Exploring evolving caring relationship experiences among nursing home residents and nurse aides in Shanghai: a dyadic perspective

Although research has shown that older nursing home residents can benefit from caring relationships with nurse aides, few studies have explored their dyadic, evolving relationship dynamics. Using a dyadic perspective, this study simultaneously explores caring relationships among older residents and nurse aides in Shanghai. In a government-sponsored nursing home in Shanghai, 20 matched resident–nurse aide dyads participated in semi-structured, in-depth interviews (N = 40). We performed thematic analysis to interpret and conceptualise the evolving caring relationships within dyads. Four types emerged during the evolution of caring relationships across the 20 dyads: (a) sharing strong rapport, (b) respecting each other, (c) hesitant responding, and (d) keeping emotional distance. Upon placement, all the residents kept emotional distance from nurse aides, and their assigned nurse aides provided care-giving by following nursing home regulations. As time passed, nurse aides began to create a family environment and tried to interact with residents on an emotional level; however, residents’ attitudes varied. The caring relationships in some dyads evolved as rapport and respect emerged, while others remained hesitant and distant. This suggests that residents and nurse aides prioritised caring relationships differently in terms of autonomy preservation and safety protection, respectively. This study sheds light on nursing home practice to facilitate building caring relationships between residents and nurse aides.

Professional Preparation: Faculty Practices for NCLEX-RN® Success

Davis proposed that there are three overlapping phases of a caring relationship to NCLEX-RN® preparation, grounded in Peplau’s theory. Faculty members’ perspectives on successful strategies related to NCLEX-RN® results were explored using semistructured phone interviews. Faculty perspectives were categorized under external support structures and internal collaborative processes. The results indicate that a multifaceted collaborative approach using commercial testing products and program evaluation is the best approach.

Exploring attributes of high-quality clinical supervision in general practice through interviews with peer-recognised GP supervisors

Background Clinical supervision in general practice is critical for enabling registrars (GP trainees) to provide safe medical care, develop skills and enjoy primary care careers. However, this largely depends on the quality of supervision provided. There has been limited research describing what encompasses quality within GP clinical supervision, making it difficult to promote best practice. This study aimed to explore the attributes of high-quality clinical supervision for GP registrars. Methods In 2019–20, 22 semi-structured interviews were conducted with GP supervisors who were peer-nominated as best practice supervisors, by Regional GP Training Organisations and GP Colleges in Australia. Purposeful sampling sought respondents with diverse characteristics including gender and career stage, practice size, state/territory and rurality. Interviews were conducted by video-consultation and recorded. De-identified transcripts were independently coded using iterative, inductive thematic analyses to derive themes that reflected quality in GP supervision. Results Seven themes emerged. Participants understood the meaning of quality supervision based on their experience of being supervised when they were a registrar, and from reflecting and learning from other supervisors and their own supervision experiences. Quality was reflected by actively structuring GP placements to optimise all possible learning opportunities, building a secure and caring relationship with registrars as the basis for handling challenging situations such as registrar mistakes. Quality also encompassed sustaining and enhancing registrar learning by drawing on the input of the whole practice team who had different skills and supervision approaches. Strong learner-centred approaches were used, where supervisors adjusted support and intervention in real-time, as registrar competence emerged in different areas. Quality also involved building the registrar’s professional identity and capabilities for safe and independent decision-making and encouraging registrars to reflect on situations before giving quality feedback, to drive learning. Conclusions This study, although exploratory, provides a foundation for understanding the quality of clinical supervision in general practice, from the perspective of peer-recognised GP supervisors. Understanding and adopting quality within GP supervision may be improved by GPs sharing exemplars of best practice and having opportunities for professional reflection. The findings could be used as a point of reference for devising GP supervisor curriculum, resources and professional development activities.

A Rationalist Critique of Sally Gadow’s Relational Nursing Ethics

The ethic of care proposed by Carol Gilligan in late twentieth century instantly elicited a wide range of adaptations and elaborations in numerous disciplines, under the banner of ‘relational ethics’. Sally Gadow’s ‘relational narrative’ is one of these adaptations. Like Gilligan, Gadow aims to dismantle ethical rationalism or universalism, wherein the foregoing mainstream nursing practice had purportedly focused on applying existing philosophical theories of ethics to all conceivable clinical situations. For Gadow, every moral engagement, such as that between a nursing professional and a patient, comes with inherent unique features that render impotent any attempt at universalisation. Each clinical encounter is rather defined by the ability of the professional to engage the client in an intimate, caring relationship that enables healing to take place. Against this backdrop, this paper argues that the theory of Relational Narrative, particularly as conceptualised and articulated by Sally Gadow, cannot be carried through without making some rationalist assumptions, because professionalism in nursing practice is by definition, a deeply embedded ingredient of rational reflection. Furthermore, nursing professionals can make progress or impact only by having recourse to the code of ethics; also, direct application of Gadow’s theory puts the nurse in a dilemma when it comes to dealing with patients suffering from chronic contagious diseases, such as the Ebola or the coronavirus disease (COVID-19). Finally, juxtaposing Gadow’s work with the ideas of the earlier scholars she criticises unsparingly, the paper found that traces of universalist, rationalist assumptions abound in her thought precisely because of the wealth of influence she has garnered from philosophers and psychologists; influences going as far back as Descartes and Kant, down to Rawls and Kohlberg. The data used for this study came from library and archival materials, as well as from internet resources.

‘Children are not small adults’—the distinctiveness of ethics in children

Clinicians working in paediatric palliative care encounter many of the same practical ethical quandaries that face colleagues working in the adult specialty. While the underlying moral principles must be the same, their application to children is often distinctive and ethics is an illustration that ‘children are not small adults’. The key ethical test is the child’s interests; the benefits that an intervention will offer relative to its harms. Establishing them, however, is often not straightforward, and there is a risk that interests become abstracted from the context of a caring relationship that defines the state of being a child. In this chapter we consider a number of specific challenges in paediatric ethics at the end of life: the source of authority in medical decision making, ethics of research in children, collusion (especially in older children and young adults), the principle of double effect (PDE), and euthanasia.

Rationalisation and 'McDonaldisation' in dental care: private dentists' experiences working in corporate dentistry

Introduction This study examines how dentists experience the corporatisation of dentistry and the impacts of rationalisation. The emergence of corporate dentistry in the early twenty-first century has introduced greater competition into the dental marketplace. Ritzer's theory of 'McDonaldisation' explores the rationalisation of services through corporatisation and provides an apt framework with which to understand the qualitative insights gathered through this project.Methods Semi-structured interviews and reflective journals were used to collect insights from dentists who were working in private practice. Data were then subjected to thematic analysis.Results A total of 20 private dentist participants provided 22 separate interviews and multiple reflective accounts. Following analysis, three key themes emerged: 1) opportunities provided by corporate dentistry; 2) balance between professionalism and commercialism in corporate dentistry; and 3) competition between independent and corporate dentistry.Conclusions The participants' insights demonstrate how Ritzer's four dimensions of rationalisation - efficiency, predictability, calculability and control - have been encapsulated by corporate dentistry in Australia. Corporate interests in Australian dentistry are perceived to improve competition and offer opportunities for younger and less experienced dentists, but the findings also suggest that those leading corporate dentistry need to ensure that rationalisation does not diminish the caring relationship between dentists and patients.

Development of a caring teacher-student realationship in higher education

Aim. This article aims to summarize the current state of understanding on a development of a caring teacher-student relationship in higher education context, grounded in relational pedagogy. Also, it provides critical reflection on the data from available literature. Methods. The development of a caring teacher-student relationship was presented using the method of description, based on the review of relevant literature. Results. The development of a caring relationship between students and higher education teachers can be monitored in stages. At first, there is the introductory meeting with the students when a teacher with his personality, authenticity, and approach lays the foundations for the development of a caring relationship. During further meetings, the teacher encourages mutual trust, respect, and appreciation and deepens the relationship by adapting the teaching process to the needs, interests, and affinities of students, until the formal completion of their cooperation. Conclusion. In order to achieve a caring relationship with students in higher education, a teacher needs to approach it consciously, intentionally, thoughtfully and to plan it well from the very beginning. It is crucial to get to know the students as real persons, and accordingly, continuously adapt the teaching process to their needs and interests, allowing them to express themselves freely in a safe, accepting, and encouraging environment. Cognitive value. By presenting the stages of a development of the caring relationship between students and higher education teachers and the synthesis of their characteristics, this paper contributes to a deeper understanding of this phenomenon.

Co-Composing an Aesthetic Self Through Play: Towards a Transformative Framework for Dementia Care

Background and Objectives Aging and deterioration mark a new phase in many older adults’ life, highlighting the importance of creativity and imagination. This article introduces the implementation of an innovative program, Play Intervention for Dementia (PID), at a nursing home in Hong Kong, with emphasis on its contribution to the conceptual framework for understanding selfhood of older adults with dementia. Research Design and Methods As a community-based participatory action research (CBPAR) project, this study democratized knowledge production by integrating voices of practitioners with diverse backgrounds through video-based methods. Results Play, as an activity replete with free expressions and impulsive interactions, is an ideal realm for exploring and establishing selfhood with older adults with dementia. It has been found that “aesthetic self”, an alternative self emerging from immediate aesthetic experience and carrying transformative power within the caring relationship, is a necessary element of self-construction in life with dementia. Discussion and Implications Integrating theories and practice, this framework provides a new lens for understanding and responding to selfhood, disease, and life.

A Theory on Caring for Women With Initial Breastfeeding Difficulties: The Breastfeeding Story as a Hub for Caring Practice

In the context of breastfeeding care, models are lacking that can guide caring practice. This article examines the prerequisites for care to be caring, based on research about breastfeeding difficulties. These prerequisites are presented as a theoretical model of caring that demonstrates that a genuine caring relationship, embodied wisdom, and an ability to create a space for dwelling, together with cultural awareness, form the prerequisites for the breastfeeding story to be a hub in caring practice. The model contributes to the development of caring practices that embrace the existentiality of each woman's breastfeeding experiences.

“We Ask for More Than We Give Back”: Negotiating the Boundaries of Informal Childcare Arrangements

There is an assumption that childcare services and workplace flexibility policies enable a seamless shift between childcare and work. Similarly, there is an assumption that informal care arrangements will be relatively seamless as the norm of reciprocity is assumed to bind families together through the bonds of love and affection. Monetary exchange for this work is seen to demean the caring relationship, but this does not mean “costs” are absent. Drawing on the work of Viviana Zelizer, this article examines how parents negotiate informal care arrangements, identifying the “payments” that differentiate family from friend care. The analysis focuses on parents working nonstandard and variable hours who were part of a broader project examining childcare flexibility, which also involved childcare providers and policymakers. This article identifies the relational work involved in the maintenance of informal care relationships and how they are negotiated when parents “ask for more than they give.”