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Dawn Freshwater

Publications and source records attributed to Dawn Freshwater.

17 recordsLinked to original sources
PubMed2006

Evidence for practice, epistemology, and critical reflection.

Evidence-based practice (EBP) has become a critical concept for ethical, accountable professional nursing practice. However, critical analysis of the concept suggests that EBP overemphasizes the value of scientific evidence while underplaying the role of clinical judgement and individual nursing expertise. This paper explores the empiricist position that valid evidence is the basis for all knowledge claims. We argue against the positivist idea that science should be regarded as the only credible means for generating evidence on which to base knowledge claims. We propose that the process of critically reflecting on evidence is a fundamental feature of empirical epistemology. We suggest that critical reflection on evidence derived from science, arts and humanities and, in particular, nursing practice experience can provide a sound basis for knowledge claims. While we do not attempt to define what counts as evidence, it is argued that there is much to be gained by making the processes of critical reflection explicit, and that it can make a valid contribution to expert nursing practice, without recourse to irreducible concepts such as intuition.

Art↗
PubMed2005

Workforce planning and education: mapping competencies, skills and standards in mental health.

This paper aims to identify and critically analyse the provision and commissioning of relevant training for multidisciplinary mental health practitioners in the South West region of England. Data were collected from 45 education and training providers across the region. A total of 132 courses were examined through analysis of a questionnaire and a further 82 courses were studied in more depth through interviews and focus groups, alongside a textual analysis of course documents. Data generated from the analyses were mapped against the competencies and skills outlined in The Capable Practitioner [SCMH, 2001. The Capable Practitioner, Sainsbury Centre for Mental Health, London.] document and National Occupational Standards for Mental Health [Skills for Health, 2004. National Occupational Standards for Mental Health. Available from: (last accessed 17.11.04).]. The findings confirmed that significant gaps exist in training and education. While some aspects of The Capable Practitioner and National Occupational Standards for Mental Health are covered well by courses provided for mental health practitioners in the region, other aspects are missed completely. Recommendations are made for further research, with the suggestion of using an action research and co-operative enquiry method to identify with participants if courses should be developed to cover these areas or if the standards themselves should be adapted. Reflections on the methodological framework and subsequent limitations of the study are outlined.

Attitude of Health Personnel↗
PubMed2005

'To save the honour of thinking': a slightly petulant response to Griffiths.

This is a response (a reply? a riposte?) to Peter Griffiths (Int. J. Nurs. Stud., in press, ) that attempts to answer some of the charges, which he levels at our book 'Deconstructing Evidence-based Practice' (Routledge, London, 2004). It begins by countering Griffiths' mistaken assertion that, in deconstruction, 'anything goes'. It argues that Griffiths is wrong because he has literally mistaken the meanings of certain words; that is, he has taken them wrongly. His biggest mistake, on which all of his others rests, is to mistake the word 'deconstruction' to imply a form of extreme relativism in which there are no right or wrong readings. In this, he is simply wrong. He is wrong in his assumption that there are no wrong readings, and the fact (yes, fact) that he is wrong demonstrates that some readings can be wrong. In particular, he mistakes the word 'challenge' to mean 'deny', and the word 'authority' to mean 'legitimacy'. This is not simply our reading of what we took him to mean (which could, by our own argument, be mistaken). It is his reading and his writing, there on the page in black and white. And this misreading, this mistake, inevitably leads him to a wrong conclusion. Having clarified the small matter that, in deconstruction, anything does not go, and that deconstructionists are not constrained to accept everything that is written about them, we then attempt to point out some other mistakes in Griffiths' non-review. Most importantly, we reject Griffiths' accusation that postmodernism is a strategy to 'save us from thinking' and instead, with Lyotard, advocate it as an attempt 'to save the honour of thinking'.

Evidence-Based Medicine↗
PubMed2004

The heart of the art: emotional intelligence in nurse education.

The concept of emotional intelligence has grown in popularity over the last two decades, generating interest both at a social and a professional level. Concurrent developments in nursing relate to the recognition of the impact of self-awareness and reflexive practice on the quality of the patient experience and the drive toward evidence-based patient centred models of care. The move of nurse training into higher education heralded many changes and indeed challenges for the profession as a whole. Traditionally, nurse education has been viewed as an essentialist education, the main emphasis being on fitness for practice and the statutory competencies. However, the transfer into the academy confronts the very notion of what constitutes this fitness for practice. Many curricula now make reference in some way to the notion of an emotionally intelligent practitioner, one for whom theory, practice and research are inextricably bound up with tacit and experiential knowledge. In this paper we argue that much of what is described within curriculum documentation is little more than rhetoric when the surface is scratched. Further, we propose that some educationalists and practitioners have embraced the concept of emotional intelligence uncritically, and without fully grasping the entirety of its meaning and application. We attempt to make explicit the manner in which emotional intelligence can be more realistically and appropriately integrated into the profession and conclude by suggesting a model of transformatory learning for nurse education.

Clinical Competence↗
PubMed2004

Analysing interpretation and reinterpreting analysis: exploring the logic of critical reflection.

This paper examines the distinction that is sometimes drawn between analysis and interpretation in the context of qualitative research, and the processes of critical analysis that underpin reflective practice. The authors consider the complementary logical processes involved in analysis and interpretation, and propose a cycle of reductive, inductive and hypothetico-deductive testing that is both rational and creative. The authors argue that the goal of critical reflection and qualitative data analysis is not to produce knowledge that can be justified in terms of 'correspondence' to 'reality'. Instead we propose a pragmatic, coherence view of knowledge that emphasizes the centrality of dialogue with texts, evidence, beliefs and practice. We conclude that evidence and belief are inextricably linked and that combined processes of reductive, inductive and hypothetico-deductive logic need to be used in a transparent manner to establish the credibility of an interpretation. Although there is no clear demarcation between what is found and what is constructed, a commitment to coherence is the basis of a pragmatic theory of knowledge.

Data Interpretation, Statistical↗
PubMed2003

Providing a seamless service for children with life-limiting illness: experiences and recommendations of professional staff at the Diana Princess of Wales Children's Community Service.

The Diana Children's Community Teams (DCCTs), a new nurse-led service funded by the Department of Health, were established to provide care in the community as an alternative to hospital for children with life-threatening/life-limiting illnesses and their families. This paper presents selected findings highlighting the professionals' experiences which formed part of the evaluation of the Diana, Princess of Wales Children's Community Service in Leicester, Leicestershire and Rutland. The Diana Service in Leicestershire attempts to encompass both parental empowerment and interagency collaboration. By working in partnership with the children and their families, the team provides an integrated and multiprofessional community-based service. This paper particularly concentrates on the perceptions and recommendations from the Diana team itself. Three independently managed Community Nursing Services existed in Leicestershire prior to the Diana teams; a Paediatric Macmillan Service, a Children's Community Nursing Service and a Respite Service. The Leicestershire DCCT integrated the three nursing services into a single team. This team has moved away from a traditional uniprofessional service structure by encompassing a wider team of multiprofessionals, including a cultural link worker, an occupational therapist, a physiotherapist, a play specialist and a team of trained counsellors, working in partnership to provide a quality service for families. * The evaluation, which used a longitudinal multimethod process analysis based on an action research framework, suggests that children with complex and life-limiting illnesses and their families benefit greatly from an effective seamless service. This paper recommends a framework of care that may be relevant to other teams of children's community services across the country. This service has been judged by the impact it has had on the families who use it and the professionals employed within it.

Catastrophic Illness↗
PubMed2002

The art of loving and the therapeutic relationship.

Contemporary developments in nursing and health-care, which emphasise evidence-based and outcome-oriented practice often fail to recognise the centrality of the caring relationship in everyday practice. This paper aims to examine the therapeutic role of the nurse within the context of an increasingly technicalized and bureaucratic healthcare system. Focusing on the importance of love and its healing potential, we intend to raise awareness of some difficult and often polemic arguments pertaining to the concept of clinical caritas. We return to the fundamental question: why do people enter nursing? In doing so we explore the concept of caring utilising theoretical and experiential examples to illustrate ways in which healthcare systems can both drain and nurture the practitioners' capacity to care. A framework for developing the art of loving within nursing care is presented, which emphasises the balance between discipline, concentration, patience, concern and activity. We conclude by outlining the boundaries in which genuine love may be expressed within the parameters of a professional role.

Empathy↗
PubMedDate not supplied

Heart of the matter.

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Empathy↗
PubMedDate not supplied

Dear CNO.

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Humans↗
PubMedDate not supplied

Managing practice innovations in prison health care services.

Prison health care is undergoing significant organisational change. This article highlights the potential for practice development in this setting, giving two examples of ongoing developments undertaken as part of a programme of research and development in mental health.

Clinical Competence↗