Foucault's notion of problematization: a methodological discussion of the application of Foucault's later work to nursing research

This study takes its point of departure in an oft‐voiced critique that the French philosopher Michel Foucault gives discourse priority over practice, thereby being deterministic and leaving little space for the individual to act as an agent. Based on an interpretation of the latter part of Foucault's oeuvre, we argue against this critique and provide a methodological discussion of the perception that Foucault's method constitutes, primarily, discourse analysis. We argue that it is possible to overcome this critique of Foucault's work by the application of methodological tools adapted from Foucault's later writings and his diagnosis of his own work as studies of forms of problematization. To shed light on the possibilities that this approach offers to the researcher, we present a reading of aspects of Foucault's work, with a focus on his notion of forms of problematization. Furthermore, we elaborate on concepts from his so‐called genealogical period, namely ‘the dispositive’, strategy and tactics. Our interpretation is supported by examples from a study of the emergence of Danish nursing education, which is based on an analytical framework that we developed in the light of an interpretation of aspects of Foucault's work.     

428篇危重病护理论文分析

目的:分析近年我国危重病护理领域护理研究的现况,存在的问题。方法:手工查阅2000～2005年发表于国内4种护理核心期刊的428篇危重病护理论文,就论文研究内容、研究方法等进行分析。结果:目前国内危重病护理研究论文数量呈逐年增长趋势,以经验性论文为主,占60%;机械通气与气道管理为研究的热点问题;实验性研究论文增长较快;需要在科学性和有效性方面进一步提高。结论:危重病护理研究水平有待进一步提高,应发挥学科优势,促进危重病护理研究的发展。     

The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation

BACKGROUND: Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. However, questions remain about what criteria are most appropriate for evaluating qualitative research. To date, little systematic evaluation of qualitative research in palliative care has been conducted. AIMS: This paper is based on a larger study in which we conducted a critical review of qualitative research in palliative care from nursing, medicine, specialist palliative care, sociology, death studies, medical anthropology, and gerontology journals published between 1990 and 1999. The aim of this paper is to present an account of the strengths and weaknesses of qualitative palliative care research in nursing, using data from this review. METHODS: In the larger study, 138 papers from 50 journals were reviewed critically using a tool developed to assess both content and quality; in one part of this tool reviewers recorded open-ended comments on the strengths and weaknesses of each paper. In this paper, we present a thematic analysis of reviewers' comments on a subgroup of 67 nursing papers from the main review, together with an analysis of comments on 29 papers from a comparison group of death studies, medical anthropology, and sociology journals. Patterns of positive and negative evaluation are identified and used to generate an account of strengths and weaknesses in qualitative palliative care research in nursing. FINDINGS: Over 40% of the subgroup of papers from nursing journals received positive comments on topic and quality of writing; around 30% received positive comments on contribution to understanding, practical value, and conceptual or theoretical issues. Less than 20% received positive comments on other critical dimensions. Over 40% of nursing papers received negative comments on the link between data, analysis, and findings, other aspects of method and theoretical and conceptual issues. A higher proportion of papers in the comparison group received positive comments on conceptual and theoretical issues and contribution to understanding. CONCLUSIONS: Nearly half the nursing papers reviewed were judged to be well written or to have a well-chosen topic. However, more than 40% of papers drew negative comments about key methods-related issues. Arguably therefore efforts to improve the quality of research evidence should focus on this area.     

Inconsistent use of the critical incident technique in nursing research

Title. Inconsistent use of the critical incident technique in nursing research. Aim. This paper is a critique of the use of critical incident technique in nursing and a demonstration of how its development has resulted in inconsistency and confusion. Background. Critical incident technique is used globally by nurse researchers to explore a plethora of nursing issues. Its main strengths are flexibility and adaptability, but its popularity has resulted in ambiguity and confusion. Data sources. A search of the CINAHL database for the period 1956–2007 was performed using the search terms critical incident technique and nursing. Together with hand searching, this produced a total of 59 papers. The papers were analysed according to country of origin, research topic, sample size, data collection method, inclusion/exclusion criteria, data analysis and terminology. We then categorized the results of this analysis depending on similarities and differences in the papers. Discussion. We focus on two areas: methodology and terminology. From a methodological perspective critical incident technique has become inconsistent and in relation to terminology, the diverse language associated with the technique has created confusion. Moreover, issues of rigour may be compromised as a result of this inconsistency. A great deal of inconsistency has been created by nurse researchers’ attempts to advance critical incident technique. This has led to confusion, which is not helpful for advancing nursing knowledge. Conclusion. While embracing the continued development of critical incident technique, we advocate a standardized approach to its use. Unless nurse researchers are alert to the methodological and terminological inconsistencies in use of the critical incident technique, it risks becoming an interminable quagmire through which navigation will be impossible.     

Evaluation of qualitative research

It is necessary to subject published research to critical scrutiny, in order to evaluate the robustness of the findings. The criteria used in evaluation require to be appropriate for the research paradigm, i.e. quantitative or qualitative. Quantitative conceptualizations of reliability and validity are unsuitable for evaluation of qualitative research as they were not devised for this purpose. The use of quantitative criteria to evaluate qualitative research may create the impression that the latter is not academically rigorous. Evaluation criteria which are specific to qualitative research require identification and application, in order to provide a formalized and rigorous approach to critical appraisal. A formalized framework for evaluation will help to ensure that the contribution of qualitative studies, with specific reference to health services research, receives optimum recognition. The work of a number of writers is used in this paper to examine the features which distinguish qualitative research and the following are discussed: the need for researcher reflexivity; the use of the 'first person' in academic work; the context in which research takes place; the selection of research participants; the interpretation of participants' accounts; the active acknowledgement of 'lay' knowledge; researcher flexibility within the research process; the generalizability of findings. It is concluded that academically rigorous criteria, which are appropriate for evaluation of qualitative research, exist and are available for use by practitioners and researchers.     

Recognition and management of critical illness by midwives: implications for service provision

AIM: The aim of this study was to explore midwives' recognition and management of critical illness in obstetric women in order to inform service provision. BACKGROUND: Critical illness is not confined to Intensive Care. Limited published work was located examining factors affecting critical care provision by midwives. METHODS: A multi-method design incorporating a paper and pencil simulation (n = 11) and in-depth interviewing (n = 5) was conducted with midwives from a large London National Health Service Trust. This study details and discusses the findings. RESULTS: Findings indicated that frequency and type of critical illness experience impact upon midwives' critical care knowledge and skills. Midwives, especially those who were more junior, expressed anxiety regarding this aspect of practice, and considered the support of senior midwives, medical and nursing staff as crucial to effective client management. CONCLUSION: This study has yielded important insights into midwives' management of critical illness. Possible mechanisms to enhance the quality of service provision, and midwife support in this area are highlighted.     

The qual-CAT: Applying a rapid review approach to qualitative research to support clinical decision-making in speech-language pathology practice

Abstract

Systematic reviews and meta-syntheses of qualitative research produce “a sum greater than its parts”. Qualitative findings are examined alongside one another, and new insights are discovered about the topic under consideration. However, a barrier to clinicians undertaking these reviews is the time and knowledge required. Rapid review approaches, such as the Critically Appraised Topic (CAT), have recently been promoted in speech-language pathology, encouraging strategic, clinically driven examination of key research in focused topic areas, with the aim of supporting clinical decision-making. A strength of the CAT approach is that it supports interpretation and use of evidence by people who are not experts in the methodologies used. Additionally, CATs reduce the time input required by focusing on the best evidence available, and take a pragmatic approach to analysis across studies. While CAT methodologies have been detailed in relation to quantitative research, qualitative CAT methodologies have not specifically been discussed. Searching, ranking of research strength, appraisal and analysis methods are all likely to vary for qualitative CATs. This paper proposes and details a methodology for a “qual-CAT” approach, providing examples and steps that support the use of this methodology in practice.     

Establishing a new falls clinic – conflicting attitudes and inter-sectoral competition affecting the outcome

Falls clinics are a newer model for falls management among the elderly. Few studies have addressed the impact of the strategy on falls prevention in the healthcare system. The aim of the present study was to describe the social processes that affect the implementation of new strategies in falls management. A newly established falls clinic was chosen as an instrumental case to describe the systematic and comprehensive approach to falls prevention among the elderly. The investigation had a qualitative case study research design with triangulation of sources and methods, including interviews, participant observation and analysis of documents. The study was conducted from January 2006 to June 2007 at a newly established falls clinic at a Danish hospital. Data were analysed qualitatively according to four main themes: The concept of falls, success/failure, competition and expertise. The study showed that the falls clinic was embedded in a context where interests varied at different levels of the organizational hierarchy. In contrast to the political agenda for falls prevention, patients and professionals did not associate falls with chronological age. The biomedical structure of the falls clinic and the hegemonic mode of handling falls prevention may have facilitated falls prevention services and patient trajectories across sectors, but if falls are associated with chronic disease secondary to an unhealthy lifestyle, the individual patient becomes responsible for the falls problem. This may subsequently prevent the patients from seeking timely help from the healthcare system, or patients may drop out of the existing programmes. Future research needs to look at sustainability and dropping out in relation to falls prevention programmes.     

综合性教学医院临床护士评判性思维的现状及其影响因素

目的探讨综合性教学医院临床护士评判性思维的现状及其影响因素,为提高护理人员评判性思维能力提供依据。方法采用分层随机抽样方法对619名临床护理人员评判性思维现状进行调查,并分析其可能的影响因素。结果临床护士评判性思维的平均得分为(275.84±29.06)分,其中认知成熟度、开放思想和寻找真相三个维度的得分为正性评判性思维。不同年龄、护龄、学历及临床科室间护士的得分差异有统计学意义(P<0.01、P<0.05),而不同职称护士的得分差异无统计学意义(P>0.05)。结论临床护士评判性思维的平均得分属于中等偏下水平,护理管理者必须加强临床护士评判性思维能力的培养。建议临床相关教育部门在临床继续教育中强化护士评判性思维的教育活动,并为护理人员创造有利于评判性思维发展的工作环境,以有效提高临床护士的评判性思维能力。     

Critical social theory as a grounded process

This article reflects upon the research process that uses critical social science as its basis. Some of the common criticisms of critical social science research are rebutted by following the research trail taken by the authors when undertaking their own projects. The similarities and differences of critical social science and the interpretative methodologies are outlined in the selection of study area, the relationship of the researcher and participants, ethical issues, and data collection and analysis. The writers conclude that critical social science research reports that are correctly carried out should be firmly grounded in each of these stages, thereby providing a foundation for nursing and midwifery practice.     

本科护生有效学习经历的质性研究

目的：探讨本科护生有效学习的特征,为护理专业课程教学改革提供参考依据。方法：采用现象学研究方法,运用特定事件回顾法收集资料,通过类属分析法进行归纳,析取出本科护生有效学习的特征。结果：本科护生有效学习的三大主题为教师的特征（教师个人品质、教学监控能力、活跃的互动方式）、教学过程的特点（多媒体教学、情景模拟、应用新知识、有效的反馈、同伴学习）和学习环境（人文环境和物化环境）。结论：护理教育者应根据学生有效学习事件的调查结果对护理专业课程进行探索性改革,转变教学观念、提升教师素质,激励学生有效学习。     

The Surviving Sepsis Campaign: raising awareness to reduce mortality

Although it has never been prospectively validated, the base excess (BE) is regarded as the standard end-point of resuscitation in trauma patients. In a rat hemorrhage model, in this edition of Critical Care, Totapally and colleagues demonstrate that the BE is an insensitive and slowly responsive indicator of changes in intravascular volume. This contrasts with changes in the esophageal-arterial carbon dioxide gap which more closely followed changes in blood volume. Esophageal or sublingual capnometry may prove to be a useful tool for monitoring the adequacy of resuscitation in trauma victims.     

Critical appraisal of rigour in interpretive phenomenological nursing research

AIM: This paper reports a critical review of published nursing research for expressions of rigour in interpretive phenomenology, and a new framework of rigour specific to this methodology is proposed. BACKGROUND: The rigour of interpretive phenomenology is an important nursing research methods issue that has direct implications for the legitimacy of nursing science. The use of a generic set of qualitative criteria of rigour for interpretive phenomenological studies is problematic because it is philosophically inconsistent with the methodology and creates obstacles to full expression of rigour in such studies. METHODS: A critical review was conducted of the published theoretical interpretive phenomenological nursing literature from 1994 to 2004 and the expressions of rigour in this literature identified. We used three sources to inform the derivation of a proposed framework of expressions of rigour for interpretive phenomenology: the phenomenological scholar van Manen, the theoretical interpretive phenomenological nursing literature, and Madison's criteria of rigour for hermeneutic phenomenology. FINDINGS: The nursing literature reveals a broad range of criteria for judging the rigour of interpretive phenomenological research. The proposed framework for evaluating rigour in this kind of research contains the following five expressions: balanced integration, openness, concreteness, resonance, and actualization. Balanced integration refers to the intertwining of philosophical concepts in the study methods and findings and a balance between the voices of study participants and the philosophical explanation. Openness is related to a systematic, explicit process of accounting for the multiple decisions made throughout the study process. Concreteness relates to usefulness for practice of study findings. Resonance encompasses the experiential or felt effect of reading study findings upon the reader. Finally, actualization refers to the future realization of the resonance of study findings. CONCLUSION: Adoption of this or similar frameworks of expressions of rigour could help to preserve the integrity and legitimacy of interpretive phenomenological nursing research.     

From individual to group: use of narratives in a participatory research process

From individual to group: use of narratives in a participatory research process Aims. This paper provides a theoretical understanding of narrative research and its use in research. It aims to expose the ways narrative research, when taken beyond the researcher’s lone analysis of text, can contribute to the development of clinical knowledge. Background. Methodological approaches involving the construction of narratives are increasingly apparent in the nursing and allied health literature. Narratives, constructed from stories of nursing practice, become texts available for analysis. This is undertaken predominantly by a researcher engaged in a lone activity with little involvement of those contributing the stories. Methods. This paper is drawn from a critical praxis study of nurse–patient friendship utilizing participatory research processes. The nurses involved in the study were co‐researchers in an indepth study of their relationships with patients. Findings. The paper traces the movement from naïve story, through individual narratives during interviews with each nursing and demonstrates the changes in understanding about the narrative accounts that occurred during the participatory group process. Conclusion. The nurses involved in this study were able, through the use of narrative stories reexamined in a group context, to develop new insights and understandings about their practice. Knowledge generated in these ways remains grounded in the real life world of clinical nursing and gives voice to the complexity of those aspects of nursing practice that are taken for granted.