NUR 805 Lecture Notes - Lecture 2: Breastfeeding, Ontario Health Insurance Plan, Neurosurgery

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10 Feb 2016
Module 1 & Lecture wk2 1
The importance of ‘language’
For the rst few weeks of the course, we spend a lot of time learning a ‘new’
language – new ideas expressed in a variety of ways that are not routinely part of
nurses’ every-day vernacular. Sometimes, students will say: “Why do we have to
learn all these new words? Why can’t we use language with which we are familiar?
Why do these ideas have to be understood in terms that we don’t use in our
everyday practice? This language is complicated!”
For years, nurses have been struggling to help others – the lay public and other
members of the health care team – understand nursing's unique contribution to
health care – what is that contribution? What is ‘nursing’? Part of that struggle is
related to having the appropriate terminology to express that unique contribution –
to help others recognize not just what we do but what nursing is. The use of words
to express what our practice is all about also assists nurses, themselves, to better
understand the focus of our profession.
One of the underlying themes throughout the course is that semantics is
everything. Semantics is a branch of philosophy concerned with what words
mean; the connotation of words and their meaning (
Concise Oxford
. Words are what we use to communicate; to express our ideas
and interests. Words have di<erent interpretations for di<erent people. These
interpretations are in=uenced by a person’s experience, learning and the context
within which a particular word or words are used.
If you look up the word ‘nurse’ in a dictionary, one of the denitions of that word is
to suckle an infant at the breast (
Concise Oxford Dictionary,
1976). So ‘nursing’ can
be interpreted as ‘suckling an infant at the breast’. Maybe this is why we have so
few men in nursing! Clearly, when we think about ‘nursing’ within the context of
health care, we tend to think about it as a profession involved in providing health
care to individuals and their families. Ask a new mother what ‘nursing’ is, and she
is likely to think in terms of breastfeeding her infant. See, context and personal
experience is important in how we interpret what words mean and how we use
When you – a nurse – think about the person who is receiving care from you, do you
label that person (in your mind) as a ‘patient’? a resident? a client? Why do you
label them this way? Why might this be important?
If you work in a long term care facility, you probably think about the recipient of
your care as a ‘resident’. Why is that? One denition of a ‘resident’ is someone
who has lived in a certain place for a long time (
Webster’s New Collegiate
1979). That place is the person’s home. Since that place is ‘home’,
people who live there have certain privileges and expectations about how they
should be treated in their ‘home’ – after all, it’s their home, not yours. As a result,
you likely take a specic approach to providing nursing care to them that re=ects
your understanding of how a person in their own home would want to be treated.
You likely consider their wants and needs in a di<erent way than if you were caring
for this same person in a hospital.
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Module 1 & Lecture wk2 2
Think about the words ‘patient’ and ‘client’. One denition of ‘patient’ is 'an
individual awaiting or under medical care and treatment' (
Webster’s New Collegiate
1979). The key words in this denition are ‘an individual’ and ‘medical
care and treatment’ – in other words, a person under the care of a physician.
‘Patient’ is usually a label associated with hospitals and illness. Since nursing has a
long history of association with hospitals, it’s not unusual that nurses usually think
of the recipient of their care as a ‘patient’.
Now think about the word ‘client’. One way to think about a ‘client’ is to think about
it as a person or persons 'who engage(s) the professional advice or services of
another' who they believe can best meet their needs (
Webster’s New Collegiate
If you work in a hospital, when you think about the recipient of your nursing care, do
you think about that person as a ‘patient’ or as a ‘client’? Some nurses tell me that
they always think about the recipient of care as a ‘patient’ – they would never think
of that person as a ‘client’ because, for them, the word ‘client’ is too business-like;
it’s too impersonal. So I ask them: 'Do you not think health care is a business?'
Because it certainly is – it absorbs a huge percentage of Canada’s gross national
product; it’s hugely expensive; it’s managed by government as a high cost business
item; more and more, hospitals are managed as any other corporation where cost is
the top consideration.
Think about the di<erence in the two denitions noted above: ‘patient’ versus
‘client’. Nurses care for not only the ‘individual’ but also for ‘individuals’ – family
and signicant others with whom the recipient of care is associated. ‘Patients’ are
under (or waiting to be under) the care of a physician. In Canada, the gate keeper
of the health care system isthe physician. People are admitted to/cared for in
hospital only through a physician (you, a nurse, can’t hang out a shingle and charge
OHIP for providing care to a person(s) – even Nurse Practitioners are paid through
their employer and not directly by OHIP the way physicians are). This means that,
when a person is admitted to the hospital, that person(s) benets from what you,
the nurse, have to o<er (the professional nursing care you provide) only
iatrogenically (inadvertently; by chance) – not because the person(s) chooses to
access/benet from your nursing services, but only because they receive those
services as a result of their physician-managed admission.
On the other hand, if you think about the recipient of care as a ‘client’ who seeks
out/accesses/benets from the unique services that you (the nurse) have to o<er,
this means you think about the person(s) as someone(s) who chooses you and
what you have to o<er.
In the opinion of some nurses, providing nursing services to a person(s) who has
chosen that nurse for the specic and/or unique services only a nurse can o<er that
the person, her/himself, believes will meet their needs makes the nurse feel more
empowered – makes the nurse think that her/his services (nursing care) are
important, sought after, believed by the person to be able to make a di<erence in
her/his life. What that suggests is that nursing is uniquely important in and of
itself. And this type of thinking that makes the nurse more condent in recognizing
that her/his unique contribution to that person’s health care is highly signicant.
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Module 1 & Lecture wk2 3
So what’s the point of this discussion? This simply illustrates that how we
understand and interpret words can have an impact on how we might ultimately
behave or think about our own nursing practice.
Here’s the good news: although the terminology used throughout the course – and
the new words that you may be learning to help you express the key ideas that we
will be focusing on – may seem complex at rst, by about week 5, the 'ah-ha'
syndrome kicks in…suddenly this new terminology will begin to make sense (and
you will think to yourself: 'Ah-ha!!!!!! That’s what we’re talking about!!!'). This
timing is fortuitous since the midterm exam falls in week 8!
Facilitate your own learning
You may nd it helpful to set up your own ‘glossary’ starting in the rst
week of class where you can keep a list of the terms we will be
introducing and what each term means.
Many of the ‘new’ words mentioned above will be introduced in various
weekly readings and these can be added to your ‘glossary’ as you go
along. By doing this, you will be able to more easily keep track of
material that you need in order to participate in the on-line discussion
and/or that you need to have claried in class.
You’ll also nd it helpful to keep handy some basic tools to help you better
understand the language you’ll be learning throughout the course. A
good, old fashioned dictionary and a thesaurus are two such invaluable
tools. In addition, a good philosophy dictionary (such as the one by
Martin (1994) - reference found in the ‘Recommended readings’ section
below) may be helpful.
The broad types of knowledge that constitute the required knowledge
base for nurses
While a broad knowledge base is integral to the practice of nursing, nurses cannot
rely solely on the knowledge from other disciplines upon which to base their
practice, nor can they assure that this knowledge will address the concerns of
nursing, per se.
If nurses rely on other disciplines to generate the knowledge they need, there is
considerable risk that important questions in nursing will not be addressed.
Because of their particular viewpoint on health and illness, nurses often see
problems that are passed over by persons in other disciplines or that may be
addressed in ways inappropriate for use by nurses.
So far, it is clear that nurses do use knowledge developed in other elds but they
also have developed and need to further develop knowledge specic to their own
foci and problems within practice and the discipline. Nurses need to be able to
describe, justify, and defend what nurses know and how they can be assured in
their knowledge claims. Finally, to determine the most appropriate and e<ective
directions for future inquiry, there is a need to consider the disparate ways in which
knowledge can be developed. (Rodgers, 2005, pp. 6 & 7)
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