Jasna K. Schwind

A cyborg ontology in health care: traversing into the liminal space between technology and person-centred practice

Person-centred practice indubitably seems to be the antithesis of technology. The ostensible polarity of technology and person-centred practice is an easy road to travel down and in their various forms has been probably travelled for decades if not centuries. By forging ahead or enduring these dualisms, we continue to approach and recede, but never encounter the elusive and the liminal space between technology and person-centred practice. Inspired by Haraways work, we argue that healthcare practitioners who critically consider their cyborg ontology may begin the process to initiate and complicate the liminal and sought after space between technology and person-centred practice. In this paper, we draw upon Haraways idea that we are all materially and ontologically cyborgs. Cyborgs, the hybridity of machine and human, are part of our social reality and embedded in our everyday existence. By considering our cyborg ontology, we suggest that person-centred practice can be actualized in the contextualized, embodied and relational spaces of technology. It is not a question of espousing technology or person-centred practice. Such dualisms have been historically produced and reproduced over many decades and prevented us from recognizing our own cyborg ontology. Rather, it is salient that we take notice of our own cyborg ontology and how technological, habitual ways of being may prevent (and facilitate) us to recognize the embodied and contextualized experiences of patients. A disruption and engagement with the habitual can ensure we are not governed by technology in our logics and practices of care and can move us to a conscious and critical integration of person-centred practice in the technologized care environments. By acknowledging ourselves as cyborgs, we can recapture and preserve our humanness as caregivers, as well as thrive as we proceed in our technological way of being.Person-centred practice indubitably seems to be the antithesis of technology. The ostensible polarity of technology and person-centred practice is an easy road to travel down and in their various forms has been probably travelled for decades if not centuries. By forging ahead or enduring these dualisms, we continue to approach and recede, but never encounter the elusive and the liminal space between technology and person-centred practice. Inspired by Haraways work, we argue that healthcare practitioners who critically consider their cyborg ontology may begin the process to initiate and complicate the liminal and sought after space between technology and person-centred practice. In this paper, we draw upon Haraways idea that we are all materially and ontologically cyborgs. Cyborgs, the hybridity of machine and human, are part of our social reality and embedded in our everyday existence. By considering our cyborg ontology, we suggest that person-centred practice can be actualized in the contextualized, embodied and relational spaces of technology. It is not a question of espousing technology or person-centred practice. Such dualisms have been historically produced and reproduced over many decades and prevented us from recognizing our own cyborg ontology. Rather, it is salient that we take notice of our own cyborg ontology and how technological, habitual ways of being may prevent (and facilitate) us to recognize the embodied and contextualized experiences of patients. A disruption and engagement with the habitual can ensure we are not governed by technology in our logics and practices of care and can move us to a conscious and critical integration of person-centred practice in the technologized care environments. By acknowledging ourselves as cyborgs, we can recapture and preserve our humanness as caregivers, as well as thrive as we proceed in our technological way of being.

Discussion of patient-centered care in health care organizations.

The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient-centered care. At the organizational level, patient-centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient-centered care have not been fully achieved. In this article, we used a critical social theory lens to examine the discursive influence of power upon the integration of patient-centered care into health care organizations. We begin with an overview of patient-centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge of health care providers and shed light on how these long-standing traditions have impeded the integration of patient-centered care. We conclude with a discussion of viable solutions that can be used to implement patient-centered care into health care organizations. This article presents a perspective through which the integration of patient-centered care into health organizations can be examined.

Opening the black-box of person-centred care: An arts-informed narrative inquiry into mental health education and practice

BACKGROUND Nursing education has a history of encouraging students to know their patients and to negotiate the in-between of art/science, person/profession, and intuition/evidence. Nurse-teachers know that students may abandon some values and practices when they encounter practice environments that are complex and have competing agendas. We are concerned that nursing knowledge is black-boxed, invisible and taken-for-granted, in healthcare settings. OBJECTIVES Our research explores how nursing students and nurses are constructing and enacting person-centred care in mental health education and practice. We want to understand the nursing standpoint on this significant ontological issue and to make nursing knowledge construction and utilization visible; illuminating how person-centred theory emerges from practice. DESIGN The process involved four 3-hour group meetings and an individual follow-up telephone conversation. SETTINGS Students and nurses met at a tertiary-care mental health organization. PARTICIPANTS Fourteen nurses (Registered Nurses and Registered Practical Nurses) and nursing students (Bachelor of Science in Nursing and Practical Nursing) participated in our inquiry. METHODS We used arts-informed narrative inquiry to explore experience through the arts such as metaphor, collage, poems, letters, and group conversations. RESULTS The black-box is opened as the inquiry reveals how nursing knowledge is constructed, assumptions are challenged and new practices emerge. CONCLUSIONS Our research is significant for education and for practice and is transferable to other populations and settings. Nurses are affirmed in person-centred values and practices that include partnership with those in their care, role modeling for colleagues and mentoring students and new nurses. Students participate in transferring their learning from school to practice, in the company of experienced colleagues; together they open the black-box to show how nurses conceptualize and enact person-centred care.

Engaging in narrative reflective process to fine tune self-as-instrument-of-care

Narrative Reflective Process (Schwind, 2008) facilitates emergence of unanticipated discoveries of personal knowing. In nursing education, personal knowing is of an essence when interacting with learners. For that reason, five nurse-teachers from Ontario, Canada, undertook a year-long commitment to engage in a guided narrative reflective process, using the metaphor self-as-instrument-of-care. Narrative reflective process, which grows out of narrative inquiry, engenders such creative reflective tools as storytelling, metaphors, writing, drawing and conversations. When this reflective process is undertaken by a group of practitioners, the emergent relational knowing deepens, becomes more complex, revealing new patterns of being, doing and becoming. These five nurse-teachers became aware of developing patterns, thus expanding consciousness of how they are in teaching-learning relationships with their learners, as well as their colleagues. They learned how increased self-knowing and awareness of who they are as persons impacts who they are as professionals.

Nursing students’ international placement experience: an arts-informed Narrative Inquiry

Research shows that high cultural competence is most often acquired through both the theoretical education and the practical experiences within the international contexts. The purpose of this project evaluation was to learn from four undergraduate nursing students, who spent three-months in a Brazilian community, how they experienced their international placement. Students’ emotive responses to their international placement were elicited using the creative Narrative Reflective Process, which is informed by the Narrative Inquiry qualitative framework. This process included stories, memory box, metaphor and drawing, and creative writing. The generated creative data were reflected upon by the participants and key narrative threads teased out. The overarching findings speak to the transcultural exchange that took place: students went to teach the local population of Brazil about the social determinants of health from the Canadian perspective, while in turn learning life lessons from their hosts that enriched their personal and professional ways of being.

Narrative Inquiry: Experience matters

Narrative Inquiry is a research methodology that we adapted over the past two decades from Canadian higher education and curriculum studies to nursing research, education, and health-care practice. The Narrative Inquiry we use originated from Connelly and Clandinin in the 1990s, and rests on John Dewey’s philosophy that experience is relational, temporal, and situational, and as such, if intentionally explored, has the potential to be educational. More specifically, it is only when experience is reflected upon and reconstructed that it has the potential to reveal the construction of identity, knowledge, and the humanness of care. Congruent with the expectation that nurses are reflective practitioners and knowledge-makers, Narrative Inquiry provides a means to enhance, not only quality of care, but quality of experience of those in our care: in education, our students, and in practice, our patients. In this article, we explicate how Narrative Inquiry may be lived in health-care education and practice, with a primary focus on nursing. We illuminate how we support our graduate students, the next generation of narrative inquirers, through a Narrative Inquiry Works-in-Progress group.

Arts-Informed Narrative Inquiry into nurse-teachers’ legacy for the next generation

Fewer teachers are available globally for nursing education positions, a fact exacerbated by retirement of ageing colleagues. As two late career nurse-teachers, we use Arts-Informed Narrative Inquiry to explore experiences of Canadian contemporaries to discern the legacy we have to share with nurse-teachers who come after us. Narrative Inquiry is a research process that reconstructs personal and professional experience to reveal learning and knowledge construction in researchers and teachers. It involves lifelines, stories, metaphors, collage-making and reflective dialogue to reveal what experienced nurse-teachers have learned about teaching-learning over their professional trajectories. As an outcome of this study, we offer a letter to new teachers as a legacy arising from conceptualizing teaching-learning practice as humanness of care; the creative processes for self-directed, site-specific faculty development are transferable to any professional and geographical contexts. The paper illuminates how research, education and practice are mutually informing and how emergent inquiry approaches are significant for faculty and curriculum development, as well as transformation of practices.

Using the Narrative Reflective Process to explore how students learn about caring in their nursing program: an arts-informed Narrative Inquiry

Although caring is one of the integral aspects of nursing practice and education, it is often left assumed and loosely threaded through the curricula. In this arts-informed Narrative Inquiry we asked nursing students how they define caring and how we could teach it. We engaged students in the Narrative Reflective Process (NRP), a creative multi-step self-expression activity that includes stories, metaphors, drawing and creative writing, followed by a group narrative interview. The outcome of this study reveals that students see caring as going beyond the expectations; receiving care is a challenge; and caring can be augmented in the nursing school through reflection on practice situations with links to theories of caring. The implication for education is to choose a caring framework which allows creative reflection and critical dialogue among students and teachers. This paper also provides an example of how NRP can be used to foster creative reflection on caring within nursing programs.

Advancement of guided creative and critical reflection in the professional development of enterprising individuals in business and nursing

Using narrative inquiry theoretical framework with creative and critical reflection to explore the personal and the professional lives of enterprising individuals reveals how metaphors, when used within the context of professional development in business and nursing, may open gates to expand and deepen reflective process and growth. Business and nursing individuals participate in guided creative and critical reflection on their lived experiences to recreate knowledge and understanding of themselves as workers in order to reconstruct their professional profiles for improved workplace discourse. The article explores the potential of guided creative narrative reflection and metaphor in the professional development of enterprising individuals in business and nursing.

Fostering Transformative Learning Through Cocreative Artmaking Processes and Emerging Artful Forms: Two Educators Reflect on and Dialogue About a Shared Arts-Based Workshop Experience

In this article, we take a retrospective look at a workshop where Jasna, a nurse educator, was a participant, and Kathy, a preservice teacher educator, was both a participant and the facilitator of an artful inquiry process she calls co-creative writing. By putting forward our stories, we share our experiences as well as contribute to ongoing discussions on the value of engaging in cocreative arts-based approaches to enhancing transformative learning. More specifically, we engage in a critical reflective dialogue to illustrate how the process of making art together can create space for transformative learning and thus help to deepen our understanding of our teaching–learning relationships. Particular attention is given to organic collaborative artistic processes and how they support dialogue, encourage critical reflection, nurture authentic relationships, and foster creative and expressive ways of knowing and being, as well as a more holistic orientation toward transformative learning.