Showing posts with label nursing theory. Show all posts
Showing posts with label nursing theory. Show all posts

Thursday, 24 July 2014

Gender models role models and cognitive models... Discuss?

As a male nurse I have been aware of gender throughout my career ever since my student days (late 1970s-early 80s) - mental health - and then as a student again for two years general nurse training. The cultural, professional and global changes over the past three decades and more have been quite profound all influencing the perspectives and realities of gender in nursing today.

Since 1987-88, when I discovered Hodges' model I was also bound to wonder about gender in terms of:
  • the number of male nurse theorists and their contribution (should this matter!)?; 
  • other male nurse theorists globally and the influence of other cultural perspectives;
  • the need to consider gender of course in terms of 'standpoint' within research;
  • Is Hodges' model gender biased as its structure and basis comprised of categories of care concepts is a very masculine activity? (Even though the intention in identifying the boxes is to transcend and integrate them.) Please see below (and no pun intended).
    • Therefore nursing (still primarily a female profession) may ignore/discredit the potential of the model?
Possibly, the stand-out feature of Hodges' model is its invitation to categorise and typify. There could be gender-based consequences in how the model is perceived and received, which in turn could affect interest and participation in research on this subject? In designing studies of the model the feminist standpoint might be useful?:
“What, then, about the further charge that making clear-cut classifications of this kind is a very masculine thing to do? … It reaches its peak in empirical science as we know it, itself a very male affair, and it embodies the desire to have control of things and to know what is likely to happen. It issues in the kind of binary opposites we have found feminists, especially postmodernist feminists, decrying so vigorously-antimonies such as thought/language, nature/culture, reason/emotion, theory/practice, white/black, and especially men/women.” Crotty, (1998) p.171.

Crotty, M. (1998) The Foundations of Social Research: Meaning and Perspective in the Research Process. SAGE Publications Ltd.

This post was prompted by an item on GANM (Global Alliance for Nursing and Midwifery)

Saturday, 1 June 2013

Review: Philosophical And Theoretical Perspectives For Advanced Nursing Practice

http://www.jblearning.com/catalog/9780763765705/
If you are a miner for insight, a pearl diver for knowledge or seeking blue sky wisdom this book can deliver and sign-post in plenty through its references. In summary: this book is a history book that nods at futurology.

I had high expectations for the text, also anticipating an exacting read. After all, as a 5th edition this is a well established text. The expectations were not wholly realized, however; many of the papers are quite dated being published originally in the 1990s.

The book is an important collection and can certainly be regarded as essential reading for advanced nursing practitioners and those pursuing post-graduate nursing studies. Several chapters hail from the same journal publisher and perhaps - as a positive - this contributes to the readable and accessible style throughout the book. The text format and size are also easy to read. I found one spelling mistake within the index entry for 'diagnosis' p.387. In addition to the historical development in part 1 the book's division into five parts - 31 chapters in total - acknowledges the reliance on the past and from it appears from a previous edition the arrival of the 21st century. Apart from the current date of issue 2013 I cannot accurately place the most recent additions to the volume. The contents listing and preface are limited in this respect. Judging from the references they are not that recent. 2010 is one of the most recent references I could find, and this, the 75ed of Toby & Mariner.

Many of the papers are seminal and include an overview of particular aspects of nursing thought - analysis and synthesis. Unsurprisingly, there is philosophy and ethics in great abundance, together with ecocentricism, several forms of feminism, aboriginal peoples and their world views, evidence, health, beliefs, art, professionalism, research, patterns, advanced practice, theory and much more. The distinction between evidence based theory and evidence based practice is something of which all nurse students should be aware.

There is specific reference to Advanced Nursing Practitioners. There could obviously be some variation in how this professional group are considered as opposed to Advanced Nursing Practice. Having just returned from Belfast and the University of Ulster there is ongoing currency in McCormack's chapter 17 A Conceptual Framework for Person Centered Practice with Older People. While dated 2003 McCormack's work was emphasized at a recent conference in Ulster I was able to attend (and there are plans for another). I am sure other chapters may be enlivened by such reviewer found co-incidences as this.

I wonder if the scope of the book and acknowledgement of the passing of time seems to shout for a two-volumed approach. As suggested above, the previous acknowledgement of the future seems to have hailed from the 20th century and got lost. We are now after all more than a 1/10 of the way into the 21st century.

Having started my nursing career in the RN, chapter 22 on military metaphor in nursing and the need for another. A researcher contacted me several years ago about using Hodges' model (a conceptual framework) in a study on bullying in nursing. I've never heard anything since, but Hodges' can help in such research in two respects. The inclusion of a political domain and the organization of groups of people, emphasizes process, procedure, protocol, routine, and may proceed to regimentation, discipline, hierarchy so to a degree language games will follow. As this chapter notes, several professions, including nursing are said to eat their young. A commentary after the chapter provides a useful balance and makes this point. The chapter is nonetheless a reminder of the role of language and how professionalism arises and is sustained (disciplines too?). The proposal of frontier as a new metaphor is fitting as Hodges' model identifies five conceptual fronts - frontiers that must be integrated. 

As a frontier - Chapter 21 on rapture and suffering with technology in nursing holds many lessons and insights. Heidegger's "standing reserve", the human-technology interface, what it means to live like a human being and the distinction of being a human being. Mobile technology, m-health, e-health are making a huge contribution to global health and need a place here. I found Macurdy's four principles 326-327 on what patients need to assume power and control over their care very illuminating, especially in highlighting information access and the importance of health literacy.

In the text and the index I could not find specific reference to capacity, as in mental capacity, informatics, global health, information (access), justice, law, legal, management, human rights, literacy, mental, political, psych-, long-term medical conditions and recovery. While the book would become incoherent if a disease/diagnosis-based approach was adopted, we might ask: does dementia deserve specific inclusion? This is an interesting (and potentially vociferous) debate in itself - to what extent should such a book record change through several decades? Of course the book is not an encyclopedia and it is easy to critique according to omission. These are pressing times demographically, however; while there is a population focus: global communities and aboriginal communities in chapter 23 and 24, this merely scratches the surface of very large world.

This book is a valuable asset and has stimulated many ideas here (and potential blog posts). I am very pleased to have read it and would recommend it to students and practitioners alike. I am grateful to the publishers for the review copy.

Thursday, 24 January 2013

Two new books ... to review and a new IPONS website

There are two books in the post for review here which I look forward to receiving. Originally I only enquired about the following:

Philosophical and Theoretical Perspectives for Advanced Nursing Practice, Fifth Edition 

The book will continue to address a need to identify philosophical and a theoretical basis for h2cm.

A phone call from the publisher's rep. Clare McMillan had noted the informatics content here on Welcome to the QUAD W2tQ and would I also be interested in another book?

Yes please, certainly... I appreciate the recognition too.


Nursing Informatics and the Foundation of Knowledge, Second Edition is also to follow and not without a challenge as Clare pointed out. This foundation on informatics is focused on the North American experience. So it is a perspective from Wigan Pier to follow.

Of related interest and with further refinements to follow apparently, the International Philosophy of Nursing Society has a new website.

Tuesday, 13 November 2012

Associate Professor Fran Biley - Bournemouth University

It is with great sadness that this week I learned of the passing of Fran Biley. In 2003 I contacted Fran having heard he had worked up in Lancashire in the early 80s as a charge nurse on a then new elderly mentally ill unit. I could not resist the possibility that here was someone who perhaps knew of Hodges' model or had used it.

There were no major leads, but Fran always encouraged me in my preoccupation with Hodges' model. I did not have a sense that I was just being indulged, or that Fran was purely exercising good manners which I'm sure he had in abundance. Fran also provided support indirectly and so I will miss both his positive words and observations.

There may be some communications on the old PC to recover, as I've enjoyed following Fran's contributions over the years. The brilliant video on students and nursing theory which I posted here on W2tQ in 2010 and Fran's missives to various lists over the years, including:

From: Francis Biley at BOURNEMOUTH.AC.UK;
To: PSYCHIATRIC-NURSING at JISCMAIL.AC.UK
Sent: Thursday, 29 November, 2007 11:58:15 AM
Subject: [PSYCHIATRIC-NURSING] Evidence

Didn't Liam mention nursing in the original post somewhere? What about Peplau, Orlando, and Travelbee and perhaps a host of others who produced buckets full of evidence of whatever flavour you'd like to choose; and Barker as well of course, not added here as an afterthought, more as emphasis.

And as for contemporary, Orlando's book was published in ?61, and Travelbee died in 73 (I think??)....and we all (should) know Peplau's history (perhaps...)...and FNs Notes on Nursing is still on and off my book shelf like a yoyo.

Or is it that we've been influenced by psychologists, psychiatrists, sociologists and etc to such an extent that these people (and nursing per se) have clearly disappeared from the horizon, or where never there in the first place?

I will keep going Fran! Many thanks.

Tuesday, 9 October 2012

A shoutout to University of Northumbria at Newcastle - and others!

Although school terms and university semesters vary especially between the northern and southern hemispheres, I can often tell when a new academic year is upon us again. Not only that, but possibly a new cohort of nursing or other health care related students.

The signal is the visitors to the old website. The past week or so there's been a lot of traffic from University of Northumbria at Newcastle. Only the institution is listed, not individuals. And don't get excited about the numbers: we are talking 10s here not 100s and 1000s.

Those tens (still greatly appreciated!) could be even more significant if I could connect with someone. So if you are revisiting this blog and from UoN or any other institution please get in touch: h2cmng at yahoo.co.uk

I would really help to hear your views on:

What prompted your visit?
Who are you - what's your role, course and stage of learning?
How are you using the site and model (if at all) is it:
  • as part of an exercise merely identifying models of nursing, aspects of nursing theory...?
  • as part of a piece of (reflective) written work?
  • applying the model to a specific context, case study, nursing (or other) discipline?
  • as a critical nursing or informatics exercise?
  • as an initial exercise to help assure holistic care?
  • some other discipline and purpose perhaps?
What would you expect to find, what is missing?
What is useful and should be archived?
What sucks!
Is there something that you could add to a future site?
Do you have work on h2cm that I could highlight here on W2tQ?

There are many rich seams to dig here and if we can work together we might find some light.

There is someone at UoN I will approach if they are still there: quite possibly!

Thursday, 4 October 2012

Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem. 

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:
On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  
I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.

Thursday, 31 May 2012

Book for Review: Risjord's - Nursing Knowledge - Science, Practice, and Philosophy

In order to put Hodges' model on a more theoretical and practical footing (especially as part of an extended project) I approached the publishers of Mark Risjord's Nursing Knowledge: Science, Practice, and Philosophy. Wiley-Blackwell have kindly forwarded me a review copy of this book.

My preoccupation with nursing theory, practice and informatics could form the basis of a multiple choice question:

Having an earnest interest in nursing theory, practice and informatics is:

a) a grand academic and intellectual enterprise (you're a historian, journalist and futurologist).
b) a sign of our times for ALL nurses (doh!) this is the 21st century after all.
c) a contradiction in terms.
d) a sign you are informationally overloaded, trapped in the gap.

Seriously, the effort to understand nursing, informatics and retrofit theory (conceptual spaces, threshold concepts...?) to support Hodges' model needs to be philosophically sound - rigorous. This book will help.

Thursday, 10 May 2012

International Nurses Day - Closing the gap: My Project for a Global Conceptual Framework for Nursing

As International Nurses Day is celebrated tomorrow on the 12th May the emphasis and work here at W2tQ lies with Hodges' model. The project is to publicise h2cm's international potential in providing an avenue to help unify nursing theory, practice and assure future research.

Fawcett wrote of the metaparadigm of nursing - namely the inclusion of the concepts of person; environment; health; and nursing.

These concepts are incorporated into Fawcett's criteria on model validation which are listed in bold-italic below.

I have also ventured some reflections on the current status of h2cm when compared against these criteria.

Assumptions underlying the conceptual model are made explicit.

It is not sufficient, but the structure of Hodges' model renders the assumptions within the model explicit. The structure identifies eight initial key concepts:

INDIVIDUAL, GROUP (population); HUMANISTIC, MECHANISTIC; SCIENCES, POLITICS, SOCIOLOGY, INTERPERSONAL

A complete description of all four concepts of nursing's metaparadigm are presented.

Reflection soon reveals that several environments are suggested:

PHYSICAL, ORGANISATION, COMMUNITY, HOME, RESIDENCES, DWELLINGS, COGNITIVE (conceptual), SYMBOLIC, ABSTRACT, VIRTUAL, FORUMS, COLLEGES

Propositions of the conceptual model completely link the four meta-paradigm concepts. 

This is feasible, reasoning from the foundation of the model's structure.

The internal structure of the conceptual model is logically congruent.

This does need to be demonstrated. Initial recognition of logical congruence might be found through the conjoining of disciplines, that is frequently taken for granted: PSYCHO-SOCIAL; SOCIO-TECHNICAL; SOCIO-ECONOMIC.

The conceptual model is socially congruent, socially significant, and socially useful.

I have claimed on numerous occasions that the model is agnostic, universal, accessible, and has educational potential. These and other qualities need to be critically examined.

Empirical evidence in support of the model has accumulated from many derived theories.

The two final criteria are the most challenging. Empirical evidence supporting Hodges' model is available, but again must be tested through research. If someone has time - could you please compare the frequency of a set of political concepts in the nursing literature since 1985?* The emergence of health literacy and self-efficacy, threshold concepts, conceptual spaces, the rise of the semantic web and developments in software can all potentially support h2cm. Producing a roll-call of some of the latest trends in contemporary education, research and culture is not good enough, specific studies are needed.

The total contribution of the conceptual model to nursing knowledge. 

There is a long, long way to go, but the contribution has begun ... every journey ...

Of course, it is almost 20 years since publication of Fawcett's criteria. Has the concept of congruence changed in that time? What is socially significant and useful now? What should the social and political weighting of evaluative criteria be in 2012...? There is a body of critique upon Fawcett's and other evaluative tools within nurse education.

Perhaps a new set of criteria could be defined using h2cm itself? For a model of nursing (health and social care) to be fit for purpose, acceptable and viable across the globe, there are new concepts to be represented. While that would certainly close a gap, it does not seem a rigorous or valid way to proceed. I will seek out other more recent criteria and present them here at some point.

Fawcett J. Analysis and Evaluation of Conceptual Models of Nursing, 3rd ed. Philadelphia, Pa: FA Davis; 1995.

*Many thanks - if someone should pick this up, which ever axes, concept or issue.