Perspectives on health and cultural pluralism: ethics in medical education.

To be responsive to the needs of today's pluralistic society, physicians require an understanding of the essential link between culture, power and ethical practice. Using a case example, the authors argue that medical educators need to: (a) critically consider how the educative process joins medical knowledge and power; (b) develop pedagogy that can bring questions of power, culture and ethics to the forefront during the process of medical knowledge construction; and (c) create an opportunity for students to learn how to work collaboratively with diverse cultures and values.

Developing health-promoting practice with families: one pedagogical experience.

As the significance of social determinants of health has been revealed and the socio-environmental perspective of health promotion has become prominent, family nurses have attempted to move away from disease-treatment models of practice towards emancipatory, health promoting practice. This paper describes a multidisciplinary team's pedagogical experience of developing emancipatory family health promoting practices. The discussion includes a description of the significant educational processes that supported the development of health promoting family practice and an outline of the transformative changes the team members experienced as they evolved their health promoting practices.

Transcending behaviorism in communication education.

During the past decade, nursing education has been engaged in a curriculum revolution. Although this ongoing revolution has led to profound changes in nursing curricula, one area that requires further scrutiny is communication education. This article addresses the limitations of behavioral communication curricula and suggests a pedagogical process responsive to the complexity of human caring relationships and the intricacies of relational practice. The discussion includes a description of a nursing communication course developed according to the principles of transformational learning theory.

The synergy of health promotion practice/research/education.

Many nurses are concerned about the lack of connection among nursing practice, research and education. However, the assumption that nursing practice, research, and education represent separate domains or activities that need to be linked, may well contravene the relational synergy they share. This paper describes a project that sought to illustrate, and further explore, the synergistic, iterative relationship of health promoting practice/research/education. The project revealed how this synergy lives out within the daily practice of frontline practitioners and how the researched knowledge practitioners bring forth through their practice can transform care.

Developing health promoting practices: a transformative process.

PIP: For health care professionals to successfully make the transition from disease care to health promotion requires a reorientation of how such professionals think and behave in their practice. This paper describes a multidisciplinary team's transition from disease care to health promotion. The research was conducted to learn what is involved in developing health promotion practices and the major changes practitioners experience as they shift from disease care to health promotion. A large, acute care institution and public health agency collaborated to address the needs of families and children with asthma, allergies, and eczema, with the goal of changing the focus from inpatient care to ambulatory or community-based care. A team of 5 nurses, 1 physiotherapist, 1 respiratory technologist, and 1 nutritionist was formed to undertake the initiative.^ieng

The meaning of diabetes. Significance for holistic nursing practice.

Recent research has raised questions about the validity and relevance of health practitioners' perspectives of diabetes and diabetes care. This article describes a qualitative research study that was undertaken to illuminate an insider's perspective of how Type I diabetes is meaningfully experienced. The results of this study reveal that although people with diabetes share a common disease, the meaning of that disease in people's lives is unique and varied. To provide holistic care, nurses must assist people in discovering and articulating the meaning of diabetes in their lives as well as acknowledging and attending to the significant elements within their experiences.

A critical pedagogy for family nursing.

Little consideration has been given to the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education. This article emphasizes the importance of students and faculty engaging in a critical analysis of family nursing theory and practice. A pedagogical approach that employs phenomenology, feminism, and critical social theory as observational lenses for examining the ontology and epistemology of family nursing is described. While family nursing is coming to be recognized as an essential element of any nursing curriculum, family nursing pedagogy is in its infancy. Family nurse educators are currently working toward developing curricula and educative processes that will furnish students with a theoretical (scientific) base for family nursing practice and will provide them with opportunities to develop the practice skills they need to work with families (Hanson & Heims, 1992; Wright & Bell, 1989). However, little consideration has been given to examining the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education (Richards & Lansberry, 1995). This article asserts that critical analysis of family nursing theory and practice is integral to family nursing pedagogy and must be a primary consideration in the advancement of family nursing education. The discussion is in two parts. Part I highlights the importance of a critical analysis of family nursing theory and practice including both ontological and epistemological inquiries. Part II describes a critical pedagogy of family nursing that addresses both ontology and epistemology.

Imaging ourselves: nurses' metaphors of practice.

Metaphors are vivid, expressive tools popularly used in everyday conversations. The familiarity of metaphors combined with their capacity for generating meaning make the metaphor a powerful heuristic device for effecting nursing discoveries and pedagogical shifts. Exploring nursing metaphors can provide opportunities to develop new understandings of nursing and challenge metaphorical images that may be constraining and/or obscuring significant elements of holistic nursing practice. A research study that examined the metaphorical images of practicing nurses uncovered a wide variety of images. The thematic analysis of the metaphorical descriptions illuminated four major themes: (a) the character of nursing work, (b) power and empowerment, (c) nursing as a growth process, and (d) the relational nature of nursing. Nurses' metaphorical images provide a window into the complexities and ambiguities within nursing practice. The images highlight the significance of social and organizational constraints that influence how nurses take up their practice, the ways in which nurses feel unable to practice holistically, and the struggles nurses encounter when they try.

Relational capacity: the foundation for interpersonal nursing practice.

Nurses have the opportunity to make a profound difference in peoples' health and healing experiences. However, our emphasis and reliance on mechanistic models of relating often results in our failure to realize this opportunity. This paper challenges the appropriateness of mechanistic models of human relating that focus on behavioural communication skills, and suggests an alternate approach that emphasizes the enhancement of relational capacity. Five relational capacities are described including: initiative, authenticity, and responsiveness; mutuality and synchrony; honouring complexity and ambiguity; intentionality in relating; and re-imagining.

Women who are mothers: the experience of defining self.

Feminist poststructuralists maintain that the self develops through the process of social interaction and is constituted and reconstituted through the various discursive practices in which people participate. For mothers, Western culture provides a confusing blend of conflicting discourses. Whereas discourses around healthy self-definition stress the importance of autonomy, differentiation, and separation of the individual from others throughout the life cycle, discourses around mothering emphasize women's abnegation of the self, self-lessness, and self-sacrifice. Drawing on elements of phenomenological research and feminist inquiry, this study examined the experience of self-definition for women who are mothers. The study revealed three elements within mothers' process of defining self, including (a) nonreflective doing, (b) living in the shadows, and (c) reclaiming and discovering self. Within each of these elements, a number of themes were described and illuminated. In revealing the process of self-definition, the women described an integral relationships between the process of defining self and their experience of health.

The experience of self for women who are mothers. Implications for the unfolding of health.

Although the expression and transformation of self is integral to people's health and healing experiences, nurses currently lack an in-depth understanding of how women who are mothers experience and express themselves. This article presents the results of a recent study that examined the lived experience of self for mothers. Principles of interpretive phenomenology and feminist inquiry guided the investigation. The results of the study describe the nature and experience of self for the 7 women/mother participants and highlight the complementary relationship between the experience of oneself and the unfolding of health. Three essential themes emerged to describe the experience of self, including (a) self as a multiplicity of parts, (b) self as a relational process, and (c) self as a synthesis. The results illustrate the complementary relationship between health and self experience and highlight the nursing imperative of supporting women/mothers in their unfolding of self.

Transforming our vision: emancipatory career planning for nurses.

Canadian nurses are experiencing profound and often disturbing changes in the health care sector. Not only have the number of jobs decreased but the nature and expectations of those jobs are changing dramatically. While these changes have raised nurses' anxiety, the changes simultaneously have presented nurses with an opportunity to transform their vision of nursing and their role in health care. This article describes a career planning pilot project for nurses which employed Freire's model of emancipatory learning. Based on the theoretical foundations of narrative psychology and critical social theory a series of four workshops were offered. Comments from the evaluation results indicate that the workshop was a transformative experience for the participants. Future implications for career planning for nurses are discussed.

Health-promoting nursing practice: the demise of the nursing process?

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all. In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives. Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged. There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective. The nursing process is based in the natural science paradigm and on a biomedical approach to health care. In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective. Such a shift requires a radical transformation in nursing practice as nurses move away from the 'top-down' approach of the nursing process and adopt a 'bottom-up' approach to health-promoting nursing practice. The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice. In particular, a framework for health-promoting nursing practice will be provided.

Family nursing assessment: meeting the challenge of health promotion.

Family nursing assessment has traditionally followed an illness-care model. This paper proposes a re-evaluation of traditional family assessment and suggests an approach which is fundamentally based in health promotion. The paper includes a discussion of varying perspectives of health and health care, the health promotion perspective adopted by the World Health Organization, and the relevance of these perspectives for family nursing practice. Central elements of health promotion are outlined and serve as the guiding principles for family nursing assessment. Two inherent aspects of health-promoting family nursing practice are proposed and described. These include an emphasis on a human caring nursing ontology, and a framework for guiding family nursing assessment. This health-promoting assessment framework contains four essential components: (a) listening to the family; (b) participatory dialogue; (c) recognizing patterns; and (d) envisaging action and positive change. These components are described, together with the strategic elements inherent in each. Based on this health-promoting family nursing assessment, implications for nursing practice are discussed, and recommendations are made for research into this assessment framework.

Staff nurse perceptions of stressors and support needs in their workplace.

This qualitative study explored the stresses and support needs of individual acute care staff nurses. Twenty-eight nurses volunteered to keep a log of these two variables during one specific work day and were interviewed on the following day to elicit their perceptions. Content analysis of the interviews revealed that at any given time staff nurses experienced stress related to organizational/environmental, job component, and/or intrapersonal factors. Stress factors, time of day, and character of the individual can all influence the need for support. Eleven support needs were described. These results indicate that future research on this subject should employ a methodology which allows support to be studied as a dynamic process.