Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings.

Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.

Is the complexity of care a paradox?

This paper looks at the phenomenon known as care and the medium through which it is expressed - caring. It explores some of the meanings of these terms but focuses particularly on nursing care. Superficially, nurses and society have a broad understanding of what 'care' means but common usage of the word belies its complexity. When examined alongside the writings of scholars the inconsistent nature of care and caring emerges. We reflect on the difficulties this presents for both the nurse and the cared for when, on the one hand care is promoted as the essence of nursing, while on the other there is no acceptable definition of care on which to base this claim. Encompassed within our discussion is the underlying theme that although care is an appropriate ideal for nursing it does not capture all of the day-to-day realities and hence it is not an overriding ideal. Care in nursing in this sense is contradictory and we describe it as paradoxical.

Some implications of postmodernism for nursing theory, research, and practice.

This paper explores ways in which some aspects of postmodernist thought impact upon nursing theory and research. The focus is on postmodernist accounts of epistemology and language, in particular notions such as multiple truths, uncertain and provisional knowledge, and claims as to the purposes of knowledge development. Common themes of postmodernism are articulated, including antifoundationalism, the dissonance between competing discourses, and the rejection of "grand theories." The paper concludes with a short set of suggestions for a postmodern approach to nursing practice.

At what cost care?

This paper looks at the concept of care in nursing and considers the ever-changing focus relative to the meaning of the term care and how this care is delivered by nursing staff. In the process of looking at these issues it examines the theoretical and practical issues and how these factors have changed considerably over the last twenty-five years. This examination touches upon some of the intermingled and not mutually exclusive issues which surround care and caring such as technology, stress and burnout, bureaucracy, fiscal policy, the humanness of the nurse and the ever changing nature of care delivery. Many readers will be able to relate to the issues discussed and understand how some of these factors tend to get in the way of one another and affect good patient care and outcomes.

What's funny about nursing?

The authors examine the topic of humour and argue that humour is needed as one of many skills within the nurse patient relationship. We advance the view that humour has been well researched as an agent of therapeutic value and as a communication tool which helps to relieve stress, but, to date is not used to its fullest potential and tends therefore to be underestimated in both general and psychiatric nursing areas. Humour has benefits for both the nurse and the patient having psychological benefits and a vast array of physiological advantages and is regarded by those who use it as a social lubricant acting as a positive in nurse patient relationships. We also argue that it is essential that nurses know when to use humour as timing and appropriateness is imperative in order for it to be most effective. Humour can be used in all areas of clinical nursing practice and may prove useful in being a reliable predictor over the course of a patient's illness. The use of humour can help improve the nurse-patient relationship by initially breaking the ice between nurse and patient. This alternative mode of delivery can then be foundational to other areas of the nurse patient relationship such as self-disclosure, the enhancement of learning and relieving stress. Furthermore, it helps to facilitate and promote mutual health and well being for both the patient and the nurse. The usage of humour in psychiatric nurse settings is discussed and the benefits to both the patients and their staff are outlined as being of immense therapeutic value. The literature perhaps tends to skirt around these benefits somewhat, as psychiatry and laughter in partnership are not really considered important discursive topics.

Understanding the prattle of praxis.

This paper will examine and discuss some of the strengths and weaknesses of conceiving nursing as a form of praxis, encompassing within this, the idea that in order to conceive nursing as a form of praxis, reflection has to be considered a key component. It will be argued that praxis can (and should) become a practical process and that, when applied to one's own nursing practice, changes, reshapes and allows one to discover new meanings (or, draws out the meanings which were always there). Clearly there are many different forms, understandings and applications of the term praxis and this paper will examine some of the tensions and the nexus that exist. These claims will be supported by using personal-professional journal extracts as a catalyst, showing that there is potential for closing the theory-practice gap through more in-depth reflection, and that this examination using reflective techniques will demonstrate that nurses, by using this process develop their own implicit personal nursing theories. Using one's colleagues as a critical resource allows what might be described as ongoing reflection to occur, where critical friends in both theoretical and practice worlds act as a dialectical catalyst for growth and change, moving toward closing the theory-practice gap.

A nursing journey through discursive praxis.

This paper argues that conceiving nursing as a form of praxis, encompasses amongst other things, the critical reflection upon one's nursing practice in order to work out and understand internal and external constructions of personal theories. This reflective examination will demonstrate the implicit knowing that nurses develop as a result of their personal, day to day practice. Highlighting this knowing and incorporating the richness of their practice experience becomes the basis for their own personal nursing praxis.

Culture, needs and nursing: a critical theory approach.

This paper will bring the critique of culture, notably that undertaken by the Frankfurt School of Critical Social Science, to bear on the problem of needs, and expose its significance for the practice and discipline of nursing. The paper begins by reviewing ways in which the idea of 'needs' has been depicted in nursing literature, and it is suggested that this depiction is inadequate in fundamental ways. The critique of existing culture is then outlined and the implications for nursing are suggested in terms of the dissolution of hegemonic practices and the development of a concept of need built around the notion of 'praxis'.

Is caring the ethical ideal?

This paper will examine the claim that caring is an appropriate ethical ideal for nursing. Initially it will examine nursing's philosophy of care and caring, highlighting some areas of difficulty and dissatisfaction articulated by many of its contemporary theorists. Evaluation of the notion of caring as an appropriate ethical ideal for nursing will be balanced against those in opposition, and in this process their critique will be discussed. This discussion will focus on areas such as virtue virtue ethics, moral responsibility, feminine values, mothering and the debate between male and female caring. Different forms of caring will be evaluated and balanced against different forms of nursing. The paper will then suggest that current views which hold aloft nursing as a bedmate of caring may be detrimental to both the cared-for and the carer, advocating in the process a move toward change.

Nurse-doctor relationships in multidisciplinary teams: ideal or real?

This paper will examine the paradox of power differentials in multidisciplinary teams. The paper begins by offering multidisciplinary teams as an egalitarian enterprise in which all disciplines are included for their particular expertise in relation to patient care. By reviewing ways in which multidisciplinary teams are constructed it will be shown that in nursing discourse these teams are portrayed rhetorically in an idealized rather than realistic way and that there is clearly a power differential between disciplines. The examination highlights the socialized and stereotypical role adopted by the nurse and other disciplines within multidisciplinary teams, so that they fit the social role/rules allotted to them. Investigation of these roles suggest that masculine ideology has prevailed whereby the doctor assumes (without question) the role of team leader. The paper then moves to suggest dissatisfaction with this and that change is underway.