Harnessing the power to bridge different worlds: An introduction to posthumanism as a philosophical perspective for the discipline.

Although it is argued that social justice is a core concern for the discipline, nursing has not generally played a leadership role in the responses to many of the greatest social problems of our time. These include the accelerated rate of climate change, pandemic threats, systemic racism, growing health and social inequities, and the regulation of new technologies to ensure an equitable future 'for all.' In nursing codes of ethics, administration, education, policies, and practice, social justice is often claimed to be a core value, yet it is rarely contextualized by philosophical or theoretical underpinnings. It appears that nurses' commitment to social justice may stem more from a penchant for 'doing good' than an attempt to explore, understand, and enact what is meant by social justice from an ontological, epistemological, and methodological perspective. We contend that the dominance of a human science perspective in nursing contributes to a narrow definition of health and relegates many issues central to social justice to the margins of nurses' care. In this article, we explore how the focus on 'the human' in the human science perspective may not only be limiting the capacity of nurses to develop strategies to adequately address social injustice, but in some instances, direct nurses to contribute to their very reproduction. We suggest that a critical interrogation of this human-centric hegemony can identify avenues of rupture and introduce posthumanism as an additional philosophical perspective for consideration to help bridge the human-social divide.

Social justice as an expression of caring through holistic admissions in a nursing program: A proposed conceptual model.

AIM: This paper presents HAR as an expression of caring to create social justice within nursing and achieve a workforce that is representative of those being served. BACKGROUND: The lack of diversity within the health professions has been expressly linked in the literature to health disparities among underrepresented and marginalized groups. RECOMMENDATIONS: Recognizing the value of diversity within healthcare has been the impetus for some health profession programs to use holistic admissions review (HAR) in the assessment and evaluation of applicant suitability. While current HAR recommendations in nursing broaden the lens on which criteria should be used to determine applicant suitability beyond standard academic metrics, existing models do not examine applicants' caring capacity. CONCLUSION: Given caring is the essence of nursing, the authors offer a guiding framework to supplement the American Association of Colleges of Nursing criteria for HAR and a model by which nursing applicants are evaluated on their capacity to care.

Promoting positive culture change in nursing faculties: Getting to maybe through liberating structures.

Organizations are complex with cultures that influence excellence, commitment and job satisfaction. In nursing schools, faculty are required to succeed within the performance driven culture of academic scholarship alongside the organizational culture that influences the work environment. The purpose of this article is to describe the process that a School of Nursing engaged in using complexity science and liberating structures to shift a perceived unhealthy organizational culture to a healthier one. Complexity science focuses on patterns of relationships within a system while Liberating Structures provide strategies for people to identify new patterns of working together which can contribute to culture change. Over two years, faculty identified the culture issues, the desired positive outcomes and implemented an action plan using Liberating Structures such as Shift and Share, Discovery and Action Dialogues, TRIZ (Theory of Inventive Problem Solving) and 15% Solutions (Power to Create Change Now). The work included a focus on understanding culture challenges, uncovering positive practices, and creating new ways to respectfully interact with each other while implementing the work of the School. Culture is ubiquitous, takes time to alter and can be difficult to measure any substantive change, however on evaluation after two years, there was guarded optimism that a healthier culture exists with knowledge of how to continue to build on the work done. While problems still arise, the new knowledge, strength of leadership within faculty and having the understanding and confidence to interact respectfully, continues to build new relationship patterns and a healthier culture within the School.

Evaluating the influence of goal setting on intravenous catheterization skill acquisition and transfer in a hybrid simulation training context.

INTRODUCTION: Educators often simplify complex tasks by setting learning objectives that focus trainees on isolated skills rather than the holistic task. We designed 2 sets of learning objectives for intravenous catheterization using goal setting theory. We hypothesized that setting holistic goals related to technical, cognitive, and communication skills would result in superior holistic performance, whereas setting isolated goals related to technical skills would result in superior technical performance. METHODS: We randomly assigned practicing health care professionals to set holistic (n = 14) or isolated (n = 15) goals. All watched an instructional video and studied a list of 9 goals specific to their group. Participants practiced independently in a hybrid simulation (standardized patient combined with an arm simulator). The first and the last practice trials were videotaped for analysis. One-week later, participants completed a transfer test in another hybrid simulation scenario. Blinded experts evaluated performance on all 3 trials using the Direct Observation of Procedural Skills tool. RESULTS: The holistic group scored higher than the isolated group on the holistic Direct Observation of Procedural Skills score for all 3 trials [mean (SD), 45.0 (9.16) vs. 38.4 (9.17); P = 0.01]. The isolated group did not perform better than the holistic group on the technical skills score [10.3 (2.73) vs. 11.6 (3.01); P = 0.11]. CONCLUSIONS: Our results suggest that asking learners to set holistic goals did not interfere with their attaining competent holistic and technical skills during hybrid simulation training. This exploratory trial provides preliminary evidence for how to consider integrating hybrid simulation into medical curricula and for the design of learning goals in simulation-based education.

Workbooks to virtual worlds: a pilot study comparing educational tools to foster a culture of safety and respect in Ontario.

Nurses frequently experience horizontal violence in their interactions with nursing colleagues within the workplace. By definition, horizontal violence includes such disrespectful behaviours as intimidation, coercion, bullying, criticism, exclusion or belittling. Educational programs addressing horizontal violence have been developed, but few have been evaluated with respect to knowledge acquisition and transfer. The purpose of this paper is to describe an experimental effectiveness study, using a pre/post design with a control group (total N=164). The research evaluated an innovative educational program in which nurses, using avatars, role-played strategies to address horizontal violence within a virtual nursing unit developed on the Second Life platform. The results of participating in this program were compared with more traditional educational methodologies, such as a workbook and a self-directed e-learning module. While all strategies were perceived by participants as beneficial, the findings from this study suggest that learning through the self-directed e-learning module followed with practice in a virtual world is an effective way of acquiring knowledge, skills and abilities to better address horizontal violence.

Collaboration to change the landscape of nursing: a journey between urban and remote practice settings.

University Health Network (UHN) became a demonstration site to test a health human resource planning model to foster inter-organizational collaboration, knowledge transfer and exchange of nurses between an urban academic health science centre and a remote region in northern Ontario. Funding support was provided by the Ontario Ministry of Health and Long-Term Care. The partnership between UHN, Weeneebayko Health Ahtuskaywin (WHA) and James Bay General Hospital (JBGH) addressed retention, recruitment, professional practice development, planning and succession planning objectives. The primary goal of this partnership was to supply the staffing needs of WHA/JBGH with UHN nurses at a decreased cost for four- to six-week placement periods. This resulted in a marked decrease in agency use by approximately 40% in the WHA site during the months UHN nurses were practicing in the north, with an overall agency cost savings of $165,000 reported in the pilot year. The project also served as a recruitment and retention strategy for all organizations. It provided an opportunity to practice in new clinical settings and to engage in knowledge transfer experiences and professional development initiatives between remote and urban practice environments. In the pilot year, 37 nurses (30 from UHN and 7 from WHA) participated. They returned to their respective organizations re-energized by the different "landscape" of practice experience and toward the nursing profession itself.

Unintended consequences: two critical events from the 1960s and '70s and their legacy for nursing in Ontario.

In the late 1960s and early '70s, two key events occurred in Ontario that greatly affected the nursing profession: the unionization of the workforce and the move of diploma-granting nursing schools out of the hospitals (first to regional schools, then to the community colleges). At the same time, university nursing programs were undergoing significant changes. A paradigm shift occurred in which baccalaureate-prepared nurses were being educated for practice as well as for roles in education and administration. While all these activities had overall positive implications, there were unintended effects that continue to influence the profession today. These include the detachment of employers from clinical nursing education; fragmentation of the profession between front-line staff and the professional elites (proletarianization); rejection by front-line practitioners and college educators of nursing scholarship in favour of experiential and technical knowledge; and rivalry between college and university educators that has hampered the development of effective collaborations. For this study, interviews were undertaken with three informants, and their recollections were considered in the context of documentation from the College of Nurses of Ontario (the regulatory body), the Ontario Nurses Association (the union) and the Registered Nurses Association of Ontario (the professional association).

A balanced scorecard approach for nursing report card development.

In this article we describe the process used to introduce and structure a nursing perspective as part of a balanced scorecard framework within a provincial hospital performance report. Results of a critical literature review and consultative process with key informants are outlined. Nurse-sensitive indicators emerged in the areas of system integration and change, clinical utilization and outcomes, patient satisfaction, and financial performance.