Journal of advanced nursing
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Review
Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm).
Normal saline instillation, in conjunction with endotracheal suctioning, is purported to be beneficial in removing thick and tenacious secretions for patients receiving mechanical ventilation. Guidelines for this routine procedure are inconsistent and its efficacy is unsupported by research-based evidence. This discussion paper highlights that the procedure produces no physiological benefits for the patient and, indeed, may have detrimental effects on the patient's psychological wellbeing. It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on techniques to prevent thick and tenacious secretions.
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As a practice-orientated profession, nursing is clearly guided by theoretical concepts. Concept clarification attempts to show speakers and readers how they can liberate themselves from the judgement limitations imposed by rigid, unexamined beliefs, by exposing differences in the interpretation of language and how that interpretation creates meaning. Critical thinking is one way nurses apply the process of inquiry. ⋯ The purpose of this analysis is to illuminate the meaning and clarify the intent of critical thinking application to nursing practice. The paper begins by briefly outlining the historical aspects of critical social theory, suggesting that the foundational tenets of critical theory have influenced the development of critical thinking. The paper also critically compares the language used to describe critical thinking and that language that has traditionally defined nursing.
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Carper's patterns of knowing expose the relevance and importance of different knowledge to the enterprise of nursing. She noted that the aesthetic pattern enables nurses to know unique perceptive experiences. Poetry captures particular perceptive experiences and reconstructs them into universal wholes. ⋯ A poem, written to express one author's unique nursing experience, is used to explore the knowledge gained through the process of writing poetry. Writing poetry can help nurses connect with and maintain their personal and professional history. Moreover, writing poetry increases our awareness of the sensibilities of nursing practice and the meanings that these sensibilities add to the depth and design of the discipline.
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The concept of the lecturer practitioner arose in one health authority in Britain in the late 1980s. Since its inception there, the concept has been widely adopted across the country suggesting that there is a perceived need for this role. ⋯ Through a review of all the available literature on this concept, the attributes, antecedents and consequences are identified and their implications discussed. Rodgers' evolutionary method is described and critiqued throughout the paper and is shown to be a suitable method for clarifying a complex concept.
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Cultural safety is a concept which has been developed by Maori nurses in New Zealand in order to reflect on nursing practice from their point of view as the indigenous minority in our country. The paper contrasts this new concept critically with Leininger's well-known model of transcultural nursing in order to suggest its potential significance. ⋯ The paper concludes that until the effects on the health care system of inequalities in power between groups in society are addressed we cannot ensure that the needs of persons from minority cultures will be met. Because it illuminates this dimension of nursing care, cultural safety is a concept of general significance for all nurses.