evidence‐based practice: a critical realist perspectiveIn this paper, we assess realistic evaluation’s articulation with evidence‐based practice (EBP) from the perspective of critical realism. We argue that the adoption by realistic evaluation of a realist causal ontology means that it is better placed to explain complex healthcare interventions than the traditional method used by EBP, the randomized controlled (...) trial (RCT). However, we do not conclude from this that the use of RCTs is without merit, arguing that it is possible to use both methods in combination under the rubric of realist theory. More negatively, we contend that the rejection of critical theory and utopianism by realistic evaluation in favour of the pragmatism of piecemeal social engineering means that it is vulnerable to accusations that it promotes technocratic interpretations of human problems. We conclude that, insofar as realistic evaluation adheres to the ontology of critical realism, it provides a sound contribution to EBP, but insofar as it rejects the critical turn of Bhaskar’s realism, it replicates the technocratic tendencies inherent in EBP. (shrink)

The oil crisis, risk and evidence‐based practice Evidence‐based practice has risen to prominence over the last 20 years. Different professions have taken it up in different ways and for different purposes. It has been seen as holding both threats and advantages to professionalising endeavours and professional identity. It has engendered controversy but some criticisms of it have been unconvincing. It is possible to account for its rise as a response to tightening financial constraints on state spending in the (...) west, as a sign of a culture increasingly concerned with risk, distrust of professionals and experts, as well as a way for professionals themselves to maintain control over their activity in the face of growing managerialism. This paper reviews the literature of some of the movement's proponents as well as criticism from various professional groups. It concludes that more useful than either arguing for or against it, is to understand the policy background and sociological reasons for its emergence and spread. (shrink)

Modern British nursing developed from the mid‐nineteenth century and was seen as a morally purifying activity and as a potential force for social cohesion. It was also considered an activity fit for women. However, it embodied a fundamental tension within Victorian sensibility between a kind of rationalistic utilitarianism and a faith in transcendent values. This paper explores this tension and suggests that it can be detected in current debates about practice and evidence in nursing in the contemporary context (...) of a rise of managerialism in public services. (shrink)

Meta‐analysis: the glass eye of evidence‐based practice?Meta‐analysis was developed as a technique for combining the results of many different quantitative studies: it is often used to produce quantitative estimates of causal relations and/or association between variables. Meta‐analysis is sometimes regarded as a central component of evidence‐based practice. We draw attention to an incompatibility in the epistemology and methods of reasoning in quantitative meta‐analysis and the epistemology and reasoning implicit in expert practice. We argue that this may be because (...) the common perception of meta‐analysis appeals to truth as correspondence; we suggest that rejecting the naïve realism that underpins truth as correspondence allows meta‐analysis to be understood in terms of truth as coherence. We can then develop an account of meta‐analysis that does not depend upon reduction to a mathematical procedure but is an attempt to maximise coherence in beliefs about what works that is consistent with clinical reasoning in expert practice. (shrink)

Relationships, jobs, and health behaviors-these are what New Year's resolutions are made of. Every year millions resolve to adopt a better diet, exercise more, become fit, or lose weight but few put into practice the health behaviors they aspire to. For those who successfully begin, the likelihood that they will maintain these habits is low. Healthcare professionals recognize the importance of these, and other, health behaviors but struggle to provide their patients with the tools necessary for successful maintenance of their (...) medical regimens. The thousands of research papers that exist on patient adherence and health behavior change can leave professionals overwhelmed. This book synthesizes the results from more than 50 years of empirical research, resulting in simple, powerful, and practical guidance for health professionals who want to know the most effective strategies for helping their clients to put long-term health-relevant behavior changes into practice. It advocates a straightforward 3-ingredient model: Before a person can change, they must know what change is necessary ; desire the change ; and then have the tools to achieve and maintain the change. This book is designed to be informative and compelling, but its numerous anecdotes and examples render it engaging and entertaining, as well. Written for a practitioners and students of medicine, chiropractic, osteopathy, nursing, health education, physician assistant programs, dentistry, clinical and health psychology, marriage and family counseling, social work, school psychology, and care administrators -- and for lay persons who wish to take an active role in their health, this book brings together major empirically-based findings within the field and provides succinct, evidence-based recommendations and strategies for using these findings to make real changes. (shrink)

In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of disease, I (...) configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008 , 783). (shrink)

This paper provides an analysis of nursing as a knowledgeable discipline. We examined ways in which knowledge operates in the practice of home care nursing and explored how knowledge might be fruitfully understood within the ambiguous spaces and competing temporalities characterizing contemporary healthcare services. Two popular metaphors of knowledge in nursing practice were identified and critically examined; evidence-based practice and the nurse as an intuitive worker. Pointing to faults in these conceptualizations, we suggest a different way of (...) conceptualizing the relationship between knowledge and practice, namely practice as being activated by contextualized knowledge. This conceptualization is captured in an understanding of the intelligent creation of context by the nurse for nursing practice to be ethical and effective. (shrink)

Clinical practice is a part of the integral learning method in nursing education. The use of information and communication technologies (ICT) in clinical learning is highly encouraged among nursing students to support evidence-based nursing and student-centered learning. Through the information-processing lens of the mindsponge theory, this study views performance expectancy (or perceived usefulness) and effort expectancy (or perceived ease of use) as results of subjective benefit and cost judgments determining the students’ ICT using intention for supporting clinical (...) learning, respectively. Therefore, the study examines whether effort expectancy moderates the relationship between performance expectancy and the intention to use ICT among Moroccan nursing students. The Bayesian Mindsponge Framework (BMF) analytics was employed on a dataset of 702 Moroccan nursing students. We found that nursing students’ performance expectancy is positively associated with the intention to adopt ICT and social media, while effort expectancy positively moderates this relationship. Moreover, the model with effort expectancy as the moderator was discovered to have a significantly larger weight than the model with effort expectancy as the direct predictor, validating our information-processing reasoning. This study provides a new perspective on the interplay between the benefit and cost perceptions of ICT use to support clinical learning methods in nursing education. Moreover, given the limited education resources, especially in developing countries like Morocco, we recommend nursing education and training prioritize communicating the benefits of ICTs and social media over ease of use. Doing so would help improve the effectiveness and efficiency of nursing education and training while lowering costs. (shrink)

Designed specifically for the educational needs of RN to BSN students This is a unique, innovative professional nursing ethics textbook designed specifically for the educational needs of RN to BSN students. Written by experts in the field, it discusses ethical concepts geared to the licensed nurse who has spent several years in practice but is learning high-level concepts and applications. The text addresses different areas of professional practice and is rich with case studies illustrating clinical scenarios involving ethical awareness (...) and decision-making. The book fulfills the necessary criteria for the AACN Essentials for Baccalaureate Education and the QSEN and ISOM competencies. Clear and concise, the text relates content to the nurse’s current practice and professional development without extraneous information typically included in other texts. Progressing from simple to complex, chapters build on previous practice experience to focus on ethical decision-making in a variety of practice environments. The book incorporates a “four boxes” decision-making model and addresses essential communication skills, how to recognize and resolve moral distress, and the role of an ethics committee. It discusses common ethical issues likely to be encountered and ethical practice as it relates to quality and safety. Case Study Dilemmas that include evidence-based research provide the opportunity to apply ethical decision-making principles. QSEN application principles are also featured in each chapter, and interactive exercises and questions and PowerPoints provide further opportunity for critical thinking. Key Features: Addresses the specific needs of students in the RN to BSN course Fulfills AACN Essentials, IOM Competencies, and QSEN KSAs Builds upon previous practice experience of RN to BSN students Discusses ethical decision-making in a variety of practice environments Includes Case Study Dilemmas to apply ethical decision-making principles. (shrink)

Evidence-based nursing practice is based on three pillars: the available research, known preferences of the patient or patient group and the professional experience of the nurse. For all pillars, research is the tool to expand the evidence we have, but when implementing evidence-based practice in paediatric nursing two of the pillars demand that children are included as respondents: practice research on the nursing interventions in paediatrics and the preferences of patients, something recognized by scholars and practitioners. But (...) including a vulnerable group as children in nursing research raises specific ethical issues that need to be considered by researchers. What are ethical considerations that are currently raised about doing research with children and what do we learn by synthesizing the narrative of these studies of why the issues are raised and which solutions can be offered for these issues? In this article, considerations on three ethical principles according to the Belmont report are described by examining recent research. Twenty-one studies were found addressing relevant ethical aspects including vulnerability, gaining consent, designing quantitative or qualitative research methods and considerations regarding the execution of the study. Ethical considerations should be much more a case of continuous awareness and attitude, then box-ticking exercise, although there are sufficient international guidelines available specifically for research that includes children to aid researchers. (shrink)

Background Triage in the emergency department (ED) is a crucial procedure that establishes the urgency of patient care based on symptoms at presentation. Although the efficacy of triage nurse training programs varies, their goal is to increase the precision and efficiency of their decision-making. Aim With a focus on research done between 2019 and 2024, the systematic review attempts to evaluate the effect of training programs on the accuracy and efficiency of triage nurses in emergency departments. Method We conducted a (...) thorough search of the PubMed, EMBASE, and Web of Science databases to find pertinent research. Studies assessing training treatments for triage nurses and reporting accuracy and efficiency-related results were included in the inclusion criteria. Both the quality assessment and data extraction were carried out separately by two reviewers. Result Ten studies that used a range of triage training techniques and covered a variety of geographic areas satisfied the inclusion criteria. Research findings consistently showed that, despite variations in study designs and outcome measures, training programs increased triage accuracy and efficiency. Interventions included clinical decision support system integration, training based on simulation, and conventional classroom-based instruction. Conclusion By increasing decision-making efficiency and accuracy in patient evaluation, training programs greatly improve the performance of triage nurses in emergency departments. To improve comparability and support evidence-based policies, future research must standardize training methodologies and outcome measurements. (shrink)

There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation is (...) unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries. (shrink)

Aim: To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard. Background: Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations. Design: The Preferred Reporting Items for Systematic Reviews (...) and Meta-analyses guide, a basic search algorithm, was taken. Data sources: Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016. Review methods: Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts. Results: This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research. Conclusion: As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject. Ethical consideration: Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review. (shrink)

This article reports on research that examines newly qualified UK nurses’ experiences of implementing their ideals and values in contemporary nursing practice. Findings are presented from questionnaire and interview data from a longitudinal interpretive study of nurses’ trajectories over time. On qualification nurses emerged with a coherent and strong set of espoused ideals around delivering high quality, patient‐centred, holistic and evidence‐based care. These were consistent with the current UK nursing mandate and had been transmitted and reinforced throughout (...) their ‘prequalification’ programmes. The existence of professional and organisational constraints influenced their ability to implement these ideals and values once in practice. Data analysis revealed that within 2 years in practice the newly qualified nurses could be categorised as sustained idealists, compromised idealists, or crushed idealists. The majority experienced frustration and some level of ‘burnout’ as a consequence of their ideals and values being thwarted. This led to disillusionment, ‘job‐hopping’ and, in some cases, a decision to leave the profession. These data are explored and discussed to inform the question of whether the current nursing mandate is sustainable. (shrink)

Notwithstanding the remarkable achievements made by medical science over the last half of the twentieth century, there is a palpable sense that a strictly medical view of human health, that is one founded on modernist assumptions, has become problematic, if not counterproductive. In this study, I argue that as nursing continues to eagerly welcome and indeed champion medical epistemology in the form of knowledge transfer, evidence‐based practice, research utilization, outcomes‐based practice, quantifiable efficiency and effectiveness, it risks becoming little (...) more than a medical science addendum and indeed one that inherits the problems now facing contemporary medicine. The purpose of this study then is to attempt to resituate nursing as a discipline at work within an ontopolitical matrix of radical democratic pluralism. I begin by tracing a philosophical line from Kuhn’s paradigms to Bloor’s strong programme of Sociology of Scientific Knowledge. Following this, I attempt to explicate the thought of Bruno Latour as a philosophical alternative to Sociology of Scientific Knowledge. Next, I outline the radical pluralism of William Connolly in an effort to demonstrate its similarity to Latour’s philosophy and finally how such a position is germane to contemporary nursing and the reality of politics. I do this with reference to the controversial issue of illicit drug use and harm reduction. In effect, I argue that such an issue cannot be dealt with using scientific evidence alone, but rather requires a philosophy of advocacy, what I term democratic advocacy, that is capable of responding to the politics of suffering, which is to say suffering that results from identity/difference. (shrink)