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  • 1. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing.
    Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting2017In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 18, no 3, article id e12142Article in journal (Refereed)
    Abstract [en]

    Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the acute care space' as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person-centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person-centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of person-centred space' helps to crystallize the relationship between space and person-centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them.

  • 2. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Austin Health, Northern Health Clinical Schools of Nursing, La Trobe University, Heidelberg, VIC, Australia ; College of Science, Health and Engineering, La Trobe University, Heidelberg, VIC, Australia.
    Reconciling conceptualisations of the body and person-centred care of the older person with cognitive impairment in the acute care setting2017In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 18, no 4, article id e12160Article in journal (Refereed)
    Abstract [en]

    In this article, we sought reconciliation between the "body-as-representation" and the "body-as-experience," that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary "technologies" and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter-bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the "body-as-representation" with the "body-as-experience" to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person-centred care which evokes nurses to respond appropriately to the older person's "otherness," their "variation of being" while enabling them to enact a continuation of themselves and their own version of normality.

  • 3. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. College of Science, Health and Engineering, Austin Clinical School of Nursing, La Trobe University, Heidelberg, Vic., Australia.
    Reconciling conceptualizations of ethical conduct and person-centred care of older people with cognitive impairment in acute care settings2018In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 19, no 2, article id e12190Article in journal (Refereed)
    Abstract [en]

    Key commentators on person-centred care have described it as a new ethic of care which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person-centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person-centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to comply more often with prevailing norms than those championed by person-centred care. We draw on elements of work by moral philosopher LOgstrup and Foucault to provide insight into nurses' ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhesia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person-centred care. We argue that nurses' responses to the ethical demand by way of parrhesia can be an important feature of intra-organizational reflexivity and its transformation towards the delivery care that is more person-centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research.

  • 4. Rushton, Carole
    et al.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Austin Health, Northern Health Clinical Schools of Nursing, College of Science, Health and Engineering, La Trobe University, Heidelberg, Victoria, Australia.
    Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings2018In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 19, no 2, article id e12169Article in journal (Refereed)
    Abstract [en]

    Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence.

  • 5. Rushton, Carole
    et al.
    Nilsson, Anita
    Umeå University, Faculty of Medicine, Department of Nursing. Latrobe University/Austin Health/Northern Health Clinical Schools of Nursing, Victoria, Australia.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. Latrobe University/Austin Health/Northern Health Clinical Schools of Nursing, Victoria, Australia.
    Reconciling concepts of time and person-centred care of the older person with cognitive impairment in the acute care setting2016In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 17, no 4, p. 282-289Article in journal (Refereed)
    Abstract [en]

    The aim of this analysis was to examine the concept of time to rejuvenate and extend existing narratives of time within the nursing literature. In particular, we hope to promote a new trajectory in nursing research and practice which focuses on time and person-centred care, specifically of older people with cognitive impairment hospitalized in the acute care setting. We consider the explanatory power of concepts such as clock time, process time, fast care, slow care and time debt for elucidating the relationship between 'good care' and 'time use'. We conclude by offering two additional concepts of time, plurotemporality and person-centred time (PCT) which we propose will help advance of nursing knowledge and practice. Nurse clinicians and researchers can use these alternative concepts of time to explore and describe different temporal structures that honour the patient's values and preferences using experiential, observation-based nursing research approaches.

  • 6. Öresland, Stina
    et al.
    Lutzen, Kim
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rasmussen, Birgit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Maatta, Sylvia
    Nurses as 'guests' - a study of a concept in light of Jacques Derrida's philosophy of hospitality2013In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 14, no 2, p. 117-126Article in journal (Refereed)
    Abstract [en]

    As revealed in previous empirical research, nurses describe their position in home-based nursing care (HBNC) as that of guests' in the patient's home. Such a description is problematic as guests' might not be considered to belong to the realm of professionalism. As Jacques Derrida's work on hospitality has received wide publicity, sparking theoretical and philosophical discussion about host and guest, the aim of this study was to explore how the concept guests' can be understood in the light of Derrida's philosophy of hospitality. The study revealed that (a) guest must be considered a binary concept; and (b) hospitality should be regarded as an exchange of giving and receiving between a host and a guest. The present study demonstrated that it is important to reflect on the meaning of the concepts used by nurses in HBNC. Further theoretical and empirical exploration of the concept hospitality' would be fruitful, i.e. what is patients' understanding of hospitality' and hostility' related to nurses' descriptions of themselves as guests' in the patient's home.

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