Nursing work and nursing knowledge : exploring the work of women's health nurses, patterns of power and praxis

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

Professional Master's degree in Nursing: knowledge production and challenges

OBJETIVO:analisar a produção do conhecimento gerada pelos programas de mestrado profissional em enfermagem e refletir sobre suas perspectivas para a área.MÉTODO:estudo descritivo e analítico. Foram incluídos dados das dissertações de três instituições de ensino que titularam alunos em programas de mestrado profissional em enfermagem entre 2006 e 2012.RESULTADOS:a maioria dos 127 trabalhos de conclusão analisados se desenvolveu no contexto hospitalar; houve tendência de concentração nas áreas organizacional e assistencial, nas linhas de pesquisa processo de cuidar e gerenciamento e predomínio de estudos qualitativos. Há diversidade de produtos resultantes dos trabalhos de conclusão: avaliação de serviços/programas de saúde e geração de processos, protocolos assistenciais ou de ensino.CONCLUSÃO:os programas de mestrado profissional em enfermagem, em fase de consolidação, têm produção recente, em desenvolvimento, havendo lacuna na geração de tecnologias duras e inovação. São fundamentais para o desenvolvimento das práticas profissionais inovadoras que articulem o setor saúde e a educação.

Advancing nursing practice : redefining the theoretical and practical integration of knowledge

Aim The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. Background The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. Design The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. Method A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. Conclusion There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. Relevance to clinical practice What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner’s work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.

Knowledge as a factor in vulnerability to tuberculosis among nursing students and professionals

The objective of this study was to identify vulnerability to tuberculosis (TB) related to knowledge about the disease among 76 nursing students and professionals. A quantitative descriptive study was conducted using a closed questionnaire for the collection of data regarding transmission, preventive and biosafety measures, diagnosis, and prejudice regarding the disease. The SAS software version 9.1.3 was used for data analysis, with the level of significance set at 5% (p < 0.05). Nursing students and professionals showed a vulnerability to TB related to knowledge about transmission, preventive and biosafety measures, and diagnosis of the disease. With respect to transmission, vulnerability was higher among nursing professionals. The results indicate the need for investment by healthcare institutions surrounding this topic in view of the important role of nursing in the establishment of strategies for prevention and control of the disease.

Building research capacity in the nursing workforce : the design and evaluation of the nurse researcher role

Objectives: The Nurse Researcher Project (NRP) was initiated to support development of a nursing research and evidence based practice culture in Cancer Care Services (CCS) in a large tertiary hospital in Australia. The position was established and evaluated to inform future directions in the organisation.---------- Background: The demand for quality cancer care has been expanding over the past decades. Nurses are well placed to make an impact on improving health outcomes of people affected by cancer. At the same time, there is a robust body of literature documenting the barriers to undertaking and utilising research by and for nurses and nursing. A number of strategies have been implemented to address these barriers including a range of staff researcher positions but there is scant attention to evaluating the outcomes of these strategies. The role of nurse researcher has been documented in the literature with the aim to provide support to nurses in the clinical setting. There is, to date, little information in relation to the design, implementation and evaluation of this role.---------- Design: The Donabedian’s model of program evaluation was used to implement and evaluate this initiative.---------- Methods: The ‘NRP’ outlined the steps needed to implement the nurse researcher role in a clinical setting. The steps involved the design of the role, planning for the support system for the role, and evaluation of outcomes of the role over two years.---------- Discussion: This paper proposes an innovative and feasible model to support clinical nursing research which would be relevant to a range of service areas.---------- Conclusion: Nurse researchers are able to play a crucial role in advancing nursing knowledge and facilitating evidence based practice, especially when placed to support a specialised team of nurses at a service level. This role can be implemented through appropriate planning of the position, building a support system and incorporating an evaluation plan.

Understanding the role of knowledge in the practice of expert nephrology nurses in Australia

This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice.

Uncovering the evidence of non-expert nephrology nursing practice

Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.

Communication and the casualisation of nursing : a critical ethnography

The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce. Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention. Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes. Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research. This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care. The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.

Paediatric Nursing in Australia

Paediatric Nursing in Australia equips students with the essential skills and knowledge to become paediatric, child and youth health nurses across a variety of clinical and community settings. It prepares students for critical thinking and problem solving within this field by emphasising contemporary issues impacting on the health of children, young people and their families. Written by a team of experienced paediatric nurses, the content is based on themes that align with Australian standards of competence and expectations of paediatric nursing: communication, family involvement and evidence-based practice. Comprehensive yet concise, the text examines the integration of theoretical and clinical components of nursing knowledge. To enhance learning, chapters feature case studies, reflection points and learning activities. An essential resource for nursing students, this text is grounded in current care delivery and professional issues for care of the child to prepare future nurses for evidence-based practice in paediatric settings throughout Australia. • Prepares students for critical thinking and problem solving within paediatric, child and youth health nursing by emphasising contemporary issues that impact on the health of children and young people and their families • Written by a team of experienced paediatric nurses • Enhances learning by providing illustrative case studies, reflection points and learning activities in each chapter

Knowledge and attitudes of Registered Nurses toward pain /

This research provided relevant data to support pain research literature that finds nurses do not have the knowledge base that they require to sufficiently provide effective pain management. The data demonstrated that nurses have mixed attitudes toward pain. These two findings have been observed in the literature for more than 20 years, but were important results for the hospitals and the nurses involved in the study. The purposes of this study were to identify the level of knowledge and attitudes in a sample of nurses fi-om the surgical and medical units in three hospitals, and determine whether a difference between these two groups existed. The institutional resources to support pain relief practices provided by each hospital were also documented. Data were collected using a convenience sample from the medical and surgical units of three hospitals. Ofthe 1 13 nurses who volunteered to participate, 78 worked in surgical units and 35 worked in medical units. Demographic data were collected about the participants. The established instruments used to obtain data about knowledge and attitude included: (a) Nurses Knowledge of Pain Issues Survey, (b)Attitude to Pain Control Scale, and (c) Andrew and Robert Vignette. Data collected were quantitative along with two open-ended questions for a rich, qualitative section. Inadequate knowledge and outdated attitudes were very evident in the responses. Data from the open-ended questions described how nurses assessed pain and the most conmion problems caring for patients in pain. Nursing practice implications for these hospitals involve initiating a process to develop an educational pain program for nurses throughout the hospital. Utilizing findings from other studies, the program should have an interdisciplinary approach to the planning, implementation, evaluation, and ongoing support. This study supports the belief that inadequate pain management has been attributed to many factors, most importantly to a lack of knowledge. Pain is a costly, unnecessary complication for the patient as well as the hospital. It follows then, that it is in the best interest of all involved to implement an educational pain program in order to influence practice.

Career development year in emergency nursing: using specific educational preparation and clinical support to facilitate the transition to specialist practice

This article outlines the development, implementation and evaluation of the Career Development Year (CDY) in the Emergency Department (ED) at Dandenong Hospital in Victoria, Australia. As a consequence of a shortage of emergency nurses, hospitals have recruited inadequately prepared nurses to staff their EDs. The resultant increase in stress of qualified and experienced emergency nurses has had a major impact on the retention of emergency nurses. The CDY aims to provide nurses with little or no experience in emergency nursing with supported entry into this area of specialist practice. The CDY is based on three factors identified as important in the transition to emergency nursing; knowledge, clinical support and professional development. By providing beginning emergency nurses with supported entry to a new and challenging clinical environment, the CDY has been an effective recruitment and retention strategy. In addition it has demonstrated that a committed ED team has the capability to teach and nurture the emergency nurses of the future.

Evidence-based mental health nursing in Australia: our history and our future

This paper will develop a discussion related to evidence-based knowledge for mental health nursing, arguing for a historical component to be included in the comprehensive degree programme that will offer significant insights into mental health nursing knowledge from historical information and constructing implications for contemporary practice. Our understanding of the present is clearer by this looking back and forth and by adding meaning (and what the meanings mean) to what historically preceded. It allows the history of psychiatry to be a much more productive, useful, and a continual source of wisdom for the here and now. This blending of past knowledge with contemporary inquiry can offer depth in mental health nursing practices by forming a context for practice for the beginning nurse practitioner.

Doctoral graduates in mental health nursing in Victoria, Australia : the doctoral experience and contribution to scholarship

The last decade has seen a substantial increase in the number of psychiatric or mental health nurses in Victoria, Australia who hold doctoral qualifications. The literature refers to the importance of scholarship for the professional development and recognition of nursing as a discipline. However, there is a paucity of literature addressing the contribution of nursing doctoral graduates to scholarship in mental health nursing or indeed the broader nursing profession. This paper presents the findings from a survey of psychiatric nurse doctoral graduates currently residing in the State of Victoria. A questionnaire was developed by the authors and distributed to the known doctoral graduates. The main findings demonstrate considerable variation in the discipline and topic of inquiry and in the extent to which doctoral studies had led to dissemination of research findings and engagement in further scholarly activity. The strengthening of mental health nursing knowledge requires scholarship and doctoral graduates are expected to make a major contribution, through research and the dissemination of findings. This paper presents a descriptive overview of doctoral graduates in one State of Australia with a particular focus on research and scholarship.

Grounded theory of nursing's contribution to inpatient rehabilitation

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

Content Validation of the Operational Definitions of the Nursing Diagnoses of Activity Intolerance, Excess Fluid Volume, and Decreased Cardiac Output in Patients With Heart Failure

Objectives To consensually validate the operational definitions of the nursing diagnoses activity intolerance, excessive fluid volume, and decreased cardiac output in patients with decompensated heart failure. Method Consensual validation was performed in two stages: analogy by similarity of defining characteristics, and development of operational definitions and validation with experts. Results A total of 38 defining characteristics were found. Operational definitions were developed and content-validated. One hundred percent of agreement was achieved among the seven experts after five rounds. Ascites was added in the nursing diagnosis excessive fluid volume. Conclusion The consensual validation improves interpretation of human response, grounding the selection of nursing interventions and contributing to improved nursing outcomes. Implications for Practice Support the assessment of patients with decompensated heart failure. Objetivos Realizar a validacAo consensual das definicoes operacionais dos diagnosticos de enfermagem Intolerancia a atividade, Volume de liquidos excessivo e Debito cardiaco diminuido em pacientes com insuficiencia cardiaca descompensada. Metodo ValidacAo consensual em duas etapas: Analogia de semelhanca das caracteristicas definidoras e desenvolvimento de definicoes operacionais e validacAo com expertst. Resultados Foram encontradas 38 caracteristicas definidoras para os diagnosticos de enfermagem. Suas definicoes operacionais foram desenvolvidas e seu conteudo validado. Os resultados mostram que houve 100% de concordancia entre os sete experts apos cinco rodada. As definicoes operacionais foram classificadas com base no nivel de concordanica. Ascite foi acrescentada ao diagnostico Volume de liquidos excessivo. ConclusAo A validacAo consensual melhora a interpretacAo das respostas humanas, embasando a selecAo de intervencoes de enfermagem e contribuindo para melhorar os resultados. Implicacoes Para A Pratica Apoio a avaliacAo dos pacientes com insuficiencia cardiaca descompensada.