Biomedical subjects

A R Rafael

Publications and source records attributed to A R Rafael.

7 recordsLinked to original sources

PubMed2000

Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice.

Criticisms of existing nursing theories in relation to community health nursing practice are that they focus on individuals and have been developed primarily for practice within the context of infirmity and disease, making them inadequate to guide community health nursing practice. Despite being developed for individuals, Watson's theory is proposed as a nursing framework that is philosophically congruent with contemporary global approaches to community health and health promotion. An overview of her theory identifies the centrality of caring, holism, and ecology in the theory as it has evolved over the past 20 years. Concepts developed for individual-nurse interactions are extrapolated to the community in a discussion of the suitability of the theory to guide community health nursing practice. A community assessment tool based on Watson's theory is provided.

Community Health Nursing↗

PubMed1999

From rhetoric to reality: the changing face of public health nursing in southern Ontario.

A feminist, postmodern oral history was undertaken to make visible the work and struggles of public health nurses in Southern Ontario in the midst of drastic cutbacks and dramatic changes in public health. The study focused on the period between 1980 and 1996, during which time two distinct practice modalities were apparent: district nursing and program-focused practice. The narrators' stories describe the nature of their work in both those modalities, the skills and expertise they demonstrated, and the often conflicting influences of medicine and the health promotion movement that dramatically changed their practice. District nursing was characterized by the public health nurse's integral connection with the community; program-focused practice, occurring at a time when political and economic factors also impacted on practice, was characterized by a loss of that integrality. Narrators saw many positive aspects to the changes in public health but identified problems as well. They articulated a preferred vision for the future as one in which "nurses should be nursing." To do that, public health nurses are challenged to return their practice to a nursing center rather than struggling to conform to dominant paradigms in public health.

Attitude of Health Personnel↗

PubMed1998

Nurses who run with the wolves: the power and caring dialectic revisited.

The dialectic of power and caring is illustrated through examples of nurses' experiences reported in a recent study of public health nursing. Examples of caring at each level of the dialectic are provided and implications for nurses and their practice discussed. Nurses whose practice was typically one of empowered caring "ran with the wolves," that is, they demonstrated a connection with their nursing legacy that gave them strength and creativity to imagine transformative possibilities.

Empathy↗

PubMed1997

Advocacy oral history: a research methodology for social activism in nursing.

The reinstatement of social activism as a central feature of nursing practice has been advocated by nursing scholars and is consistent with contemporary conceptualizations of primary health care and health promotion that are rooted in critical social theory's concept of empowerment. Advocacy oral history from a feminist postmodern perspective offers a method of research that has the potential and purpose to empower participants to transform their political and social realities and may, therefore, be considered social activism. A recent study of public health nurses who had experienced significant distress through the reduction and redirection of their practice is provided as an exemplar of advocacy oral history. Philosophies underpinning the research method and characteristics of feminist postmodern research are reviewed and implications for the use of this methodology for social activism in nursing are drawn.

Feminism↗

PubMed1996

Power and caring: a dialectic in nursing.

The tension between power and caring in nursing is evident through the volume of nursing literature related to power and powerlessness and through nurses' discomfort with notions of power. A dialectical examination of the concepts of power and caring reveals that at one level they appear to be polar opposites. Additional layers of the dialectic reflect different relationships between power and caring until they are seen as intertwined and mutually generative concepts in an approach to caring labeled "empowered caring".

Empathy↗

PubMed1995

Advocacy and empowerment: dichotomous or synchronous concepts?

An examination of the concept of advocacy in the nursing literature reflects diverse and sometimes conflicting usage. It may denote a set of behaviors not associated with any specific ethical basis, an approach grounded in a justice ethics, or a philosophical basis for nursing. Although some conceptualizations of advocacy are incongruent with empowerment, others that reflect an existential, relational ethics are indeed synchronous with empowerment. Furthermore, the centrality of mutuality and the nurse-patient relationship to both advocacy and a unitary-transformative approach to caring is consistent with the conditions under which empowerment can occur.

Ethics, Nursing↗

PubMedDate not supplied

Nurses' orientations to change: debunking the "resistant to change" myth.

In 1996, a contemporary oral history of public health nursing in Southwestern Ontario was undertaken. The study period was from 1980 to 1996, a time of tumultuous change in public health in Ontario. Interviews with 14 staff-level public health nurses were the primary data source and, where possible, factual data were corroborated through written documentation such as newspaper accounts. Major findings related to the changing scope and practice of public health nursing have been reported elsewhere. The findings reported in this article focus on nurses' experiences of change. Despite common myths that nurses are resistant to change, six different orientations to change were identified. Critical approval, insidious assimilation, and wounded acquiescence were three ways in which nurses accepted change. Judicious circumvention and constructive opposition described both resistance to control and resistance to changes that most often jeopardized client health from the nurses' perspectives. Finally, the findings included evidence that nurses sometimes initiated change through visionary transformation. Acknowledging nurses' various orientations to change is important in neutralizing the controlling and powerful myth that nurses are "simply resistant to change."

Attitude of Health Personnel↗