Transformation of story to practice: an innovative approach to long-term care.

The negative effects of institutionalization in a long-term care facility include depersonalization, decreased self-concept and self-esteem, and decreased psychological well being. To modify these effects, an innovative narrative approach to long-term care in the format of story telling and listening is proposed. Narrative practice, in the format of story telling and listening, leads to an ethics-based care that prioritizes the resident's personal meanings, values staff-patient relationships, and permits the resident to define quality care. The purpose of this article is to demonstrate how the functions of storytelling can be applied in the long-term care setting using the themes that emerge in the life story of a particular resident. These themes, findings of a phenomenological study, were incorporated into the resident's care plan by staff and, consequently, quality of care improved. Recognizing the value of story and incorporating the themes that emerge into a personalized care plan transforms nursing practice.

A narrative approach to quality care in long-term care facilities.

The negative effects of institutionalization caused partially by homogeneity and uniformity of care prompts the exploration of personal and common meanings of nursing home residents. This study is viewed as an initial step in providing quality care as defined by the resident. Personal and common meanings embedded in the lived lives of five older women residing in a long-term care facility are interpreted using a seven-stage Heideggerian hermeneutical phenomenological approach. An unstructured modified life review format is used to interview each participant on three separate occasions. Three constitutive patterns emerge: dwelling in remembering, living relatedly, and being after loss. These patterns endure across the life span of each woman and continue to endure after admission to the facility. The revelation of common and personal meanings provide new possibilities for the transformation of nursing practice to ensure quality care from the perspective of what is considered meaningful to each resident.

Meeting the challenge of the curriculum revolution: problem-based learning in nursing education.

Nursing education today faces a great challenge as it reviews the outcomes of traditional teaching strategies and seeks to explore new alternatives in preparing the nursing student for the complex and diverse profession of nursing. Problem-based learning is one alternative to meeting the needs of a society with health requirements as diverse as its population. Nurses must be capable of exploring options, asking questions, articulating explanations, and developing appropriate nursing care plans based on reflective decisions. They must continue to value learning throughout their careers to maintain their expertise. The role of the educator today is to probe student thinking toward conceptual understanding, to increase depth of subject knowledge, to provide student learning opportunities, and, by encouraging the articulation and contrasting of different points of view, to allow the emergence of common understandings. A problem-based curriculum can provide the framework for the revolution in nursing education to occur.

Reevaluation of a nursing diagnosis: spiritual distress.

The purpose of this paper is to reevaluate the nursing diagnosis of spiritual distress in relation to Marjory Gordon's criteria of discriminatory power, generality, flexibility, usefulness, and inclusiveness. The author suggests that nursing's perspective of the spiritual dimension and spiritual distress is both narrow and inadequate in today's multicultural, multidimensional healthcare setting. Views of spirituality from multiple disciplines are discussed to illustrate the diversity of the phenomenon and contrast views that primarily emphasize religiosity and psychosocial factors. Reevaluation of spiritual distress and spirituality must come in the form of holistic and humanistic approaches in nursing education and research, integration of the spiritual dimension within nursing curricula, and recognition of multidisciplinary, global perspectives of the spiritual phenomenon. The author stresses the importance of the spiritual dimension and its impact upon a person as a multidimensional being.