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Aranda, Sanchia K; Street, Annette F
doi: 10.1046/j.1440-1800.1999.00019.xpmid: 10696199
This paper explores contradictory understandings of nurse–patient interaction arising through an exploration of ‘being authentic’ and ‘being a chameleon’. The concepts arose during a critical praxis research study exploring nurse–patient relationships in the context of life‐threatening or terminal illness. Being authentic can be understood as a dominant view in the nursing literature of the nurse–patient relationship, incorporating the value of being genuine. However, we argue that this concept offers only a partial and inadequate framework from which to understand nurse–patient interaction. The paper argues that nurse–patient relationships develop intersubjectively, with both the nurse and the patient choosing to reveal or conceal aspects of themselves in response to their interactions. Intersubjectivity as a concept provided the nurses in this study with a means for understanding how the nurse and the patient each contribute to interactions; nurse–patient relationships being understood as mutually constructed. These ideas are explored in this paper using examples from the nurses’ stories, along with the implications raised for nursing practice.
Tang, Sannie Y S; Anderson, Joan M
doi: 10.1046/j.1440-1800.1999.00022.xpmid: 10696200
In this paper we examine the notion of human agency in the context of women experiencing a chronic illness. Based on two qualitative studies conducted with Canadian women of Chinese‐ and Anglo‐descent living with diabetes, we unmask the complex power relations inherent in patient–practitioner interactions, and problematize the privileging of healthcare providers as knowers and experts on the patient’s body. Specifically, we analyse the meanings that women ascribe to their illness experience. We discuss how women experience the loss of agency in healthcare encounters, how they resist patienthood by reclaiming agency, and how healthcare providers foster agency in their interactions with women. Rather than suggesting that biomedical experts should be ‘written out’, we propose to rewrite healthcare providers as ‘reflexive practitioners’ through the construction of transformative knowledge. We argue that praxis‐oriented practice, which is based on transformative knowledge, will provide the space for women and healthcare providers to enter into a new dialogue and a relation in which women can sustain a sense of self, and begin the journey of healing.
Meleis, Afaf Ibrahim; Im, Eun‐Ok
doi: 10.1046/j.1440-1800.1999.00015.xpmid: 10696201
Quality care requires a body of knowledge that reflects the experiences and the responses of the marginalized populations to health and illness, and requires demarginalization of nursing knowledge. We argue the significance of developing an understanding of people who are marginalized, and organize our arguments and discussions into four sections: (i) developing knowledge that is not marginalizing; (ii) developing knowledge about marginalized populations; (iii) integrating nursing knowledge and making it visible; and (iv) the future of research enterprise. We propose that nurses critically consider strategies and processes to deal with and transcend marginalization of populations and of nursing knowledge.
Barker, Phil; Jackson, Sue; Stevenson, Chris
doi: 10.1046/j.1440-1800.1999.00018.xpmid: 10696202
Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. Although research has documented psychiatric nursing activity, little study has been made of the ‘need’ for psychiatric nursing within a multidisciplinary service. Employing adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals. The study was based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: ‘knowing you, knowing me’. Within that complex, nurses either elected, or were required, to move — or ‘toggle’ — between three discrete domains of relating: the Ordinary Me (OM); the Pseudo‐ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses’ depth of knowing, power, use of time and use of translation distinguished these domains. The emergent theory extends current awareness of the importance of interpersonal relations in nursing. To what extent current health care policy, which emphasizes the promotion of alternative roles for nurses, will challenge this essential focus remains unclear.
doi: 10.1046/j.1440-1800.1999.00020.xpmid: 10696203
After a brief description of Helga Kuhse’s arguments on the place of caring in moral decision‐making in her recent book, Caring: Nurses, Women and Ethics, the author suggests that Kuhse is committed to reasons externalism and to a moderate form of motivational externalism. This compartmentalizes the psychology of moral agency and fails to see caring as the holistic stance toward patients which some nursing theorists have been espousing. The author then goes on to sketch such a holistic conception and to overcome difficulties relating to objectivity, the place of practical reason, and to weakness of will, which the new conception raises.
Thorne, Sally E; Kirkham, Sheryl Reimer; Henderson, Angela
doi: 10.1046/j.1440-1800.1999.00016.xpmid: 10696204
Whilst the notions of paradigm and paradigm shift have become popularized in nursing’s scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivations underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.
doi: 10.1046/j.1440-1800.1999.00014.xpmid: 10696205
In this paper it is argued that the way in which ageing is portrayed is culturally constructed and historically located. The terminology used to describe older people becomes part of nursing taxonomy but the issue that it is a cultural construct remains hidden. Nurses use histories and records as a means of communication about the condition of the client or patient. The notes mediate the way in which the patient comes to be known as an individual in need of services and help define the way in which nursing care is undertaken. Nursing notes help construct the ‘manageable’ patient. Noncompliance disrupts this notion of the manageable patient and it challenges medical and nursing dominance of the body. However, noncompliance then becomes reinterpreted as ‘risk’, which has the effect of extending the clinical gaze from the confines of the body to extra‐corporeal spaces. Older people, because of their corporeality, can subvert and resist this clinical gaze.
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