This chapter presents an overview of the state of the art ethnographies conducted by nurses and highlights a few works by the early generation. An extensive search of the literature was conducted to identify ethnographies completed by nurses. Nursing knowledge was a common thread throughout the literature reviewed. The literature review revealed the progress nursing is making in recognizing this gap and attempting to close it. Nursing knowledge is essential in patient care. Using the ethnographic method of inquiry, nurses have been able to identify areas of need both in knowledge and practice and make recommendations for enhanced practice. Caring and patient advocacy were other common themes in the literature. Caring is the essence of nursing and consequently should be incorporated in nursing research. The common purpose of the ethnographic studies reviewed was to explain or understand a phenomenon to increase nursing knowledge.
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This chapter examines pre- and postconference expectations and activities, explores forms to be used by the professor and the students, suggests care plans and patient assignments, and describes sample concept maps and a math skills assessment. A student with no experience in health care may be shy or sheepish when it comes to hands-on care. It may be of benefit for the students to be paired in the first few weeks of clinical classes. The care plan forms can help guide the student through the nursing process. Medication forms will help the student learn about various medications. Nursing education has adopted the use of concepts maps to assist students in gathering patient information. Patient safety is the number one priority for all health care professionals. Dose calculations are a daily activity for nurses.
The author, Martin Alpert, presents a method by which individual nurses can be independent, improve patient care, have fun, and earn more money. He proposes that the nursing profession become the leader in a shift to sustainable, least invasive therapies and evaluations (LITE). LITE represents a major profit opportunity for nurses. Many of these new therapies require medical professionals, but not necessarily doctors. They can be administered by dedicated and trained nurses. The impact of LITE on the global society of nursing leading this area of medicine could be transformational for nursing, medicine, and society. Nursing could lead in diagnosis and treatment under the LITE paradigm. Acupuncture is becoming part of conventional therapy. It can be a part of nursing practice. Recently, the World Health Organization estimated that 80” of people worldwide rely on herbal medicines for some part of their primary health care.
Mindfulness provides a framework for monitoring the emotions and examining the thoughts as one move through their professional lives. However, for mindfulness to become a way of life, deliberate and consistent practice is required. For many people, that practice is fostered through meditation. Meditation is a cognitive practice where the goal is to focus the mind and foster the capacity to remain centered in the present moment, here and now, rather than be ruminating about the past or worrying about the future. Some practice walking meditation as methods that help to keep attention focused on the present moment and on the immediate sensations within the body. Through meditation, people can easily shift into calm centeredness, a state of balanced equilibrium that allows them to achieve a tranquil state, able to strategically think through the steps of mindful patient care. This chapter shows several techniques that enhance mindfulness and mindful practice.
Interprofessional education (IPE) and collaborative practice are increasingly called upon to improve these domains such as patient care, community health, health care delivery systems respective and overlapping spheres of activity with the larger goal of improving the overall health care system. Nurse leaders are moving the interprofessional collaboration agenda forward by serving in key leadership positions nationally and on local campuses. Nurse leaders, through a combination of their training, professional experiences, and personal preferences, have unique knowledge and skills for which they are enthusiastic champions. Effective leaders apply principles of good communication in their work with individuals and groups. Nurse leaders possess valuable professional knowledge and skills, and when coupled with individual talents and strengths, they offer important assets to the success of a collaborative effort. Nurse leaders should recognize how they can best capitalize on their leadership abilities and confidently apply them.
Steven A. Wartman, the author, provides key advice for potential and aspiring nurse leaders. He advises to let go of the guild mentality, particularly important for nurses who aspire to leadership positions that transcend nursing. Nurse’s perspectives are invaluable in bridging the gap between the technical experience of health care and its meaning in the lives of patients and their families. Nurse leaders are advised to become transformational rather than transactional leaders, and to move beyond the rewards and punishments inherent in transactional leadership styles. Transformational leadership is especially challenging, given the traditional hierarchies in the medical fields and academia. To provide the most effective and “transformational” leadership, potential nurse leaders should focus their efforts on four areas: eliminate the “guild mentality”; change restrictive policies and regulations that weaken the role of nursing; seek to become a “transformational” leader; and learn to take the ego out of the job.
Listening is an obvious and often overlooked aspect of high-quality patient care. Given the environment in which modern health care is provided, the ability to stop, shift, and turn one’s full attention to a patient and family, to their thoughts, feelings, and needs, means having to temporarily “turn off and tune out” all manner of distractions. Being able to focus is a core aspect of mindfulness. To engage in quality listening is a commitment, made over and over again, in the service of effective patient care. Vulnerable patients who express doubt about the suitability of their treatment or question the clinician’s opinion run considerable risk of being marginalized or treated with dismissive indifference. When a patient challenges a provider’s perspective, conclusion, or diagnosis, the clinician needs to honor that challenge; have the emotional maturity and humility to use the patient’s concerns as data.
Crisis situations are common in the care of acutely and critically ill patients. A psychiatric crisis calls for de-escalation strategies, security personnel, sedation, and restraints. During a crisis, in addition to providing direct care in response to the patient’s urgent physiological needs for intervention, the nurse must also prepare, orchestrate, and coordinate multiple aspects of the environment. Acute and critical care environments are generally set up at all times for a possible emergency. Experiential leadership is seeing what needs to or must be done before or during a crisis and doing it, even though a physician is present. Recognizing clinical talent and marshaling skilled clinicians requires astute clinical judgment and skill and is a pervasive aspect of caring for critically ill patients in crisis. An aspect of skilled know-how required for smooth management of a crisis is modulating one’s emotional responses to assist others in their ability to function well.
This chapter presents some of the educational strategies and implications of integrative teaching and learning. It describes two major types of integrative strategies that follow the logic of practice. First, multiple examples of how to coach situated learning in actual practice that have proven successful in developing embodied knowledge and skillful, intelligent performance, are detailed. Second, a Thinking-In-Action approach to integrating classroom with clinical teaching exemplifies how to teach learners to use extensive scientific, technological, and theoretical knowledge in the context of an unfolding patient situation that changes over time, while imaginatively responding to the patient’s multiple needs and other demands in the situation. In order to be effective clinicians, the student and developing nurse must progress to grasping the nature of whole clinical situations, developing an experience-based sense of salience and using multiple frames of reference that encompass patient and family-focused care.
This chapter highlights strategies for identifying educational and other opportunities within professional associations (PA) for promoting cultural competency. It highlights strategies for recognizing and overcoming barriers and challenges. The chapter addresses key features for inquiry, action, and educational innovation within the PA. Systematic self-assessment evaluates the various dimensions that can impact upon the educational process and the achievement of educational outcomes, including optimal cultural competence development. Transcultural self-efficacy (TSE) is the mediating factor that enhances persistence in cultural competence development despite obstacles, hardships, or stressors. One needs to evaluate if the PA is truly committed to the goal of cultural competence development, cultural diversity within the profession, and culturally congruent patient care. National Student Nurses’ Association (NSNA) emphasizes ethics and cultural competence for diverse cultures and subcultures through such visible areas as bylaws and resolutions, publications, websites, activities, membership, topics, and speakers.