Articles in Careful Nursing News
Negotiations were completed in 2015 for the sale of St. Clare's Health System, one of the largest healthcare systems in New Jersey, to the company Prime Healthcare. As of June 2016, as part of the changeover process, publication of Careful Nursing News has been placed on hold.
An exploration of the nature of the human person as a unitary being guided by the neo-Aristotelian metaphysical philosophy of Thomas Aquinas. This philosophy is considered fundamental to understanding the nature of the nurse-patient relationship as a central component of nursing practice. Practice examples of differing nurse-patient relationships are given to illustrate the importance of nurses being aware of themselves and patients as unitary beings.
In Careful Nursing the source of the spiritual dimension of human life is thought of as Infinite Transcendent Reality. While Careful Nursing has a particular approach to understanding spiritual life, it is recognised that nurses have a range of different understanding of spirituality and what it means for practice. The meaning of Infinite Transcendent Reality, its historical relationship to nursing, and non-theist views of spirituality are addressed.
The philosophy of Aristotle and of Thomas Aquinas are used to explore Infinite Transcendent Reality as the source of human spirituality. Aquinas's philosophy of the human person and human spirituality and its implications for clinical practice are discussed. Suggestions made for exploring the role of spirituality in nursing practice. The importance for nurses of deepening their awareness of their inward life is emphasised.
The source and development of the Careful Nursing definition of health as human flourishing is explained. The virtue theories of Aristotle and Aquinas are explored. While they include the common understanding of health as freedom in mind and body from illness and injury and having our basic social needs met, they are shown to reach well beyond this to include how we live our lives as unitary human persons and seek to fulfil our purpose in life.
How health as human flourishing is understood in psychology and in nursing generally is outlined. The initial Careful Nursing definition of health as human flourishing is reviewed. It is shown to require revision to include Aquinas's neo-Aristotelian philosophical understanding of human flourishing. Drawing on virtue theory understandings of human flourishing, discussed in Part I, practice implications for nurses and patients are suggested.
An overview and explanation of developments and revisions of the philosophy and practice model which have evolved through discussion and implementation in practice. The term, philosophical assumptions, is changed to philosophical principles and names of two principles are specified more clearly. In the professional practice model, the terms concepts and dimensions are switched. There are now four dimensions and twenty concepts. One concept is revised and one concept added.
Moving from the Careful Nursing philosophy to the professional practice model, the therapeutic milieu dimension of the model is described. The six concepts of the therapeutic milieu are identified and their relative importance is considered. The first concept, caritas, is defined and its fields of meaning described. It can also be thought of as a professional practice value. The importance to caritas of nurses spending at least five minutes in 'quiet time' each day is emphasised.
The therapeutic milieu concept of inherent human dignity is explored. The difference between unconditional inherent dignity and conditional inherent dignity is addressed. Varieties of dignity, particularly dignities of identity, are examined. The implications of different aspects of human dignity for professional practice are discussed, both for recipients of nursing care and for nurses themselves. Arguments opposing the inherent human dignity of human persons are summarised.
The importance of nurses caring for themselves and one another is considered central to creation of a therapeutic milieu. Human nature itself is considered to explain why all nurses have the potential to not care for themselves and engage in disruptive relational behaviour. The practice of friendship as a virtue, according to the virtue theories of Aristotle and Aquinas, is proposed as a way nurses can enhance care for themselves and one another. Speculative suggestions are given.
A discussion of the range of ways in which intellectual engagement informs nursing practice and knowledge development. The rationale for using the philosophy of Aquinas is discussed and illustrated, using an example of argument by disputation. Intellectual engagement in the nurse-patient relationships is explored. The idea of intellectual engagement as personal transformation, as suggested by the phenomenological philosopher Edith Stein, is also explored using an illustration.
Contagious calmness, often nurses' favourite Careful Nursing concept, and its vital importance in nursing practice is discussed. The origin of the meaning of the word calm; stillness needed to cope with the heat of Mediterranean midday sun; is used as an analogy to describe how a sense of stillness/calmness is often needed to cope with the 'heat' of practice settings. The importance for nurses of the practice of stillness each day is emphasised and illustrated.
The importance of the physical state of the immediate environment of a sick, injured or vulnerable person is emphasised, especially in relation to persons' safety and to fostering their healing. While Nightingale focused on these concerns, particularly in her 1860 Notes on Nursing, it is observed that they were being addressed by lay nurses in a Dublin hospital as early as 1817. Examples are given for contemporary practice, with a concern noted for elderly persons.
The Careful Nursing dimension of practice competence and excellence is introduced. The relationship between competence and excellence is discussed. Great tenderness in all things is the first of the dimension's eight concepts. Tenderness is discussed and noted to have been long associated particularly with nursing. But today it appears only rarely in nursing literature. Tenderness research is found only in psychology. Is the idea of tenderness appropriate for contemporary nursing?
The origin of the idea of 'perfect' skill In Careful Nursing is described. Contemporary understandings of perfection are identified and hotly contested arguments for and against aiming for perfection in nursing practice are considered. It is noted that excellence is often considered a more appropriate aim than 'perfect' skill and that nurses can consider which is appropriate them. Examples are given to illustrate the significance of aiming for perfection in art.
Watching-Assessment-Recognition is introduced as a single concept with three qualities. It is illustrated as the first of a sub-group of practice competence and excellence concepts considered to be a 'critical circle of clinical responsibility', vitally concerned with patient safety. Each of the three qualities of the concept is discussed. The conceptual fit of the critical circle of clinical responsibility concepts with the structure of Careful Nursing as a whole is also discussed.
Clinical reasoning and decision-making is shown to follow in a wholly interrelated way from watching-assessment-recognition, and to follow from the therapeutic milieu concept of intellectual engagement. Reasoning is considered broadly, from both a scientific and a holistic philosophical perspective, and implications for clinical reasoning and decision-making are discussed. The related, vitally important, nursing responsibility of monitoring patients for collaborative problems is also discussed.