CNUR 400- week 12 - Lecture notes 12 PDF

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Dr. Shauna Davies...

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CNUR 400 Week 12: Transition to Practice/Wrap Up

Duncan, S.M. (2019). Onward to 2030: Nursing’s momentum for global health equity. In M. McIntyre, & C. McDonald (Eds.), Realities of Canadian nursing: Professional practice and power issues, 5th ed., (pp. 428-444). Philadelphia, PA: Wolters Kluwer. -

Contemplate the future of nursing. “In this context of the future, nurses must continue to be bold in their vision, and informed by what people throughout the world need to attain health. In this inspiring future, nurses acknowledge the challenge of persistent issues and tensions as well as the promise of nursing in the 21st century” (Duncan, 2019, p. 429).

Eggertson, L. (2013). The gap between clinical practice and education. Canadian Nurse,109 (7), 23-6. -

Nurse educators call for reform to better align the two- to “future proof” nurses and improve health outcomes

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Dylan brown began working as a OR nurse, and was excited to sue the knowledge he had gained from nursing school

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He was particularly keen on evidence demonstrating the using forced-air warmers to warm patients in the OR is the best way to prevent hypothermia, a common problem

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But when he approached his colleagues about using the warmers – a change tot heir normal preop routine, he was instantly rebuffed

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:”it was frustrating and disenfranchising” brown said of trying to introduce an evidence-based change he knew would help the patients. “there is more resistance to any small change, particularly one that comes from a student or a very inexperienced nurse”

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A hidden curriculum: o

Browns experience is an example of what 15 nurse leaders in education, policy, and service fields recently identified as barriers that are diluting the ability of undergrad nursing education .

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Many new nurses are eager to put into practice the latest evidence based research, but are quickly deflated when they begin work and discover the workplace culture ignores their desire to transfer knowledge and rejects their attempts at change.

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the biggest problem in nursing education is the disconnect between practice and education

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much nursing practice follows rigid procedures and has failed to adapt to the latest research that could improve outcomes, including patient safety, at the patient, provider, and system level.

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The disconnect occurs because students are exposed to what has been termed a hidden curriculum during their clinical placements.

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Students receive an unspoken message: their job is to follow orders and procedure, not to try and change the status quo.

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Often educators are desperate for placements, and they don’t want to jeopardize their relationship by questioning care at the institutions where their students are placed.

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Wide spread change required:

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Canada needs to undertake a comprehensive, national review of undergrad nursing education that will better equip nurses like brown to assume leadership roles in interprofessional teams and support them in providing high quality patient centered care

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Adhering to traditional procedures blocks the spread of knowledge nurses like brown could bring to bedside care

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Front line colleagues may not have grown and developed alongside with the system. They are technically highly competent, but they have not yet brought into their role as change agents, patient advocated and leaders in adopting evidence based practice

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Closer partnerships between practice and education are needed to support nurse educators and nurse managers in advancing practice

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Intellectual capital being wasted: o

Another reason for disconnect is that not enough clinicians are teaching in nursing schools

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We aren’t using enough of these highly competent direct-care practitioners- often because they are not academically prepared at the graduate level

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There needs to be an increase in baccalaureate-prepared nurses helping us bridge theory and practice into our classrooms as well as in clinical placements, rather then needing your masters.

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Learning to work in a team: o

Another recommendation is that nursing schools develop models that educate nurses to practice more effectively within interprofessional teams, whether those are in primary care settings or specialized units.

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Using students have opportunities to work along side students of other professions would make a difference in preparing students for working interprofessionally right after schooling

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To specialize or generalize? o o

Discussed whether to educate nurses as generalists or if there is a need for specialization Teaching all nurses a foundation of general knowledge is important to ensure workplace flexibility, but the reality is that many full-time jobs are now in specialty areas

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Brings forth discussion of a residency in the nurses first year of practice would allow clinical institutions to impart knowledge specific to the graduates chosen area of practice

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A new system needs for new service providers: o

Turing around health and health are systems the way we envisioned will require radical change in health care education

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New topics, teaching methods, science and research are all needed to prepare health professionals for a very different health system

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Nothing is more fundamental to transforming health care than the way professionals are educated, but more curricula are out of date and out of step with the transformations ahead.

McDonald, C. (2019). The gendered nature of nursing. In M. McIntyre, & C. McDonald (Eds.), Realities of Canadian nursing: Professional practice and power issues, 5th ed., (pp. 276-284). Philadelphia, PA: Wolters Kluwer. -

Terms: o

Complexity: our own participation in, for example, supporting or reinforcing societal norms that undermine the value of women’s work

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Essentializing: seeing something as representative of all members of a particular group or category. For example, Essentializing nurses’ work in a women’s domain implies that there is something about nursing that could only be preformed by women

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Discourses: social practices, values, and cultural beliefs that prevail in a given culture or subculture at a specific historical moment and shape a collective sense of what is right, proper, worthwhile, or valuable

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Discourses of care: the ways in which ideas about care have been represented in nursing, particularly the values and beliefs that have placed care central to nursing practice

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Discursive process: how we learn to be and to behave in particular ways through the messages received in social disclosures

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Gender: the ways in which femininity and masculinity are reflected in the lived life. Gender is distinct from the biologic sex of a person. Culturally, there is value attached to particular genders and the way in which that gender is preformed

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Ideologies: not merely ideas, but a powerful and authoritative voice in society that tells us who we are and how we are to behave

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Location of gender: gender is constructed through the interaction of the person with the social realities, values, and beliefs of a culture at a particular time in history. In this sense, gender sides both within and beyond the individual.

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Naturalized: when some quality is taken to be innately, or obviously “the way it is” without questioning the beliefs on which that assumption is formed. Ex) women- dress, man-pants have become neutralized in our culture to represent the washrooms in public places to be used by women or men.

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Reinscribing: reinforcing or reproducing a concept or belief, at times without the thoughtful intention of doing so

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Social construction: ideas, concepts and roles that are understood to be formed or built up through the agreed-on ideologies of a society

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Transparency: in ways in which we can see something clearly, or obviously (high transparency), or in which something is obscured from our view. Ex) increasing our awareness of material and social realities that contribute to gendering of nurses’ work will improve our ability to see, or make transparent to us, manner in which nursing is undervalued because it is “women’s work”.

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Articulating the issue for nursing: o

Gender is a concept in our society that is simultaneously taken for granted and poorly understood

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Gender refers to ways in which a person lives life that demonstrated or reflects masculinity and femininity

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Gender can be thought of a constructed through social influences outside of a particular individual.

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The gender binary: 

Common categories are : boy/girl, or man/woman

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The role played by this categorization of gender in society is very real

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It is in childhood that we are acculturated to the social regulations that underpin our local world.

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For children, the binary is clearly differentiated in the gendered nature of toys, clothing, and activities

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Gender as socially constructed: 

Social construction means that ideas, concepts, and roles are understood as formed or built upon the shared assumptions and beliefs of a society

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Over time, these shared assumptions become disclosures that develop the authority to tell us who we are, what we are to think, and how we are to behave.

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The gendered nurse as socially constructed: 

The concept of nurse is not a naturally occurring phenomenon.

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The concept has been constructed over time, through disclosures of what constitutes or makes up the role of a nurse

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Although we acknowledge that there is no natural role or personality attributed to a nurse, we act as if the opposite is so. 

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“male nurse” but not “female nurse”

Analyzing the issue: o

Historical analysis of the issue: 

Begins with looking at the gendered nature of knowledge that predates the professionalization of nursing, visits the historical disclosures of nursing education and practice, and ends with transition of disclosures attached to “women’s work”.

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Before the industrialization of nursing, women healers are caregivers were privilege to gynocentric knowledge.

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Nursing practice has long been equated with “female virtues” – the virtues of care, nurturing, and altruism.

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Gentleness and quietness were required of nightingales nurses and many nurses in todays workforce that “trained” in the 60s can attest to the importance attached to those virtues.

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Both the work and work of nursing are firmly associated in the public mind with the female sex

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Social-cultural analysis of the issue: 

Explores prevailing attitudes and assumptions, continues with a view of nurses’ work through the lens of “women’s work”

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Men are often in higher, hierarchal positions

Critical feminist analysis of the issue: 

Questions the assumptions held about gender and often interrogates the intersection of gender with other discursive realities that form personal identity.

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The analysis of the gendered nature of nurses work explores myths that underlie stereotypical gender roles, the meanings attached to care in nursing and some of the paradoxes for men in nursing

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Gender and the intersectionality of identity: 

In recognizing how dominant social disclosures influence who we are to be, the production of identity becomes a discursive process. o

Discursive process: refers to how we learn to be, in particular ways, through the message we receive in social disclosures

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Our concept of ourselves as gendered, the way we live as masculine and feminine, is one way in which we become people with particular identities.

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The experience of living ones liege as a young, black, middle class, heterosexual, male nursing student would be quite different from the experience of living as a white, middle aged, working class, lesbian, single mother nursing student.

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Stereotypical gender attributes: 

In the article discussion the tensions between power and caring in the nursing profession

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Falk atomizes the characteristics traditionally associated with femininity and masculinity as follows: o

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Femininity: CARE 

Submissiveness

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Helplessness

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Dependency

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Tenderness

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Nurturance

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Altruism

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Competiveness

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Ambition

Masculinity: POWER 

Strength

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Aggression

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Mastery

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Independence

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Logic

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Being unemotional

Discourses of care: 

The association of nursing with caring is complicated by the social belief in care as an innately female quality

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“care” is undervalues, as merely a “feminine virtue”

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women are naturally caring

Men in nursing: 

Nightingale excluded males from nursing in her effort to construct a viable profession for women during Victorian times

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Percentage of male nurses in Canada: 5.1%

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Many men experience gender bias and discrimination in their nursing educational experience

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Men becomes nurses for the same reason as women: caring for others is identified as a principle reason for pursuing a career in nursing by both men and women

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Barriers to and strategies for issue resolution:

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The gendered nature of work in general, and nurses’ work in particular, is concealed- or implicitly present- in nursing practice. Although the effects of gendering on nursing practice are part of our experiences, there is a lack of discussion that identifies these experiences as the problematic effects of gender and power.

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The effects of power and gender in nurses’ work and nursing knowledge are taken for granted in nurses’ practice and education. The lack of transparency regarding the gendered nature of nurses work contributes to our inability to question the embedded assumptions of gender and nurses’ work

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Historically, nurses have lacked a critical feminist analysis that provides a framework to critique and question the taken-for-granted social disclosures of gender, nurses’ work and the valuing of care in society

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Although the gendered divisions of labor have long been ingrained in society, only recently has the gendered nature of work been called into question in academic disclosures that are accessible to nursing

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Understandings of the gendered nature of nurses’ work are impaired by the lack of clarity and articulation of the nature of nurses’ work in general. The accurate and limited public representations of the nurse and nurses work contribute to the limited understanding and devaluing of nurses’ work and nursing knowledge

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Individual efforts to disrupt the taken-for-granted ideas of gender require one to challenge social disclosures and dominant views. This necessary strategy produces a barrier for the individual by placing her or him in tension with commonly heal societal views....