Transforming practice into clinical scholarship.

AIM: The aims of this paper were to explicate clinical scholarship as synonymous with the scholarship of application and to explore the evolution of scholarly practice to clinical scholarship. BACKGROUND: Boyer contributed an expanded view of scholarship that recognized various approaches to knowledge production beyond pure research (discovery) to include the scholarship of integration, application and teaching. There is growing interest in using Boyer's framework to advance knowledge production in nursing but the discussion of clinical scholarship in relation to Boyer's framework is sparse. DESIGN: Discussion paper. DATA SOURCES: Literature from 1983-2015 and Boyer's framework. IMPLICATIONS FOR NURSING: When clinical scholarship is viewed as a synonym for Boyer's scholarship of application, it can be aligned to this well established framework to support knowledge generated in clinical practice. For instance, applying the three criteria for scholarship (documentation, peer review and dissemination) can ensure that the knowledge produced is rigorous, available for critique and used by others to advance nursing practice and patient care. Understanding the differences between scholarly practice and clinical scholarship can promote the development of clinical scholarship. Supporting clinical leaders to identify issues confronting nursing practice can enable scholarly practice to be transformed into clinical scholarship. CONCLUSION: Expanding the understanding of clinical scholarship and linking it to Boyer's scholarship of application can assist nurses to generate knowledge that addresses clinical concerns. Further dialogue about how clinical scholarship can address the theory-practice gap and how publication of clinical scholarship could be expanded given the goals of clinical scholarship is warranted.

The scholarship of application: recognizing and promoting nurses' contribution to knowledge development.

The generation of knowledge is fundamental to the practice of nursing and occurs through various forms of scholarship. Boyer recognized this and described knowledge production through research, integration, teaching, and application. The focus of this article is on the scholarship of application and its role in the development of nursing knowledge. Examples of achievement in the scholarship of application are provided with outcomes of work between community and education partners and innovative clinical practice changes. The scholarship of application is of particular importance to nursing as it bridges research, practice, and education, and documents and disseminates nursing knowledge to enable peer critique. Approaches for developing a climate of scholarship are discussed, including differentiating scholarly practice from clinical scholarship and how the scholarship of application is situated in practice arenas. The role of clinical scholars and clinical leaders and the continuing development of future scholars are proposed.

Scholarship in nursing: current view.

Knowledge, as it relates to scholarship, has traditionally been developed through research, which for years was viewed as the sole method of knowledge generation. An expanded view of scholarship was proposed by Boyer, and includes the scholarship of discovery, integration, teaching, and application. This broader framework of scholarship is more suited to today's world. The aim of this paper is to provide clarification regarding the definition and criteria of scholarship and the differences between scholarly activities and scholarship. Nurses are held to the same standards of knowledge generation as other disciplines. There should be clarity on differentiating scholarly activities from scholarship.

Practice doctorates in nursing: developing nursing leaders.

Over the past two decades, doctor of nursing practice (DNP) degree programs have grown rapidly in the United States, Australia and the United Kingdom. The DNP has as its emphasis the preparation of leaders for clinical practice, health policy, administration and clinical research. DNP-prepared nurses are in a prime position to work with nurse researchers and to provide leadership in nursing in a variety of settings. DNP programs prepare nurses for the highest level of practice, while PhD programs will continue to prepare nurse researchers. Both PhD and DNP programs are needed to advance nursing knowledge and provide leadership in healthcare.

Scleroderma: living with unpredictability.

Every individual with scleroderma is unique. Symptoms vary in severity, duration, and effect on the individual. Many with scleroderma live an unpredictable life, as they struggle to understand the condition and to manage the unpredictable symptoms. Because of rarity of the condition, many nurses know little about scleroderma, its symptoms, and how to manage them. Nurses should equip themselves with information about rare conditions and not shy away from asking individuals about their condition and how best to help them. It is essential for occupational health nurses to appreciate the individuality of the condition and discuss workers' unique symptoms and care needs with them. Equipped with knowledge, caring for clients with scleroderma can be a rewarding experience for both the nurses and the client. In the work setting, the occupational health nurse can provide leadership to assist the individual with scleroderma to live as productive a life as possible. Nurses in all settings, hospital, community, and work, can do much to assist individuals with the management of chronic conditions such as scleroderma.

Life with a rare chronic disease: the scleroderma experience.

BACKGROUND: Little is known about the experience of living with a rare disease and how people with rare diseases cope with not only the disease but also the reactions of others. Scleroderma is a rare chronic connective tissue disease that results in fibrotic changes involving all or some organs of the body. The two types of scleroderma are systemic scleroderma, which involves the skin and internal organs and is the more serious type, and local scleroderma, which attacks the skin and surrounding tissues. Some people with scleroderma have signs that are visible to outsiders, while others have invisible signs. Having this chronic condition and being different from the general population may subject people with scleroderma to stigmatization by others. AIM: The aim of this study was to understand, from the individual's perspective, the experience of living with scleroderma. METHOD: Focus group interviews were conducted with two groups of individuals with scleroderma. Because of the rarity of the disease and the illness of the participants, only two groups were held. The same questions were asked of both groups. A moderator and assistant guided the groups. FINDINGS: Data analysis revealed five themes: physical manifestations, disclosure/non-disclosure to others, living, being normal and facing the future. The data are discussed in light of participants' having visible signs, invisible signs and the rarity of their condition. For those with visible signs, disclosure was automatic. They were conscious of being different from others without scleroderma. Those with invisible signs managed their disease information in such a way as to minimize the stigma of being different. The rarity of the disease added the problem of others not understanding their difficulties. Those who disclosed their disease not only had to deal with the reactions of others, but faced the additional burden of having to explain their condition. CONCLUSION: Nurses may have little knowledge about scleroderma. It is possible that they, through their ignorance of such rare conditions, may stigmatize individuals. Through understanding about rare diseases will they be able to teach patients the skills necessary to help them cope with their symptoms, as well as the reactions of others to their diagnosis and appearance.

Workplace violence in Alberta and British Columbia hospitals.

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical-surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.

Measuring the hospital practice environment: a Canadian context.

The primary purpose of this study is to document the psychometric properties of the revised Nursing Work Index (NWI-R) in the context of a large Canadian sample of registered nurses. A self-administered survey containing the NWI-R was completed by 17,965 registered nurses working in 415 hospitals in three Canadian provinces. Using exploratory principal components analysis, with a forced one-factor solution, the practice environment index was obtained. In addition, key assumptions were tested from previous work about the rationale for the aggregation of NWI-R responses. In the Canadian context the one-factor solution provides a parsimonious index of the practice environment of registered nurses working in acute care hospitals. Further work is needed to determine the predictive capability of this index and its relevance to cross-national organizational contexts.

Chronic illness experience: insights from a metastudy.

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and metasynthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.