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La autoetnografía como estrategia para el análisis y comprensión de narrativas de enfermería
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Aims and objectives
To elucidate the synergies between fundamental care and seminal nursing theories.
Background
Nursing theories are often criticised for their limited clinical relevance, with the existence of a theory‐to‐practice gap widely acknowledged. Pervasive examples of poor‐quality care, particularly for people’s most fundamental needs, raise questions as to whether nursing theories sufficiently prioritise fundamental care. The Fundamentals of Care Framework (hereinafter ‘the Framework’) represents a valid, comprehensive and evidence‐based description of fundamental care. The Framework captures the complexity and multi‐dimensionality of fundamental care delivery, predicated on the nurse‐patient relationship; integration of physical, psychosocial and relational needs; and a supportive context. Despite strong face validity, the Framework’s alignment with seminal nursing theories remains unexplored.
Design
Narrative review.
Method
Twenty‐nine seminal nursing theories were included. Categories for analysis were developed inductively and deductively, focusing on the themes of relationship, integration of care, context and the theories’ ease of use. Results are reported in accordance with PRISMA‐ScR guidelines.
Results
Though relationship, integration of care and context and were features shared across a number of nursing theories, no single theory depicts these collectively to the same extent as the Framework. In particular, integration of physical, psychosocial and relational aspects of care was found to be poorly described in the theories.
Conclusion
Failure to account for integration of care means that nursing theories continue to conceptualise fundamental care as a series of discrete tasks. To ensure relevance at the point of care, future nursing theories must accurately reflect the complexities of fundamental care delivery, specifically the need to integrate multiple care needs simultaneously, alongside being straightforward to apply in practice.
Relevance to clinical practice
Bridging the theory‐to‐practice gap requires a nursing discourse that is relevant at the point of care. We provide suggestions for how future nursing theories can bridge this gap.
Este trabajo describe y analiza las trayectorias y las estrategias de búsqueda de sanación entre los miembros de un movimiento católico carismático de sanación en Argentina. A partir de una investigación etnográfica realizada entre julio de 2009 y abril de 2015, se focaliza en las concepciones, prácticas y experiencias en torno a la salud-enfermedad-atención. Se señala que el evento de enfermedad requiere una respuesta cognitiva y otra práctica para su gestión e involucra, principalmente, dos recursos terapéuticos: la biomedicina y las terapias religiosas. Asimismo, se postula que cada recurso es referido en momentos específicos de las trayectorias y el pasaje de uno a otro implica el cambio de una noción restringida por una holística del proceso salud-enfermedad-atención.
Background
The objective of the present study was to examine the role of perceived stress, ego-resiliency, and relational resources in maintaining psychological well-being in parents of children with Down syndrome, in particular in groups of mothers and fathers. Being a parent of a child with a disability is stressful, and it can be a burden. Despite these negative aspects of child-rearing, mothers and fathers are supported by their own resources and help from other people.
Participants and procedure
The study included 126 parents of children with Down syndrome (75 mothers and 51 fathers). All parents were married at the time of the study (i.e. the study did not involve single parents). The subjects completed questionnaires of psychological well-being, perceived stress, ego-resiliency, quality of marital relationship, and perceived social support.
Results
Perceived stress proved to be a negative predictor (β = –.35) of psychological well-being both in the group of all parents and in groups of mothers and fathers. Ego-resiliency, perceived social support, and quality of marital relationship were positive predictors in the group of all parents, whereas ego-resiliency was a positive predictor (β = .29) of psychological well-being of fathers; perceived social support constituted a positive predictor (β = .25) in the group of mothers.
Conclusions
The results of the present study show the factors that have a significant effect on parental well-being and may, thus, be unfavourable (e.g. perceived stress) or favourable (e.g. perceived social support for mothers, ego-resiliency for fathers) for adaptation of parents of children with Down syndrome and their mental health. Particularly interesting are the differences in groups of mothers and fathers with regard to factors positively affecting their psychological well-being: relational resources (social support) are factors important for mothers, whereas psychological inner resources (ego-resiliency) are important for fathers. Further research on the topic is needed.
Background:
Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care.
Objective:
To implement and evaluate a palliative care professional development program for ICU bedside nurses.
Methods:
From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds.
Results:
Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them.
Conclusions:
Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs.
Most studies of parenting children with Down syndrome (DS) have been conducted in industrialized countries. They suggest that sensitive communication on the part of professionals, and social support, can lead to acceptance and positive adjustments in the family. This study examined the impact of a diagnosis of DS on Ecuadorian families, in particular at how the diagnosis had been communicated and received, as well as the feelings and experiences which followed. Despite considerable progress in recent years, Ecuador is still marked by discriminatory attitudes which affect children with disabilities and their families, and by the persistence of widespread poverty. This qualitative study, conducted in Cuenca, Ecuador’s third largest city, is based on a focus group discussion and four in-depth interviews with Ecuadorian parents of DS children attending a specialist center in the city. The study shows that, reflecting the effects of status differences and lack of appropriate training, professionals rarely communicate a DS diagnosis in an appropriate manner. Further, it is shown that lack of social support, and the widespread stigmatization confronting children with DS and their families, hinder development of positive and empowering adjustments that would best serve the child’s and the family’s interest.
La autoetnografía es un enfoque de investigación y escritura que busca describir y analizar sistemáticamente la experiencia personal con el fin de comprender la experiencia cultural. Esta aproximación desafía las formas canónicas de hacer investigación y de representar a los otros, a la vez que considera a la investigación como un acto político, socialmente justo y socialmente consciente. Para hacer y escribir autoetnografía, el investigador aplica los principios de la autobiografía y de la etnografía. Así, como método, la autoetnografía es, a la vez, proceso y producto
The aim of this paper is to explore the essential elements and value of narrative inquiry in nursing research. We propose that understanding a previous experience allows the nurse researcher an “insider view” and hence a deeper understanding of the issues that arise in the relationship between participant and researcher. We suggest that narrative inquiry in nursing research offers a particular way of caring about how knowledge is produced. Nursing science would benefit from the understanding that health and nursing practices are dynamic processes characterized by the continuous interaction of human thought and behaviour that continuously ‘pumps’ into personal, social and material environments. Narrative inquiry as a methodology in nursing research is exceptionally useful to uncover nuance and detail of previous experiences.
Using systematic sociological introspection, this study is simultaneously a retrospective participant observation of the experience of being sexually abused as a child, and an argument for a new writing format, the “layered account.” Acknowledging that sociology is a personal reflection of the sociologist creating it, the author has structured the layered account to emulate the freedom of the duree. It enables ethnographers to break out of conventional writing formats by integrating abstract theoretical thinking, introspection, emotional experience, fantasies, dreams, and statistics. The author concludes by examining the intertextual quality of the two texts—child sex abuse and social science reporting—presented here.
Autoethnografie ist ein Ansatz zum Forschen und zur Präsentation von Forschungsergebnissen, der persönliche Erfahrungen systematisch beschreibt und analysiert, um auf diesem Weg kulturelle Erfahrung zu verstehen. Hierbei werden traditionelle Wege des Forschens und der Darstellung "der Anderen" kritisch infrage gestellt, denn Forschung wird als politisches, auf soziale Gerechtigkeit zielendes und sozial bewusstes Handeln verstanden. Forschende nutzen Mittel der Autobiografie und der Ethnografie, um Autoethnografie zu betreiben und darzustellen. Als Methode bezeichnet Autoethnografie gleichermaßen einen Prozess und ein Produkt. Autoethnography is an approach to research and writing that seeks to describe and systematically analyze personal experience in order to understand cultural experience. This approach challenges canonical ways of doing research and representing others and treats research as a political, socially-just and socially-conscious act. A researcher uses tenets of autobiography and ethnography to do and write autoethnography. Thus, as a method, autoethnography is both process and product. La autoetnografía es un acercamiento a la investigación y a la escritura que busca describir y analizar sistemáticamente la experiencia personal con el fin de comprender la experiencia cultural. Este acercamiento desafía las maneras canónicas de hacer investigación y representar a los demás y trata a la investigación como un acto político, socialmente justificado y socialmente consciente. Un investigador usa principios de la autobiografía y la etnografía para hacer y escribir autoetnografía. Porque, como método, la autoetnografía es tanto proceso como producto.
Nurses have unique clinical responsibilities and opportunities with patients that require strong communication skills. However, many nurses lack effective communication skills and often receive inadequate palliative care communication training and education. To promote communication education for palliative care nurses, the End-of-Life Nursing and Education Consortium created a Communication Curriculum for nurses and developed an in-person train-the-trainer course. Organized by the 8 domains of the National Consensus Project Guidelines for Quality Palliative Care, a 1-day course was provided in August 2018 to 46 nurses representing 38 institutions. Completion of precourse surveys demonstrated participants' institutional resources for palliative care communication education and their greatest communication challenges. Immediate postcourse evaluations demonstrated that the course improved nurses' knowledge and confidence in communication and their ability to educate others. Palliative care nurses can incorporate communication skills into their practice and provide communication skills training to their institution.
a collection narratives based on my work as a clinical ethicist at Vanderbilt University hospitals and clinics
A. Irving Hallowell challenged those involved in cross-cultural research to establish the categories used for making comparisons through an examination of how experience is endowed with meaning within the context of culturally constituted behavioral environments. Here, published comparative frameworks for explanations of illness are considered in light of findings from research in two culturally distinctive settings. Adopting Hallowell's behavior-centered orientation, I suggest that following actual cases in a systematic manner is critical to understanding the range of explanatory frameworks in a cultural setting, as well as the relative importance of available explanatory frameworks as cultural resources when dealing with illness. Taking Hallowell's challenge seriously requires that anthropologists maintain an openness to change in the categorical abstractions used to reflect epistemological and ontological realities in diverse environments.
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