This chapter focuses on introductory arguments about the Doctor of Nursing Practice (DNP) student and graduate’s clinical scholarship, a future practice-oriented nursing epistemology. It explores a model of scientific inquiry and stewardship for the nursing discipline through the development of a body of practice-oriented nursing knowledge to improve health. There is a very strong case to be made that the “good science” evolving from the DNP programs where nursing epistemology and practice knowledge development is valued is indeed being conducted within the framework of a Mode 2 knowledge production paradigm. Finally, there is an operational concern for how practice knowledge is made formal within the academy before it is then further synthesized, reduced, and disseminated in journal format and oral presentation. Practice knowledge generation only needs rigor, proper mentoring, an inquiring mind, and some creativity.
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The health professions have taken very seriously the importance of ethical considerations in research and practice. Most of the ethical issues regarding measurement of human subjects have been addressed in connection with biomedical and social research. Three basic, comprehensive ethical principles provide the foundation for the guidelines, recommendations, and standards that provide for the rights and well-being of human subjects in measurement and research: respect for persons, beneficence, and justice. In accordance with these ethical principles, researchers are obliged to recognize and protect the basic rights of subjects in measurement activities. The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations took effect on April 14, 2003. These provisions, which require health care organizations and providers to protect the privacy of patient information, underscore the importance of privacy in the measurement context, and limit communication and use of individual patient health information in both practice and research.
This chapter addresses selected measurement issues that threaten the reliability and validity of the measurement effort. Topics include social desirability, process and outcome measurement, measuring state and trait characteristics, cross-cultural measurement, and triangulation. During the selection and/or development phase of instrumentation, the investigator should consider how the respondent is likely to think about each item when responding to the measure of interest. Outcome measures help health care and social welfare agencies establish indicators against which to evaluate the success of changes made to bring about improvement, and to identify areas in processes, programs, or interventions in which improvements are still needed. The specific process that is the focus of measurement should be clearly defined in a manner that captures the essence of its characteristics. Within nursing, specific nursing interventions or programs are common processes that are the focus of measurement.
In this chapter, the author began working in international medical humanitarian aid, with an organization called Medecins Sans Frontieres/Doctors without Borders (MSF). Pediatrics and Pediatric Intensive Care are where the author’s nursing career had started. With assignments in the Democratic Republic of the Congo (DRC), Haiti, and South Sudan, the author have provided care for people who have been displaced due to conflict, victims of war trauma, women with high-risk pregnancies, malnourished and critically ill children, and people with HIV and tuberculosis, and responded to outbreaks of preventable illnesses such as measles and cholera. MSF opened the Sibut project, with a focus on providing care for young children and women of child-bearing age. The security system includes daily contact with all of the village leaders in Sibut, including the Catholic priests, the imams at the Muslim mosque, the village elders, and the militia leaders.
Nursing practice is a symbiotic relationship between the art and science of professional care. One cannot exist in isolation from the other. Nurses are inclined to connect the art of nursing with terms such as compassion, caring attitudes, the therapeutic relationship, presence, professionalism, advocacy, and competence, otherwise known as the “soft or caring side of nursing”. The greatest threat to the disappearance of the art of nursing lies with the perceived “big three”: time, fiscal restraint, and failure of the system to support a full staff of nurses, so those employed are working at full capacity. It is important to recognize that different practice settings have varying needs. One size does not fit all. Yet the requirements for nursing assessments, developing a plan of care, coordinating care with other health care providers, implementing interventions, and evaluating care outcomes are a requirement of all.
The 19130 Zip Code Project at the Community College of Philadelphia (CCP) started as a curriculum innovation: the CCP Department of Nursing’s response to the national shift toward community-based health care. The project resulted in the refocusing of the nursing curriculum and the development of partnerships with CCP’s neighbors in the 19130 zip code. It also is an excellent example of a nurse-managed wellness center without walls. The Zip Code Project has put down deep roots in the neighborhood and in the nursing curriculum. It has produced a community-based model for educating local health professionals and a service-learning model for enhancing health service delivery by local agencies. The faculty arranged community-based clinical experiences for nursing students in the neighborhood surrounding CCP. Although CCP sits in the middle of the zip code, faculty knew little about community-based health care services in the community.
This chapter opens with the challenge Nightingale and her close colleagues faced in establishing nursing as a profession when the ethical standards of the existing (secular) nurses were (generally) so low. The ethical issues she had to deal with in her own school, soon after it opened, are discussed three thorny problems with appointments. Anyone reading Nightingale’s writing on nursing will be struck by how often and how forcefully she insisted on high ethical standards. The reason for the emphasis on ethical standards is obvious enough in the task Nightingale faced in raising the new profession from its disreputable past. The International Council on Nursing (ICN) established its Code of Ethics in 1953, again based on Nightingale principles. It identified four responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering. The code asks nurses not only to act ethically themselves, but to challenge unethical practices.
This chapter examines the evolution of caring in nursing and nursing curricula. It explores the philosophies and theories of being and becoming that anchor a Caring Science curriculum. The chapter helps the caring-healing nurse able to understand how alternative educational pedagogies support the values of a Caring Science curriculum. It summarizes the ways in which a Caring Science curriculum can help nurses develop Caring Literacies through various classroom pedagogies, development of a community of caring/learning, and self-care. It identifies ways to embody (through being/becoming) Caritas Literacies in nursing education to promote the development of caring-healing nurses. The chapter discusses the meaning and values of being and becoming a nurse grounded in Caring Science. Finally, it proposes the many benefits of framing a nursing curriculum in Caring Science, including student affirmations of this process.
The caring nature striven for is that which has the potential to “gently shake the world”, as Gandhi said, and to move healthcare toward the whole-person, whole-planet healing that Nightingale. This work continues to be an invitation to pause, intentionally create space for reflection and intention, and move into the world with a refined sense of purpose, presence, and authentic power. Caring Science is not the property of a particular profession or system; it does not belong to the annals of nursing any more than the halls of medicine, finance, or law. Nurses have simply been granted the privilege of ushering the texture of its message into the stratosphere; a nursing lens has been the kaleidoscope of sacred human interaction chosen for this tender phase of its being and becoming.
This chapter describes the state of Caring Science nursing practice in Peru. It discusses how performance improvement initiatives contribute to the success of advancing nursing as a caring discipline. The chapter is the narrative, lived experience of a Peruvian American nurse who reflects on a 10-year journey to create space for the emergence of postmodern nursing in Peru. It describes the traditional machismo and paternalistic environment where enfermeras peruanas practice, an environment not reported in the peer-reviewed literature. Next, the chapter describes the exemplar project implemented to develop a space for nursing and then explains the curative versus carative epistemology. Finally, it describes the recent advancements and discusses the relevance to the future plans. The Caritas revolution in nursing continues to advance from North America, to Europe, to Africa, to Asia, and now to South America through the Watson Caring Science Institute scholars and postdoctoral fellows.