Do enhanced recovery after lung cancer surgery programs risk putting primacy of caring at stake? A qualitative focus group study on nurses' perspectives.

Aims And Objectives: To gain insight into nursing in an enhanced recovery after surgery program for lung cancer, we explored its meaning for nurses in a thoracic surgery unit.

Background: Since nurses play a key role in overcoming implementation barriers in enhanced recovery after surgery programs, successful implementation depends on their care approach during the surgery pathway.

Design: Qualitative focus group study.

Overcoming Descartes' representational view of the mind in nursing pedagogies, curricula and testing.

Currently, Nursing Education draws on a commonly taken-for-granted folk psychology of a representational view of how the mind works and how human beings learn. Descartes' representational view of the mind strongly influences pedagogies, theories of learning, curricula, and approaches to testing nursing knowledge and more broadly in academia. A representational view of the mind holds that perception occurs in the mind only through representations in the mind through ideas, concepts, templates and schema.

Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience.

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects.

The evolution of case management for service members injured in Iraq and Afghanistan.

In this article we describe the nursing care needs of wounded service members (WSMs) from the wars in Iraq and Afghanistan and the evolving role of the nurse case manager (CM). New types of injuries, in-field treatment, immediate transport to multiple care centers, and new technologies have created a new patient population of WSMs that requires new types of nursing care and knowledge. We interviewed 235 nurses, including CMs from nine military treatment facilities (MTFs) and the Veterans Administration (VA), on actual patient care experiences and new knowledge development, and 67 WSMs about their experiences of care.

Caring for loved ones with frontotemporal degeneration: the lived experiences of spouses.

There is an abundant literature about the experience of caregiving for a spouse living with Alzheimer's disease (AD), but there are very few qualitative studies about caregiving for persons living with Frontotemporal Degeneration (FTD). FTD causes a change in personality and affected persons may lose the ability to adhere to social norms. Thus, the emotional loss caregivers experience is often confounded by anger in response to embarrassing and socially inappropriate behaviors.

Formation in professional education: an examination of the relationship between theories of meaning and theories of the self.

Being formed through learning a practice is best understood within a constitutive theory of meaning as articulated by Charles Taylor. Disengaged views of the person cannot account for the formative changes in a person's identity and capacities upon learning a professional practice. Representational or correspondence theories of meaning cannot account for formation.

Learning formative skills of nursing practice in an accelerated program.

The purpose of this qualitative research study was to describe how students in an accelerated master's degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development.

Mass casualty care in an expeditionary environment: developing local knowledge and expertise in context.

To discover new experience-based clinical and care delivery knowledge learned in the Iraq and Afghanistan combat zones, 107 Air Force, Army, and Navy nurses were interviewed. Eight areas of experiential knowledge were identified in the new care delivery system that featured rapid transport, early trauma and surgical care, and expeditious aeromedical evacuation: (1) organizing for mass casualties, (2) uncertainty about incoming casualties, (3) developing systems to track patients, (4) resource utilization, (5) ripple effects of a mass casualty event, (6) enlarging the scope of nursing practice, (7) operating medical facilities under attack, and (8) nurse emotions related to mass casualties.

Augmenting the Cartesian medical discourse with an understanding of the person's lifeworld, lived body, life story and social identity.

Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and constraints. The work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld.

Economism, efficiency, and the moral ecology of good nursing practice.

The free-market rhetoric dominating health-policy discussions today frames health-care goods and services as commodities that consumers will or will not buy at a given price. Health-care systems are being redesigned and hospitals restructured with a view to increased efficiency and productivity. Drawing on the experiences of clinical nurses in the United States, this paper shows how the application of economism to nursing may severely disrupt the ecology of good practice, leading to difficulties in meeting minimal standards of nursing care and severely constraining the acts of compassion called for by the human experiences of illness, loss, and death.

Learning across the professions: the clergy, a case in point.

In this article, we examine similarities and differences in the educational goals and pedagogies of nursing and clergy students. We argue that nurse educators can learn a broader perspective of rationality than the narrow, technical rationality of instrumental problem solving taught in most professional schools. An interpretive form of rationality is needed to address suffering and human concerns in the world.

Advanced nursing training in health policy: designing and implementing a new program.

Although the nursing profession has a growing role in the health policy arena, the rapidly changing health care environment means that clinicians need a sophisticated understanding of health policy. Nurses are assuming leadership roles in advocacy, research, analysis, and policy development, implementation, and evaluation, contributing to a growing need to educate nurses to specialize in health policy research and analysis. This article provides an overview of a new master's and doctoral educational program specializing in health policy for advanced practice nurses who are culturally diverse and sensitive to issues of diversity.

Nursing as a caring practice from a phenomenological perspective.

Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps.

Reflections on the doctorate of nursing practice.

A debate is currently raging in many academic nursing circles about a new degree, the Doctor of Nursing Practice (DNP). The degree is envisioned as the terminal degree in the discipline that focuses on clinical practice, and it is proposed to supplant the master's degree by 2015. There are a number of driving forces fueling the proposed change, including the hoped-for parity it will create with other health care disciplines and the potential for addressing the complexity of today's health care system.