Gweneth Hartrick Doane

Knowledge Translation in Everyday Nursing: From Evidence-based to Inquiry-based Practice

The interconnection of theory, evidence, and practice is most often conceptualized as an epistemological enterprise. In this article, we shift the discussion from one that is solely concerned with epistemology to one that considers the significance of ontology and the way in which epistemology and ontology are intricately intertwined in every nursing action. Drawing on deconstructive hermeneutics, we contend that to understand and affect the interconnection of theory, evidence, and practice, an ontological inquiry at the action level is required. Using a nursing practice example, we illustrate the complexities of knowledge translation and how effective integration of knowledge into practice involves an embodied process of ontological inquiry and action. This inquiry process draws on theory and evidence to enlarge and imagine possibilities for action in particular moments, situations, and contexts and rests in a way-of-being in which the interconnection of theory, evidence, and practice is embodied.

Recontextualizing learning in nursing education: taking an ontological turn.

An ontological focus has been embedded within nursing education since its inception. There has been a strong emphasis on teaching students to become safe, competent nurses by translating knowledge into clinical action. But how would nursing education shift if we were to more intentionally orient the educative process ontologically and explicitly put epistemology at the service of ontology? We consider this question of an ontological turn in nursing education by examining what is commonly referred to in nursing curricula as interpersonal communication. With the goal of providing learning opportunities that can support students to develop confident and competent practice within the shifting, complex terrain of contemporary health care milieus, we explore the possibility of shifting the relationship between epistemology and ontology, and purposefully orienting the educative process in such a way that emphasizes and illuminates the manner in which nursing knowledge and action intersect with subjectivity and context.

Highlights From the 7th International Family Nursing Conference: Plenary Address: The “Hard Spots” of Family Nursing: Connecting Across Difference and Diversity

The focus of this discussion is how nurses might more effectively work within the “hard spots” of family nursing to connect across difference. Taking a pragmatic stance toward knowledge, the practical consequences of ideas and theories informing definitions of family and family nursing practice are examined. The authors propose that the provision of competent, ethical, and culturally safe nursing care could be greatly enhanced by a relational view. In particular it is suggested that understanding family as a relational experience, understanding nursing and culture as relational processes and conceptualizing difference as a basis for connection can provide a foundation for more effectively working across differences. Using this relational view the authors outline processes that have the potential to foster more equitable, just, and compassionate family nursing practice.

Best Practice in Provider/Parent Interaction

In this 3-year prospective grounded theory study in three pediatric settings, we aimed to develop a conceptualization of best practice health care providers (BPHCPs) in interaction with parents of children with complex, chronic, life-threatening conditions. Analysis of semistructured interviews with 34 parents and 80 health care professionals (HCPs) and 88 observation periods of HCP/parent interactions indicated that BPHCPs shared a broad worldview; values of equity, family-centered care, and integrity; and a commitment to authentic engagement. BPHCPs engaged in direct care activities, in connecting behaviors, and in exquisitely attuning to particularities of the situation in the moment, resulting in positive outcomes for parents and HCPs. By focusing on what HCPs do well, findings showed that not only is it possible for HCPs to practice in this way, but those who do so are also recognized as being the best at what they do. We provide recommendations for practice and initial and ongoing professional education.

Enacting Nursing Obligations: Public Health Nurses' Theorizing in Practice

A recent study illustrated Public Health Nurses’ theorizing of obligation within their everyday practice with high priority families. As a practical (and practice) activity this theorizing shaped and enhanced PHN practice in complex nursing situations and served to affect desired outcomes for families. Using a hermeneutic methodology, six features were identified as central to this practical theorizing process: (a) being in the complexity of families’ lives, (b) responding to relational cues, (c) putting the primary investment in people and families, (d) working toward potential, (e) working the relational “in-betweens,” and (f) reflexive inquiry. The findings have implications for understanding theory and theory development in everyday nursing practice.

Family Nursing: Challenges and Oppotunities: The Challenge and Opportunity of Complex Uncertainty

I believe the most significant challenge we currently face in family nursing is that of complex uncertainty. Advances in technology, increased acuity rates in hospital and community settings, the trend of specialized care, and the way in which corporatization of health care is shaping health care decisions including allocation of resources are just a few of the factors that have contributed to health care becoming an increasingly complex enterprise. At the same time, people and families today are incredibly complex. What actually constitutes family has turned into a complex issue with everyone from politicians, religious institutions, and special interest groups arguing their different perspectives. There is no longer a unified or certain truth about family. One just has to look at the recent debate in North America about same-sex marriages to glimpse the complex uncertainties inherent in families today. Because of what is playing out in the larger society, there is little that is straight forward in family nursing today. Nurses are routinely faced with complex, uncertain situations. Who and what a family is, what families experience, what they value, what they need or want, and what ultimately is effective in promoting their health is complex, uncertain, and often fluctuating. These complex and uncertain circumstances raise questions about the very core of our work as family

Highlights From the 7th International Family Nursing Conference: Plenary Address: The “Hard Spots” of Family Nursing

The focus of this discussion is how nurses might more effectively work within the “hard spots” of family nursing to connect across difference. Taking a pragmatic stance toward knowledge, the practical consequences of ideas and theories informing definitions of family and family nursing practice are examined. The authors propose that the provision of competent, ethical, and culturally safe nursing care could be greatly enhanced by a relational view. In particular it is suggested that understanding family as a relational experience, understanding nursing and culture as relational processes and conceptualizing difference as a basis for connection can provide a foundation for more effectively working across differences. Using this relational view the authors outline processes that have the potential to foster more equitable, just, and compassionate family nursing practice.

Boundaries and the Culture of Theorizing in Nursing

In this dialogue we direct attention to the way in which each of us (including you the reader) is a knowing practitioner, examining how our ontologies and the cultures we live and create are (and are not) shaping theorizing and ultimately family nursing practice. Questions we explore include: How might closer attention to ontology enhance theorizing in family nursing and healthcare? How might we enlist boundaries and differences as potential lines of joining? How might we engage in theorizing as a unitary act—living the values and ideals we espouse and aspire toward?