Sirpa Janhonen

Applying Ethical Guidelines in Nursing Research on People with mental illness

This article describes how ethical guidelines have been applied while interviewing psychiatric patients who were recovering from mental illness, especially from psychosis, to allow nurses to understand these patients’ experiences. Because psychiatric patients are vulnerable, their participation in research involves ethical dilemmas, such as voluntary consent, legal capacity to consent, freedom of choice, and sufficient knowledge and comprehension. The first part of this article describes the most important ethical guidelines concerning human research. These have been published by different organizations, departments, committees and commissions for the purpose of protecting human rights and dignity whenever research participants are vulnerable persons or their capacity to consent is limited. At present, however, no special regulations govern research involving adults who have been diagnosed with a condition characterized by mental impairment. Furthermore, a relatively small body of research has documented the effects of various disorders (e.g. psychiatric conditions) on decision-making capacity per se. One basic moral and policy question is whether these individuals should ever be involved in research. The second part of this article concentrates on how the investigator made sure that participating patients had understood their role in this particular piece of nursing research. During the interviews the investigator noticed that some ethical dilemmas required further study and debate because of the lack of consensus on the proposed regulatory provisions on research involving institutionalized persons and their ability to make an informed and voluntary decision.

Ethical Dilemmas in a Psychiatric Nursing Study

This article describes the ethical dilemmas encountered by the authors while conducting qualitative research with psychiatric patients as participants. The ethical conflicts are explored in terms of the principles of personal autonomy, voluntariness and awareness of the purpose of the study, with illustrations from the authors’ research experience. This study addresses the everyday life of psychiatric nursing in a psychiatric hospital as described by patients, nurses and nursing students. The data were collected in a university hospital in northern Finland, using videotaped observations and recorded interviews. Although no definitive resolutions are proposed to the conflicts, the article endeavours to enhance awareness of the ethically perplexing situations possibly encountered by researchers during a study process. The institution where the study was conducted has a Research Board entitled to resolve ethical questions. The Ethics Review Committee of the Medical Faculty at the University and the Research Board of the University Hospital’s Department of Psychiatry reviewed and accepted this research plan. They also recommended solutions to some specific ethical problems that occurred in the course of the study. Moreover, some ethical dilemmas required further study and debate during the process.

Andragogy as a didactic perspective in the attitudes of nurse instructors in Finland

In this article the didactic perspectives of nurse instructors (NIs) is examined with the help of andragogy defined by the concepts of self-directed learning, learning as a process and lifelong learning. The results of a pilot study of ongoing research on the educational perspective of NIs, are used as examples to discuss how far NIs have accepted the features of andragogy as their didactic perspective both in their public stance and in their actions as described by NIs themselves.

Finnish nurse instructors' view of the core of nursing

The purpose of this article is to describe how nurse instructors understand nursing and the necessary conditions for high quality nursing care. The approach of the study was inductive and based on phenomenology and a sociological field research method, i.e. grounded theory. It emerged that the core of nursing is a process, termed here caring, with three stages. Three types of caring emerged. Understanding the client, the art of nursing, co-operation between the nurse and other health care professionals were found to be necessary conditions for a high quality nursing care and it was also found that it is not possible to separate caring from the society and its history.

Methodological Reflections: Supervisory Discourses and Practice-Based Learning.

The concept of dialogue is often examined apart from the social and historical context in which it is embedded. This paper identifies how dialogue between a superior and a subordinate generates a reorganisation of situated knowledge in the education and training of nurse teachers. We created an analytic method of supervisory discourse founded on differences between discourse-based and practice-based theories. The findings elicit two forms of dialogues: transformative and exploratory. Through the former, supervisors try to make their students reformulate their understanding by facilitating learning through questions and hints or to support their self-reflections in local contexts. Conversely, exploratory dialogue involves the participants’ willingness to raise and share their tacit knowledge, including an orientation towards current practices and relational change, and go beyond the local contexts. We suggest that our findings create ways of understanding the meaning of generative discourse in higher education.

Teaching Practice as a Testbench of Learning in Master's Degree Education for Nurse Teachers in Finland.

This article presents the approach and procedures used in a Finnish developmental study on nurse teacher education. The teaching practice period was organized by dividing student teachers into small study groups and assigning the group an entire course to be planned and carried out in teacher/student collaboration. The work process of the groups was videotaped and analysed qualitatively. Preliminary results and ideas concerning the developmental needs of nurse teacher education are presented.

Traditional or systematic nursing? An evaluation of the written curricula of registered and enrolled nurses in Finland

In order to develop the professional identity of registered nurses (RNs) and enrolled nurses (ENs), it is essential that the core of the written curricula be based on nursing science. In this study, content analysis was used to examine how theoretically-developed elements of nursing education were taken into consideration in the curricula (one local and one nationwide curriculum were analysed). The research questions were: 1. to what extent do the characteristics of either traditional or of systematic nursing appear in the educational objectives of nursing education? 2. to what extent do the characteristics of systematic nursing appear in the curricula, and as distinct elements in the objectives of nursing education? The written nursing curricula which were analysed seem to be characterised by traditional nursing, while features of systematic nursing appear as minor elements only.

Utilising the Concept of Protection in Health Maintenance among the Bena in Tanzania

This article reports the findings of a study of the protective health care actions by the Bena. The article is based on an ethnographic research project that dealt with cultural care among the Bena tribe in the Ilembula villages in Tanzania. The data were collected with open-ended interviews and participatory observation. Forty-nine villagers were interviewed. The findings show that childhood and adulthood include some sensitive phases of the Bena life span that require protective actions to ensure reproductive, physical, and mental health. The following main protective actions were related to health protection in the sensitive phases: taking local herbs, avoiding sexual relations, hiding menstruation and early pregnancy from others, avoiding contacts with magic, avoiding kitchen work, using one’s own utensils, and omitting greeting others.

Patient's Capable of Managing — Basic Process of Psychiatric Nursing in a Hospital Environment

The aim is to describe the basic process of psychiatric nursing in a hospital environment and to produce a practical theory of psychiatric nursing by the grounded theory method. The data were collected by means of observation and interviews and analysed simultaneously, so that the preliminary results and experience gained in the field shaped the data collection process. The data were subjected to continuous comparison analysis and classified into categories by open coding. The basic process was identified by means of axial coding and theoretical memos. The selective coding consisted of related categories grouped around a core category. The basic process of psychiatric nursing involves the patients needs for care, the helping methods available and the objectives of care. The patient needs help because of his/her inability to manage in daily life, and the role of nursing is to help the patient to manage. The basis of psychiatric nursing lies in caring for the needs of the patient by employing various helping methods. Patient management consisted of three categories, each subsuming three subcategories. Examination of the content of these led to the identification of different types of psychiatric nursing, labelled as confirming, educating and catalytic. The results suggest that collaborative methods in psychiatric nursing enable and support the patients participation in his/her care and show that both nurses and patients consider collaboration a good helping method, although requiring a change in attitudes and activities for both the nurse and the patient. In spite of changes in psychiatric nursing, there has been no essential development, as most of the care provided is still normative and traditional and the patient is a passive recipient.

Grounded Theory in Nursing Education and Nursing Practice Research

24 The aim of this article is to describe the grounded theory method and the knowledge gained in nursing education and nursing practice by using this method. The grounded theory method is qualitative and inductive, analyzing data from the empirical world, from which categories and concepts are derived. Analysis iscarried out by coding and writing memos. The focus of analysisis in maintaining the links between the original indicators, the codes and the memos during the research process.The derived categories are structured, restructuredand developed continually during the research process,and this leads to the formation of hypotheses and eventuallyof theories. In the theory, the concepts and the relationships between them are defined in their social process.