Towards a Hermeneutics on Ageing: Or What Gadamer Can Teach Us About Growing Old.

Ageing is one of life’s most pervasive shared experiences, and one that is imbued with social, cultural and bio-medical meaning. This paper begins a conversation on what hermeneutics, and in particular, the philosophical hermeneutics of Gadamer, can add to contemporary understandings of ageing

Book Review. Towards an Ecology of Nursing Knowledge: Nursing and Humanities by Dr. Graham McCaffrey

McCaffrey, G. (2020). Nursing and humanities. Routledge. (pp. 127, $63.95 CAD, Hardcover) Nursing and Humanities by Dr. Graham McCaffrey explores the role of humanities in nursing knowledge, and McCaffrey makes a compelling case that humanities are an integral, though often invisible, part of nursing practice. He places nursing humanities within the sphere of health humanities and provides a cogent argument, along with examples and insights, to support the claim that the humanities offer not merely another form of knowledge to sit alongside science, but also a way to integrate the diversity of nursing knowledge into a coherent framework or ecology of nursing practice. In this respect, the book serves as an important development in understanding nursing practice and forms a possible bridge between the tensions inherent in contemporary explorations of nursing as an art and science. The book is aimed at nurses, graduate students, nurse educators and researchers, and anyone with an interest in nursing theory. Nursing and Humanities is rich with ideas and propositions, often thought-provoking and challenging in its offering of an evolution of thinking about nursing knowledge and practice.   &nbsp

Editorial: Transporting History: Last Night My Parents' House Was Moved

On history, home, and identity..

Identifying outcomes associated with co-managed care models for patients who have sustained a hip fracture: an integrative literature review

Aims and objectives: The aim of this integrative literature review is to identify themes associated with improved patient outcomes related to orthogeriatric co-managed inpatient unit models of care for patients who had sustained a hip fracture. Approach: An integrative literature review was undertaken from 2002-July 2013 using electronic databases with specific search terms. Methods: The theoretical framework of Whittemore and Knafl was used to guide the review. This framework was chosen as it allows for the inclusion of varied methodologies and has the capability to increase informed evidence-based nursing practice. Results: Five distinct themes relating to outcomes emerged from the analysis, which were: time from admission to surgery; complications; length of stay; mortality and initiation of osteoporosis treatment. Conclusion: The analysis of this integrative literature review clearly indicates the need for national and international sets of agreed outcome measures to be adopted to facilitate the comparison of models of care. This would significantly improve the way in which outcomes and costs are reported, further enhancing international partnerships as the health care team strive to achieve overall improvements in the management of older people presenting to hospital with hip fracture

Is it Really “Yesterday’s War”? What Gadamer Has to Say About What Gets Counted

In this paper, the authors address the perceived recent trend of funding and publishing bodies that seem to have taken a regard of qualitative research as a subordinate to, or even a subset of, quantitative research. In this reflection, they pull on insights that Hans-Georg Gadamer offered around the history of the natural and human science bifurcation, ending with a plea that qualitative research needs to be received, appraised, judged, and promoted by different lenses and criteria of value

Meaningful connections in dementia end of life care in long term care homes

Background: Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. Method: This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. Results: Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. Discussion: Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives’ questions about end of life. Conclusions: Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents’ experiences of deaths of other residents is needed.Brock University Library Open Access Publishing Fun

A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions: The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size

A practice divided: Registered nurses' experience of policy and reform in residential aged care

With the increase in the percentage of the population aged over 65 years, there is increased pressure on the health care system and the nursing profession to provide quality, cost effective care to meet this growing demand for aged care services. As a result, residential aged care services in Australia have undergone a period of extensive reform, including policy and funding changes, impacting on all areas of practice. This demand for high quality, cost effective aged care requires both the involvement of committed professionals and the development and implementation of appropriate plans and policy. This study explores the experiences of registered nurses in residential aged care facilities and how these experiences are shaped by government aged care policy and reform. By posing the research questions: How do registered nurses experience everyday practice in residential aged care? and What influence have policy and reform processes had on registered nurses' experience of their everyday practice? this study aims to further develop understanding of aged care practice and the contextual factors that define it. Thus, the purpose of this study is to challenge registered nurses to reflect on their role in residential aged care (what they do), and through examination of policy and reform (why they do it), explore nursing practices and options for service delivery aimed at creating a care environment of excellence for older Australians. The qualitative research methodology designed for this study is based on a critical hermeneutics approach informed by the works of Gadamer and Habermas. Such an approach recognises the historical, contextual and linguistic basis for interpretation and critique. While Gadamer provides direction for the study to reveal an understanding of registered nurses' experiences, Habermas provides insight into the role of critique in understanding the contextual conditions of such experience. Ultimately, this study seeks to make explicit the cultural and political meanings that operate to establish meaning and context in residential aged care in Australia. Fourteen (14) registered nurses practising in both public and charitable residential aged care facilities were interviewed as part of this study. Registered nurses from high, low and mixed care facilities were interviewed in-depth. Journal notes provided insight into assumptions and prejudices involved in interpretation and facilitated the critical examination of practice experiences within the residential aged care context. Findings suggest that residential aged care is a complex and challenging environment, full of tensions, contradictions and frustrations for registered nurses employed within the system. Three aspects of the experiences of aged care practice are revealed in this study: Searching for Value; Dealing with Change; and Dividing Practice. The search for value reveals the tensions registered nurses experience in seeking to reconcile those aspects of practice that construct meaning and value in their everyday practice with dominant social and professional values that fail to acknowledge the value of ageing and aged care. Dealing with change is an everyday aspect of practice for registered nurses as they struggle to redefine their roles and responsibilities within a changing environment. This struggle highlights the tensions that exist between traditional nursing roles and their expanding managerial responsibilities. Registered nurses also identified conflicts in caring as a result of their changing roles, which have resulted in a division of practice. These conflicts in caring contribute to the tensions experienced between registered nurses and other stakeholders in residential aged care in relation to everyday practice and quality of care. Findings indicate that aged care policy and reform have a significant impact on the experiences of registered nurses in residential aged care and contribute to the tensions, challenges and frustrations facing nurses in their everyday practice. These findings indicate that aged care policy and reform processes are integral in the restructuring of practice in residential aged care. This analysis illuminates the ways in which aged care policy constructs the tensions and evident contradictions within registered nurses' roles. Based on these findings, recommendations for practice and further research encourage cooperation between government, service providers and the nursing profession to assist registered nurses to reconcile past, present and future practices in order to redefine practice and meaning in residential aged care

Searching for value : the influence of policy and reform on nurses’ sense of value in long-term aged care in Australia.

Contemporary literature on long-term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses' experiences in long-term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses' everyday experience also contributes to a broader understanding of job satisfaction in long-term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses' sense of value in long-term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.\ud \u

From apprehension to advocacy: a qualitative study of undergraduate nursing student experience in clinical placement in residential aged care

Abstract Background Undergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students’ experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care. Methods This qualitative study used a participatory action research approach, and this paper reports on the thematic analysis of data from one cycle of undergraduate nursing placement in a Canadian residential aged care setting, with two groups of 7–8 students and two university instructors. Staff and residents at the research site were also included. Researchers interviewed both groups of students prior to and after placement. Instructors, staff and residents were interviewed post placement. Results Students commenced placement full of apprehension, and progressed in their learning by taking initiative and through self-directed learning pathways. Engagement with residents was key to student learning on person-centred care and increased understanding of older adults. Students faced challenges to their learning through limited exposure to professional nursing roles and healthcare aide/student relationship issues. By placement end, students had gained unique insights on resident care and began to step into advocacy roles. Conclusions In learning on placement within residential aged care, students moved from feelings of apprehension to taking on advocacy roles for residents. Better formalizing routes for students to feedback their unique understandings on resident care could ensure their contributions are better integrated and not lost when placements end