This paper describes the kind of engagement and emergent learning that happened in three different sections of a graduate nursing course. Three nursing educators used an e-learning platform called Daagu that was developed by faculty guided by complexity pedagogy. A total of 43 students were enrolled in the full credit foundations course in theory and philosophy. Authors describe two specific instances of emergent learning: one was expressed by students in relation to a particular resource (article, TedTalk, YouTube, Poem) or discussion, and the second is in relation to specific “aha moments” or shifts in understanding that changed student attitudes and actions. Quotes of emergent learning provide a source of narrative data for conversing about and developing quality e-learning platforms for students and educators.

Objective: Nine nursing faculty explored the effectiveness of teaching undergraduate and graduate nursing courses using a complexity-based pedagogy with an e-learning platform. Complexity pedagogy requires a commitment by educators to reside within a networked community of teachers-learners where all participants contribute to an organically growing curriculum over the course of study. Methods: The approach is non-linear and student-centered. Faculty co-developed course outlines, resources for teaching learning, and regularly connected over a two-year time frame to mentor each other, strategize, and share resources. Individual faculty first wrote about their experiences of e-learning with complexity pedagogy and then collaborated to generate this descriptive report. Results: Faculty reported enhanced student-student engagement and higher quality critical thinking than experienced previously with traditional e-learning platforms. Conclusions: This article suggests complexity pedagogy offers quality education and merits further exploration.

This book introduces the reader to Western philosophy from historical origins to contemporary thought. The authors, Dahnke (PhD, Philosophy) and Dreher (RN, PhD, Nursing Science), state that it was written primarily for students of the Doctor of Nursing Practice (DNP) but might equally be used by students in PhD nursing programs. Nursing in this text is described as a young practice discipline that only developed over the last 100 years and currently remains intently focused on reproduction of evidence-based practice (EBP). Meanwhile, the authors maintain that inquiry and critical thinking are left somewhat on the back burner or at the very least remain in the domain of the PhD programs. There is currently a plethora of avenues to educational preparation into the nursing profession in the United States, including diploma programs outside the university. The authors argue that, as a result of this varying educational preparation, nursing seems somewhat mired in the concrete and many nurses feel alienated from more abstract levels of thinking, knowledge development, and academic research. Yet in order to be recognized as a discipline and a science, a discipline-specific knowledge base is essential. The authors make a convincing argument that all practitioners prepared at the doctoral level should be familiar with philosophy of science to be able to carry out knowledge development in order to ground and legitimize stewardship of their own disciplinary practice. After reading this book, the authors hope this text will facilitate a shift of students’ thinking from the concrete to the abstract, as “doctoral education is about debate and discourse, and not merely acquiescence to another scholar’s ideas” (Dahnke & Dreher, 2016, p. xvii). Furthermore, students should be able to answer the question of whether nursing is a science. Lastly, the authors anticipate that the gap between the two professional nursing communities, one of researchers and the other of practitioners, will be narrowed by using this text as a starting point for discussion (p. xix). The first two chapters deal with what it means to be a practice discipline, particularly its interpersonal aspects. The authors elaborate on concepts such as practice, discipline, profession, the role of ethics, and who should be able to generate knowledge within a discipline. In chapter 3, the authors deliberate on the role of philosophy of science in the practice discipline of nursing. Questions are raised about how much philosophy is needed in the DNP curriculum, as opposed to the more academically oriented PHD programs. There is also discussion about what should be a requirement for graduation from a DNP program. Should DNP students produce more practical types of projects, or should theses or dissertations be an expectation? Various types of research with practical knowledge and application research are proposed (Dahnke & Dreher, 2016), preferably conducted in the students’ own practice environments to ensure usefulness and relevancy for the practitioner. This type of actionable research could further expand and enrich the knowledge base of the discipline. Chapters 4 to 14 introduce the student to Western philosophy and philosophizing beginning with the ancient world philosophers, like Socrates and Plato, and ending with contemporary social sciences and post-modernism. The basic concepts of philosophy are discussed in chapter 4 and the concepts of science in chapter 5. Chapter 6 focuses on the last 100 years, when philosophy of science became a clearly identifiable branch. Various presumptive theories are introduced here and further elaborated on in the following chapters. The purposes and functions of theory in describing, sometimes predicting, and other times explaining the world and its phenomena are discussed. Science, scientific method, and deductive and inductive logic in scientific investigation are also explored. Lastly, the reader is introduced to feminist 661117 NSQXXX10.1177/0894318416661117Nursing Science QuarterlyDaiski book-review2016

Type 2 diabetes (T2DM) is a serious life-threatening chronic disease whose prevalence is especially high among Canadians living in poverty. And these Canadians with T2DM in poverty are especially likely to experience serious consequences of the disease. Of special concern is Statistics Canada reporting an explosive increase in mortality rates from diabetes (of which 90% represent T2DM) in low-income urban neighbourhoods across Canada. We place findings from interviews with 60 Canadians with T2DM who live in poverty within the context of recent shifts in public policy that have affected the distribution of the social determinants of health. Findings of material deprivation among our participants indicate that it is almost impossible for these individuals to acquire the diet necessary to prevent the adverse outcomes associated with T2DM. These findings draw attention to consideration of the important role public policy plays in affecting the situation of people living in poverty who are afflicted with T2DM and other chronic diseases.

This paper describes findings of a research inquiry into the lived experience of homelessness in Peel, a suburban region located in the Greater Toronto Area in Ontario, Canada. It is based on the data from a collaborative project undertaken by members of the Faculties of Health and Education of York University with two local community organizations. The dominant theme of the narratives was that suburban homelessness is similar to being engulfed in a grotto of poverty, isolated from the rest of the community and invisible to it. Once entrapped in the grotto, it is almost impossible to escape from it. There were four sub-themes: (a) falling into the grotto, (b) living/struggling in the grotto, (c) envisioning escape routes from the grotto, and (d) beauty, community and hope in the grotto. Following a discussion of the findings, researchers describe strategies to address homelessness through promotion of social justice for all.

This paper sheds light on the dynamic relationship between people's experiences of low income and the development of type 2 diabetes (T2DM) by moving beyond the static perspective provided by cross-sectional studies to a long-term approach informed by longitudinal analyses. Methods: We analyzed data from the Canadian National Population Health Survey (NPHS) conducted by Statistics Canada from 1994 to 2007. The longitudinal sample is composed of 17,276 respondents (8046 males, 9230 females) 12 years of age or older. We further developed an algorithm to distinguish T2DM from other types of diabetes. Proportional hazard models with time-varying predictors were used to explore the dynamics of the relationship between low income and T2DM. Results: The results suggest that living in low income and experiencing persistent low income are significant precursors of developing T2DM. Being in low income in the previous cycle of T2DM onset was associated with 77% higher risk of T2DM (hazard ratio 1.77; 95% CI: 1.48-2.12). The association between low income and diabetes incidence remains significant after adjusting for age, sex, health behaviors, and psychological distress (hazard ratio 1.24: 95% CI: 1.02-1.52). Conclusion: This study contributes to the under-developed research examining longitudinally the relationship between socioeconomic status and diabetes incidence. Employing this long-term approach, this study calls attention to the primary effect of socioeconomic position on diabetes incidence that cannot be explained entirely by behavioral factors. Findings draw attention to the need to address the role played in T2DM by the inequitable distribution of the social determinants of health. Crown Copyright (C) 2012 Published by Elsevier Ireland Ltd. All rights reserved.

Objectives: To identify a) ways of enhancing health services for vulnerable populations with type 2 diabetes, taking into account the social determinants of health; and b) health and social policy approaches to reducing the incidence of type 2 diabetes and improving its management. Methods: Focus groups were held with 18 community healthcare providers at 3 community health centres in Toronto, Ontario. Results: Community healthcare providers' perspectives were organized under 3 themes: a) the compounding effects of social factors on the health of people with diabetes; b) the need for responsive support at multiple levels; and c) barriers to change. Participants showed a good understanding of the impact of social determinants of health on patients' lives, and they had many ideas about prevention/ health promotion and strategies to enhance health services. They seemed less aware of the important role that political advocacy can play. Conclusion: Assessment of the policy environment and political advocacy through coalition-building with communities and other health and social sector service providers should become part of healthcare professionals' education and responsibility. Adequate income and access to proper resources would help with the prevention and optimal management of diabetes.

OBJECTIVE: To enhance understanding about how living on a low income affects patients' self-management of type 2 diabetes, from their perspective.METHOD: A qualitative inquiry using semi-structured interviews was conducted to explore the experiences of low-income persons with type 2 diabetes. Participants were 60 patients from 4 community health centres in a large Canadian city.RESULTS: An overarching theme and 3 sub-themes were generated, which describe participants' struggle to survive and manage their diabetes as best they can, given their circumstances.CONCLUSIONS: Findings support the importance of providing patient-centred care, incorporating poverty as a clinical risk factor, assisting patients to access resources and advocacy to bring about policy changes needed to prevent and properly manage diabetes.

This paper contributes to a growing body of literature indicating the importance of income as a key socioeconomic status marker in accounting for the increased prevalence of type 2 diabetes (T2DM).Methods: We analyzed data from the Canadian Community Health Survey cycle 3.1 conducted by Statistics Canada. Descriptive statistics on the prevalence of self-reported diabetes were computed. Multiple logistic regression was used to examine the association between income and prevalence of T2DM.Results: In 2005 an estimated 1.3 million Canadians (4.9%) reported having diabetes. The prevalence of T2DM in the lowest income group is 4.14 times higher than in the highest income group. Prevalence of diabetes decreases steadily as income goes up. The likelihood of diabetes was significantly higher for low-income groups even after adjusting for socio-demographic status, housing, BMI and physical activity. There is a graded association between income and diabetes with odds ratios almost double for men (OR 1.94, 95% Cl 1.57-2.39) and almost triple for women (OR 2.75 95% Cl 2.24-3.37) in the lowest income compared to those in highest income.Conclusion: These findings suggest that strategies for diabetes prevention should combine person-centered approaches generally recommended in the diabetes literature research with public policy approaches that acknowledge the role of socioeconomic position in shaping T2DM prevalence/incidence. Crown Copyright (C) 2010 Published by Elsevier Ireland Ltd. All rights reserved.

AIMS AND OBJECTIVES:To examine and critique various models guiding the care and education of people with diabetes, to develop more helpful and effective approaches to care. The focus is on relationships and communication between patients and healthcare providers.BACKGROUND:Many patients are not adhering to the recommended treatments, hence it seems that effective diabetes care is difficult to achieve, particularly for patients of lower socio-economic status, who are disproportionately afflicted. The results are usually devastating, and lead to serious health complications that incisively diminish quality of life for patients with diabetes, frustrate healthcare providers and increase healthcare costs.DESIGN:Critical review.METHOD:This paper represents a critical review of various approaches to diabetes care and education. A CINAHL search with relevant key words was carried out and selected exemplary research studies and articles describing and/or evaluating the various approaches to diabetes care and management were examined. Particular attention was paid to how the paradigmatic underpinnings of these approaches construct patient - healthcare provider relationships.CONCLUSION:The literature revealed that the traditional top-down approaches to care were largely ineffective, while collaborative approaches, based in respect and taking the whole persons and their unique situations into account, were found to be central to good care. Further, an integration of the different kinds of knowledge contained in the various approaches can complement and extend one another.RELEVANCE TO CLINICAL PRACTICE:Avoiding devastating complications by improving the management of diabetes and overall quality of life of patients is a worthwhile goal. Therefore expanding diabetes care beyond the traditional bio-medical model to develop more effective approaches to care is of interest to all healthcare professionals working in this area.

Aim. This paper is a report of a study of the perspectives of homeless individuals on their health and healthcare needs.Background. Many studies show the high incidence and severity of diseases, physical and mental, amongst the homeless populations. However, the views of homeless people themselves are usually omitted. In order to provide appropriate care, healthcare professionals need to be aware of these perspectives.Method. A descriptive, exploratory design, using semi-structured interviews and observational field notes, was chosen for this qualitative study. A convenience sample of 24 participants experiencing homelessness was recruited in one Canadian city in 2005.Findings. Participants described their health and healthcare needs in a holistic sense. They reported concerns about physical illnesses, mental health, addictions and stress. Shelter life promoted spread of diseases and lacked privacy. Violence was rampant in shelters and on the streets, leading to constant fear. There was emotional distress over social exclusion and depersonalization. Participants wanted to work and to be housed, yet felt trapped in a dehumanizing system.Conclusion. The recommendations are (a) elimination or mitigation of most health problems of the homeless through safe, affordable housing; (b) reintegration into the community through job counselling, treatment of addictions and employment. Negative societal attitudes towards these clients need to change. Healthcare professionals, particularly community nurses, have opportunities to collaborate respectfully with these clients and work for changes in public policies, such as national housing and addiction treatment policies, and for streamlined, humanized services to smooth the processes of social reintegration.

Oppression exists at many levels and in varying degrees. To demonstrate how marginality affects differently situated professionals, two occupational groups considered to be marginalized were studied: bedside nurses and elementary core French teachers. The findings confirm that women (and men) in ‘feminized’ fields experience, as well as exercise, oppression. Devaluation of their worth is internalized and taken for granted by most who inhabit these work spaces, including the members concerned. While those groups ‘on top’ bully those ‘below,’ dominance is also reinforced laterally amongst the members. Thus marginality between groups, as well as within them is thereby produced, with the centre of oppression constantly shifting. The authors conclude that professionals are not unified categories, readily distinguishable from outside oppressors. Their members, too, are caught up in power relationships amongst themselves. Recognition of the shifting centre of oppression is an essential first step to improve conditions for the marginalized.

The Health Bus, an innovative outreach program, serves the marginalized population of a large Canadian city. In this article, a needs assessment/evaluation study of its services is discussed. Barriers to mainstream healthcare and solutions are examined. This study was qualitative, descriptive, and exploratory and surveyed 58 client volunteers of the program through semistructured interviews and focus groups. Thematic analysis of data was carried out. The Health Bus was found to provide basic healthcare and supplies effectively. Clients value respectful treatment, competency of healthcare professionals, and accessibility, whereas disrespectful treatments and lack of transportation are barriers to mainstream healthcare. A conclusion of this study is that Health Bus services should be expanded with clients' input. Mainstream institutions need flexibility and a change in attitudes toward the marginalized.

This qualitative study reports on the perspectives of hospital staff nurses regarding the recent restructuring of Canadian healthcare.They were the group on the front lines bearing the brunt of the changes.Yet, mostly they had not been consulted, as the decisions were made elsewhere.Twenty staff nurses working in a variety of Toronto hospitals were interviewed and described the impacts on themselves and their patients.While restructuring focused on deficit reduction and increased efficiency, the factors affecting quality of patient care and work life of nurses were neglected.The major strategies employed -increased workloads, casualization and deskilling -changed nurses' work at the bedside.Stable teams disappeared as nurses were hired into casualized positions.Care was reduced to specific tasks and routinized, to be carried out by a "skill-mix" of workers.The nurses' relationships with patients, the "heart and soul of nursing," became largely limited to managing care for a number of patients over one shift.Lack of time and continuity with their patients left nurses dissatisfied.The voices of bedside nurses and their suggestions for change add some novel perspectives to the restructuring discourse.This study reports on the thoughts and experiences of hospital staff nurses during the recent restructuring of the Canadian healthcare system.The purpose is to bring nursing voices into the discussion about the effects of restructuring and the possible changes that nurses envision.

BACKGROUND:Nurses' inter- and intra-disciplinary relationships are frequently interpreted as oppressed group behaviours, contributing to their relatively dis-empowered status. In the context of restructuring in health care, this study examined the views of hospital staff nurses about their relationships with nursing colleagues and other health care professionals and their ideas for change. AIM:The aim of this paper is to report a study to add the views of staff nurses to the discourse on restructuring and to make visible the processes that contribute to their marginalization. DESIGN:The study was descriptive and exploratory. Staff nurses from various hospitals in a large Canadian city were selected by theoretical sampling. METHOD:Twenty volunteer staff nurses were interviewed between 1998 and 1999, using broad, open-ended questions and prompts to explore nurses' various relationships in the health care system. This approach allowed for multiple responses and expansions of ideas, without losing focus. The interviews were audio-taped and later transcribed. Thematic analysis was carried out. FINDINGS:Many participants were aware of inter-disciplinary hierarchies, particularly between nurses and physicians. Many also showed insights into their own intra-disciplinary hierarchies and mutual non-supportiveness. Both types of relationships were found to be inextricably linked, sustaining nurses' oppression through dis-empowering discourses. Nurses expressed many ideas about how to promote mutually supportive relationships. CONCLUSION:Change for the better needs to come from within the nursing profession. To develop effective strategies, bedside nurses have to be included in decision-making processes affecting them and their practice, about which they are the experts. Mutual respect, awareness-raising through education, development of caring nursing communities, mentorship and non-hierarchical leadership are key to stopping dis-empowering discourses and practices amongst nurses.

Nursing InquiryVolume 11, Issue 2 p. 117-121 Response to ‘The influence of liberal, political ideology on nursing science’, an article by Annette J. Browne (2001) Isolde Daiski, Isolde Daiski York University, TorontoSearch for more papers by this author Isolde Daiski, Isolde Daiski York University, TorontoSearch for more papers by this author First published: 20 May 2004 https://doi.org/10.1111/j.1440-1800.2004.00208.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume11, Issue2June 2004Pages 117-121 RelatedInformation