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Posts tagged ‘Complexity’

Caring as Emancipatory Nursing Praxis

The new featured article in the current ANS issue challenges readers to examine values and believes that form a foundation for nursing as caring within complex technical and economically driven systems. The article, titled “Caring as Emancipatory Nursing Praxis: The Theory of Relational Caring Complexity,” is authored by Marilyn A. Ray, PhD, RN, CTN-A, FAAN and Marian C. Turkel, PhD, RN, NEA-BC, FAAN.  They have each provided interesting background about their work, and insight in to how their ideas have emerged:

From Dr. Ray:

My journey focusing on the study of human caring in complex hospital cultures began in 1969 as an MSN student in nursing and anthropology where I conducted an ethnography of a hospital. My interest in the study of nursing as a “small” culture and health care/hospital organizations as “small” cultures led to seeking a Master of Arts in Cultural Anthropology, and a PhD in

Dr. Marilyn Ray

Dr. Marilyn Ray

Transcultural Nursing where, within my dissertation, grounded theories of nursing as transcultural caring were discovered. The substantive theory of Differential Caring unfolded showing how the dominant environmental context of different hospital units influenced the meaning of caring, such as, the interrelationship between technology and caring in an Intensive Care Unit, economics and caring in Administration, and spiritual-ethical caring in the Oncology Unit. Analysis and insight led to the discovery of the formal theory of Bureaucratic Caring (rendering the paradox of human caring in complex organizations which continues today). Subsequent research on the technology and economics of caring, exposure to Rogerian unitary science and the emerging field of complexity science/s through teaching philosophical inquiry, caring science, qualitative research methods, and conducting research with the late Dr. Alice Davidson continued to open my mind to the significance of human-environment integrality. Over the past 20 years accomplishing funded research with Dr. Marian Turkel on economic caring within many public, military, and private complex healthcare systems exposed more of how the contextual dimensions of economics, political, legal and technological phenomena enlightened our understanding of contemporary practice, and how the research illuminated the discovery of the Theory of Relational Caring Complexity. This theory deepened our commitment to seeking understanding of human rights, social justice and social caring ethics as emancipatory praxis in complex systems and prompted us to share this content.

As a doctoral student of Dr. Madeleine Leininger, my classmates and I received the gift of exploring “caring as the essence of nursing.” As a former faculty member of the University of Colorado College of Nursing (and now as a Professor Emeritus at Florida Atlantic University), I have had the opportunity of sharing ideas of and learning about, and researching caring science, ethics, unitary science, complexity sciences, and the feminist ideal of peace power with Drs. Jean Watson, Sally Gadow, Marlaine Smith, Peggy Chinn, the late Alice Davidson, and many other professionals. This knowledge has directed and continues to direct the discipline of nursing. At the same time, as an officer in the United States Air Force Reserve, Nurse Corps, I was aware of how these ideals needed to be embedded in local and global cultures, including not only the military, but also, the Transcultural Nursing Society, World Health Organization and United Nations. I am a charter member of the International Association for Human Caring and have been committed to co-creating awareness of caring science and art, respect for human dignity, cooperation, and reasoned dialogue to lay the foundation for a sustained commitment to human rights and social justice. These actions hopefully will lead to peaceful coexistence among all people and a world without war. Nurses have the obligation to be examples of human caring–to seek ethical caring knowledge, promote moral mindfulness, give voice to the voiceless, cultivate humanity, understand transcultural nursing and social/cultural contexts, and exercise ethical judgment and evaluation to facilitate the creation of peaceful communities of caring worldwide.

From Dr. Turkel:

Like my co-author and colleague, I am committed to the advancement of the scholarship of caring science and complexity science. My professional career trajectory is grounded in the philosophical tenets of caring being essential to the disciplinary foundation of nursing and the theoretical concepts of caring and complexity serving as a framework for professional nursing

Dr. Marian Turkel

Dr. Marian Turkel

practice. My journey into caring as a substantive area of study within the discipline unfolded when I entered graduate school at Florida Atlantic University (FAU) in 1989. It was a wonderful time to be at the university as our Dean, Dr. Anne Boykin was integrating caring into the curriculum and Dr. Leininger and Dr. Watson came to university sponsored conferences. I became very involved with the International Association for Human Caring (IAHC) and met Dr. Ray who was our eminent scholar. My favorite story is that I knew she was important, not sure what an eminent scholar was, and did not know if I was allowed to talk with her. She taught nursing leadership and we formed an instant personal and professional relationship as we had shared values related to caring in complex systems. As a nurse leader, I was always challenged by the paradox between caring and economics within complex systems and the social injustice that registered nurses often face in the real world of hospital nursing practice. My master’s thesis was A Journey into Caring as Experienced by Nurse Managers. Managers shared their frustration of trying to care when economics ruled decision making. My doctoral dissertation, Struggling to Find a Balance examined the paradox between caring and economics from the perspective of patients, nurses, and administrators.I was on faculty at Florida Atlantic University and the sentinel qualitative and quantitative research that Dr. Ray and I completed validated that caring was explicitly linked to improved patient and nurse outcomes and hospital system economic outcomes.

My life journey took a turn and my husband and I relocated to Chicago and then Philadelphia. I made an intentional decision to return to practice and began my journey into “praxis” (informed practice). I went back into the hospital setting but with a new lens, using research, evidence-based practice and caring theory to inform and transform practice. I continued my involvement with the IAHC, re-connected with Dr. Watson and became involved with the Watson Caring Science Institute (WCSI). As faculty within WCSI, I work with hospitals to create caring healing environments for employees, patients, and families by integrating caring theory into the practice setting. My scholarship is now focusing on leadership framed in caring science where intention setting, caring , love, peace, and values ground the practice of leadership. I just ended my IAHC Presidency May 2014 with a conference in Kyoto, Japan sponsored by IAHC and Kobe University. The conference theme was the Universality of Caring with over 781 Registered nurses from 20 countries and regions in attendance. On a personal note, I am moving back to Florida in July and returning to Holy Cross Hospital where I used to work and met my husband. My vision is to co- create a very innovative Service-Academic Partnership with Florida Atlantic University College of Nursing. In caring and peace, Marian

Visit the ANS web site to see this wonderful article – you can download it at no cost while it is featured!  Then return here to share your comments and ideas!

Improving transition outcomes

Carol Geary and Karen Schumacher explain some of the most vexing issues in nursing care – effective transitions for patients who move from one care setting to another.  The evidence points to major issues in health care that add up to astounding costs – readmissions for Medicare patients alone add up to billions of dollars.  Geary and Schumacher address this issue theoretically by proposing an integration of transitions theory and complexity science.  Their work provides a new and expanded perspective that can improve outcomes for people who are transitioning from hospital to home.
Carol Geary shares this message about her work:
My research addresses care transitions from hospital to skilled nursing facilities among aging patients with advanced chronic disease. I am specifically interested in the multiple perspectives of patients, informal caregivers, and health care providers as described within this paper and suggested by viewing the phenomenon through a complexity lens.
Professionally, as an administratively focused nurse functioning both within and as a consultant to hospitals, the dynamic of care “across the continuum” intrigued me. When Dr. Sheila Ryan introduced me to complexity science in an informational interview for the PhD program in nursing at UNMC, my initial response was: “THIS changes everything.”  After two years of study, I remain fascinated by the challenge of viewing the world through this new lens.
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