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Sioban Nelson

Publications and source records attributed to Sioban Nelson.

17 recordsLinked to original sources
PubMed2006

Issues in weaning from mechanical ventilation: literature review.

AIM: The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation. BACKGROUND: Mechanical ventilation is an essential life-saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process. METHOD: In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision-making and weaning readiness were used separately and combinations. DISCUSSION: Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision-making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level. CONCLUSION: Further research is required that better quantifies critical care nurses' role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.

Australasia↗
PubMed2005

An end to angels.

Explore the source record for details and available documents.

Advertising↗
PubMed2005

Interfacing clinical practice and error prevention.

Medication error is a major source of preventable harm to patients in hospitals and is an area in which, it is suggested, information technology will have a positive impact. This paper presents findings from part of a study that examined current information utilisation patterns during nursing medication rounds. Nursing working patterns in medication administration are poorly understood despite being one of the most likely sources of medication error. Methods used were drawn from principles of Human Computer Interaction (HCI), using a semi-structured observational tool for analysing system requirements and data elements. Results from this study indicated that clinical and contextual factors impact on nursing patterns of information handling in many ways, including documentation quality, location of information sources and current patterns of computer utilization. Numerous extraneous interruptions also impact on the ability of nurses to assimilate and use clinical information effectively. These results were used to develop a conceptual framework for interfacing error prevention in clinical practice. These insights into the human factors that are the reality of clinical practice allow us to design and develop effective information technology systems to help prevent nursing medication administration errors.

Humans↗
PubMed2004

Expertise or performance? Questioning the rhetoric of contemporary narrative use in nursing.

BACKGROUND: In the early 1980s there emerged in nursing a self-conscious and well-articulated concern to articulate nursing's contribution to patient care. This has fostered the production of a large volume of practice narratives that today form the basis of professional self-understanding. First-person practice narratives are now widely used as the evidence base for nursing expertise, not only in their natural home, the world of interpretative research, but also in the bureaucratic-judicial domain of professional regulation, health care organizations, trades unions and professional associations. AIM: The aim of this paper is to question the use of individual narrative accounts of nursing practice as evidence of nursing expertise. METHOD: We examine the model, method, and continuing consequences of these discursive formations of practice. First, we present a methodological discussion of how personal narratives are produced by the interplay between discourse and subjectivity. Second, we explore clinical narratives of expertise in the work of Patricia Benner and others to uncover the common template for contemporary narrative. DISCUSSION: Narrative production in nursing has led to particular constructions, rather than free representations of practice. It is these particular constructions that we call into question. Rather than viewing these narratives as revelatory of nursing practice, we argue that they place a 'spotlight' on the individual actor - the nurse - with an absence of structural practice context. CONCLUSION: We make the case that treatment of these narratives as individual evidence of expertise fundamentally misunderstands their function and purpose, and reduces the constitution of nursing expertise to the performance of a palatable and highly desirable discourse for a nursing audience.

Clinical Competence↗
PubMed2004

Mandatory reflection: the Canadian reconstitution of the competent nurse.

Over the past two decades, the competency movement has been gathering momentum internationally within the ranks of professional nursing. It can be argued that this momentum is in response to government initiatives aimed at improving consistency in workforce training and accreditation, and fostering national and international portability of qualifications. At the same time, the competency movement has provided the opportunity for regulators, service providers and government to develop mechanisms to reconstitute competent nurses as accountable, self-regulating subjects and to monitor this transformation in particular ways. The ways in which competencies have been taken up to do this transforming work in Canada are unique and deserving of some detailed description and analysis. We argue that Canadian nursing regulatory authorities have chosen to view competence as the rehearsal of ethical attributes consonant with the professional role, as opposed to the enactment of skilled conduct. As a result, reflective practices rather than skill and knowledge have become the cornerstone of nursing competency formulation and review. We argue that this distinctly Canadian approach to competency serves three ends. First, it privileges the "attribute" element of the nursing competency model and side steps the ever-problematic "nursing knowledge" issue; second, self-surveillance by nurses shifts the onus for professional development from industry to the individual; and third, it concedes responsibility for skill assessment by the regulatory authorities to industry control, leaving employers free to determine skill base and skill mix requirements for practice. Finally, we argue that the reflective component of the regulatory framework for Canadian nurses radically fails as a tool for auditing quality and assessing competency. Rather, it functions as a governmental practice that furthers the deregulatory and economic rationalist aims of the Canadian health reform agenda.

Attitude of Health Personnel↗
PubMed2004

The search for the good in nursing? The burden of ethical expertise.

This paper examines the increasing trend by nursing scholars such as Patricia Benner to conceptualize ethics as a contextual and embodied 'way of knowing', embedded in nursing expertise. The intellectual origins of this development and its debt to neo-Aristotelian thinkers such as philosopher Charles Taylor are discussed. It will be argued that rather than revealing a truth about ethical expertise, the emergence of the 'expert' nurse as a moral and ethical category is the result of the elaboration of neo-Thomist discourses in the educational and professional shaping of nurses. These discourses act on and are enacted by the individual nurse through his or her participation in specific ethical exercises that result in the constitution of the desired subjectivity - or 'expertise'. Central to this shaping are particular notions of 'the good' and its relationship to knowledge, skill and practice. Critiques of these neo-Aristotelian perspectives are discussed and applied to the notion of moral expertise in nursing, and the claims made by its proponents concerning the 'ethical' distinction between experienced and expert nurses. Finally, a call is made for a more pluralistic approach to ethics.

Ethics, Nursing↗
PubMed2002

Core research teams: A strategy to research critically ill pregnant and postnatal women.

There has been little research conducted on critically ill pregnant and postnatal women. When developing a research protocol to conduct a prospective multi-centre survey on this study population, we found there were vital concerns that needed addressing prior to the research proceeding. Prompt identification of the study population and valid, reliable data collection were two aspects that needed particular attention with study recruitment potentially occurring in a total of eleven clinical areas from seven hospitals. In this paper we outline the particular issues faced by us when conducting multi-centre research on a study population that occurs infrequently and unpredictably, and when there is a necessary urgency to identify eligible study participants. The key strategy to overcome these difficulties, was the creation of 'Core Research Teams' in each clinical area. Our experience of using Core Research Teams in our pilot study is described in this paper. We found that the Core Research Team model is a very positive strategy to overcome the methodological challenges when operating a multi-centre study.

Critical Illness↗
PubMedDate not supplied

The rhetoric of rupture: nursing as a practice with a history?

In this paper we argue that nursing is consistently presented as a practice without a history, constantly reinventing itself within new professional and technical realms. This rupture with and repudiation of a past deemed to be pejorative, coupled with a rebirth in a "preferred present," raises recurrent problems in the construction of nursing's contemporary professional identity and search for social legitimacy. Furthermore, constituting new nursing knowledge and practice as discontinuous with the past produces a sense of historical dislocation of that nursing knowledge and practice that, in turn, reproduces the need for relocation through reinvention. This phenomenon, which we term the "rhetoric of rupture," in our view, arises from nursing's frustrated attempts to gain social status and legitimacy. Paradoxically, this constant reinvention in fact hampers nurses' attempts to gain that status and legitimacy.

Australia↗
PubMedDate not supplied

Our heels are praying very hard all day.

In this article, prayer is represented not as a single or individual action, but as an entirely integrated part of nursing work. Case examples from American, Irish, and Australian Catholic women's religious congregations who nursed in hospitals in the 19th century are used to analyze the significance of prayer to Catholic sisters' nursing. The issue highlighted in this historical examination of prayer is the power of the sickroom (particularly the deathbed scene) in the battle for souls. Sisters' prayers functioned as invitations to religious experiences and means for patients to meet God. Although based on an ancient religion that embraced medieval notions of penance and Counter-Reformation evangelism through good works, sisters' practices, in the turmoil of 19th-century immigration and social upheaval, contributed greatly to the production of the modern hospital and the modern nurse.

Catholicism↗
PubMedDate not supplied

Science: nursing's big secret.

Nursing knowledge and skill are vitally important to the healthcare system, and nurses must dare to say so.

Attitude of Health Personnel↗