Nursing

Joan Liaschenko (1994), a nursing researcher interested in the nature of nursing and nursing work, and who acknowledges a Foucauldian philosophical influence (Foucault, 1975), has argued that nurses now routinely extend the physician's "gaze" within and across various health care settings. Such an extension impacts the nursing profession's ability to implement its own more holistic gaze as well as its ability to facilitate patient agency. She has argued that nursing work, whether carried out in the home or in institutional settings, is conducted within "gendered space" that reflects “literal and metaphorical space in the social and political life of societies" (Liaschenko, 1997, p. 51). In a qualitative study in which she asked experienced, educated nurses to speak about an incident from their practice that highlights ethical concerns, she found that the delivery of patient care and the execution of nursing practice were subject to the social and political space occupied by both patients and nurses. Multiple "spatial vulnerabilities" were found which then significantly impacted both patients and nurses. These vulnerabilities included poverty, the exploitation of patients to meet institutional needs, the homogenization of patient identity, and the fragmentation of patient and family care. After asking, "... what is the place of nurses" and "Do they even have a place?" (p.52) she argues that, although nurses are seen as both nurturers and executors of physician orders, the socially reinforced portrayal of nursing work "fails to reveal a whole domain of absolutely essential work" (p.52) (what she calls complex connecting or relational work) that "literally keeps the patient cared for and the institution going" (p52). Dissertation Introduction

The reason nursing work is not seen, she argues, is because, "as a society we have been schooled to see the work of medicine rather than the work of others as most significant in patient care." (p.52) - this invisibility of nursing work occurs because it is work conducted by women, viewed as women's work, and therefore devalued. Nursing work, Liaschenko argues, becomes at risk of turning into instrumental work that serves more powerful and visible interests (physicians, administrators, insurers). She concludes by making a case for a linkage between nursing and human and/or cultural geography because of the scope (local, global, structural) that this sub discipline can bring to a consideration of care environments.

In a related article, Peter and Liaschenko (2004) note that the construct of proximity, that is, nearness to patients, is problematic because of the issues related to moral ambiguity and moral distress that it can elicit—proximity "(can) propel nurses to act, it can also propel nurses to ignore or abandon" (p218). It may be that proximity itself is not the problem but rather the deficiencies and inequities within the health care system that is revealed by the various types of proximities that nurses are able to develop with patients and families. Peter and Liaschenko argue that nursing needs to bring others (administrators, physicians, policy makers, and the public) into proximity with patients so that the moral ambiguities can be better understood and appreciated. They also argue that nurses need more frequent breaks and quiet areas away from patient care, and that nurses in academia need to teach new nurses how to "articulate their practice, including the social space they occupy" (p.223). Finally they argue that a more robust exploration of nursing ethics, especially as it relates to the moral ambiguity that can develop with proximity to patients, could assist in deescalating the moral distress that may be a large component of the stress nurses experience in their work.

Malone (2003) has also considered issues encompassing physical space, health policy, nursing care and nursing ethics - arguing that the ethical integrity of contemporary professional nursing practice in hospitals is increasingly at risk because the three types of proximity that hospital nurses have traditionally had with patients (physical, narrative, and moral), and that are fundamental to ethical nursing practice, are being threatened by contemporary health care management practices and policy. In particular, "hospital nursing is spatially vulnerable (and that) a taken-for granted proximity to patients...” is acutely threatened by the localized special and power dynamics of macro-originated economic and ideological pressures." (p. 2318). Malone grounds her argument within two theoretical perspectives: 1) The phenomenological perspective on space and place that argues that place "grounds our subjective, embodied experience and can only be understood through experience" (p. 2318) as articulated by Casey (1993) and Malpas (1999); and 2) Critical and historical perspectives that address the power relations embedded in place and space (Foucault, 1975; Foucault, 1977; Lefebvre, 1991; Massey, 1994).Dissertation Introduction

Malone portrays professional nursing practice as a relational one in which the nurse develops three types of proximity with patients—physical, narrative, and moral. Physical proximity is a proximity that develops when a nurse gains particularistic knowledge about a patient's body. Narrative proximity is a proximity that develops when a nurse gains particularistic knowledge about a patient's background, i.e. his or her "story". Moral proximity is a proximity that develops when a nurse has developed both a physical and narrative proximity with a patient, and because of these proximities (knowledge), is able to infer what a patient may desire or wish, but may be unable to articulate. She argues that these proximities are nested within each other—physical proximity enables narrative proximity, which then enables moral proximity—and that these three types of proximities are limited by contemporary forces in health care, which include: 1) chronic nursing shortages, the use of flexible staffing structures, and the use of lesser-trained and lesser-empowered health care workers; 2) shorter lengths of stay, structured forms of nurses' notes (charting by exception), and multiple care settings; and 3) abstract classification systems and standardized plans of care that reduce patient care down to a series of tasks to be managed and/or outcomes to be achieved. Malone calls this evolution "distal" rather than "proximal" nursing and believes that it may lead to a "we're just running the trains" mentality within the profession (p. 2324).

Human/Cultural Geography

Gavin Andrews, a geographer within the School of Nursing at the University of Toronto, has echoed and reinforced Liaschenko's call for a link between nursing and geography, calling for a "geography of nursing" linking the broad constructs of nursing, people, health, space, and place (Andrews, 2003 a). He argues that Nightingale used geographical references to space and place within Notes on nursing: What it is and what it is not, such as her articulation that, for proper healing, patients need, among other things, ventilation, warmth, light, and proximity to nurses (Andrews, 2003b), and that given the increasing diversity of places and spaces in which nursing occurs, an emerging area for a trans-disciplinary scholarship linking nursing with health geography could begin to examine the dynamic relationship between people, health, and place (Andrews, 2002).

Health geography emerged in the 1990's as a theoretical and social development of medical geography, an area of 20^th century research that has traditionally addressed spatial and geographical issues related to disease distribution as well as the distribution, accessibility, and utilization of health care services facilitated by humanistic and Marxist oriented critiques of the prevailing views of geography as spatial science that emerged in the 1970's (Andrews, 2003). Andrews notes that work by Liaschenko has already begun to examine how patient care settings reflect larger economic, social, and cultural issues. Other scholars have noted that the discipline of cultural studies may be a vantage point to study the complex interrelationship between power, technology, culture, and space (Poland, Lehoux, Holmes & Andrews, 2005).

One study pertinent to a consideration of hospital nursing work environments that reflects the geography of nursing emphasis called for by Andrews is a study of English hospital nurses conducted by sociologists (Halford & Leonard, 2003). It explores how the material space within hospital settings influenced the construction and performance of nursing identities. Repeated observations were made of staff level nurses within a large 700-bed district hospital and smaller 60-bed community hospital. Observation sheets were used to record details related to the physical environment, the individuals present, activities, movements, and conversations that the researchers had with the nurses. The findings included that, in comparison to physicians, nurses had less access to various hospital spaces and that many of them were virtually confined to the wards in which they worked. Additionally, the public "ward space" of the units was the only space that many nurses had access to and that within these ward spaces, little or no space that was allocated to them as specific individuals. They also found that nurses were allocated significantly smaller amounts of private space than physicians. They concluded that the material space within the hospital work environments did have implications for the construction and performance of the nurses' workplace identities.

Work-Related Stress and the Physical Work Environment

Work-related stress (defined as work-related physical and mental strain) is accepted as a contributing factor in negative individual and organizational outcomes such as poor job performance, absenteeism, job dissatisfaction, turnover, and health problems (Brisco, 1997; Caplan, 1975; Heerwagen et al., 1995; Theorell & Karasek, 1996). Worker health and organizational productivity has also been linked (Murphy & Cooper, 2000). The role of the physical work environment on worker health and productivity and organizational health and productivity has also been theorized (Becker, 1981; Becker & Steele, 1995; Carnevale, 1992; Vischer, 1996). The health of work environments has been theorized as varying along a continuum; healthy work organizations promote and/or maintain worker health and organizational productivity. Healthy work environments are conceptualized as ones that successfully address the issue of work stress. Karasek has theorized that employee involvement and input into the work environment, reduces the risk of heart disease among workers (Karasek, 1990).

The management of occupational stress through changes in the physical work environment is the subject of a review (Heerwagen, et al., 1995), which arguea that although the issue of work stress is of critical importance, organizational leaders all too often assume that the root causes of these problems lie within individual workers, not the physical environment. Australian researchers reached a similar conclusion in a case study of work stress within a public hospital (Trubshaw & Dollard, 2001).

Research Using Person-Environment (PE) Fit TheoryDissertation Introduction

PE Fit theory has been proposed as a theoretical framework for addressing work related stress (Caplan & Van Harrison, 1993; French, 1982; Van Harrison, 1978). The roots of the theory have been attributed to Kurt Lewin's Human Needs Field theory (Lewin, 1951) and Henry Murray's Needs-Press theory of personality (Murray, 1938). Lewin theorized that human behavior was a function of the person within the environment. Murray envisioned people as having basic needs (for safety, socialization, privacy, accomplishment, etc.), while the environment exerted various types of "press" or demands on them. PE Fit theory argues that people within their environments exhibit varying levels of congruence or "fit". When a person's needs match his or her environmental press, it results in congruence or a "good fit", which facilitates the satisfaction of needs and attainment of goals. A "bad or poor fit" hinders the satisfaction of needs and attainment of goals leading to strain, dissatisfaction, and/or other negative outcomes.Dissertation Introduction

Dissertation Introduction Theory

Dissertation introduction is one of the most essential parts of your dissertation. It is the arrangement of your suppositions that has to be proved even as conducting research moreover in theory, or practically. Theoretically proved supposition means that you will have to use theoretical clarification for proving your point of view on the difficulty. Practically proved statement means that you will have to resort to moving out the experiments in arrange to show your estimation.

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Each dissertation introduction must there the purposes of your search. The most important purpose of your search is to demonstrate this or that point of vision.
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Dissertation Introduction Chapter

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Dissertation Introduction

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The Importance of the Dissertation Introduction

The dissertation introduction part is one of the most important parts of your whole dissertation. It is where you first initiate the topic of your paper, where you present an overview of the background of your research, and where you publicize your intentions. It is, in a way, your dissertation’s first idea. Consequently, it is very important that you boot it off right!

While consider likely dissertation ideas, you have to consider the dissertation introduction. Principally, you have to ask yourself – will this thought, or that one, lend itself well to an introduction? Will you be intelligent to keep the introduction both concise and informative? Questions such as these can keep you from choosing too large a topic and too narrow a subject. Believe it or not, some dissertation thoughts are too large, even taking into deliberation how much time you will have to write your dissertation. This is especially true with the MA dissertation. It may seem like you have all the time in the world and like you need not worry about the amount research involved in your subject, but assuming that could be a big mistake. You see, you do have to take the research process into account, plus any interviews, all the time you will need for editing and rewrites, et cetera.

The research paper writing necessary for your dissertation introduction is very specific. Unlike the introduction of other academic papers, your dissertation introduction is very involved. You will begin by presenting your main problem, argument, issue, et cetera. You need to include all the vital details concerning the importance of your topic investigation. Succinctly, you need to talk about what you are hoping to discover, how you intend to do discover those things – i.e., your methodology. However, all the technical information required does not preclude creativity. You can write your introduction with your own style and flair, as long you remember to get all the pertinent facts in place.

Now then, your introduction is actually comprised of several sections, which is yet another thing that makes dissertation writing different from other forms of academic writing. In the first part, you need, like say, to introduce your topic and its background. It is very important to discuss all aspects of your chosen topic, in order to show how it is relevant to your field of study and to prove just how and why the research will be important. The second part is actually the first part of your thesis and the various sections of study into which it fits. Thirdly, you simply continue to illustrate your over all theme and link its relevancy to your field of study. Lastly, you simply tie the entire introduction together, in such a way that it flows naturally into the first paragraph of the body of your dissertation.

In the direction of set it simply, the dissertation introduction needs to present and explain the authentic purpose of your research and analysis. You need to present all the relevant information and methodology, which you will actually define in the body of the essay. For some students, this process is not only deadly, but confusing. If you have difficulty understanding how to set up your introduction, there is dissertation help at your removal. For example, you may find it helpful to look at examples of other dissertations, consequently you can really see the good format in action.

It’s All About Dissertation Introduction

Possibly the a large amount important part of your paper, a dissertation introduction informs about the topic of your writing and provides a conditions to your research.

Dissertation introduction is a part of your thesis project that contains the most important purposes of your examination and the ways you want to get them. What you need to do in dissertation introduction, on the other hand, is express your proficiency and research skills. You also have to stress your professional domain and the capability to present result. Try to acquire your hands on some earlier dissertation samples.

A dissertation introduction starts with the presentation of your main problem. It should give details the importance of the investigation of the topic you have chosen. You simply state what you want to discover and what methods you intend to use in order to achieve your purposes. Someone might think that writing a dissertation introduction is rather a tedious task. You may agree, but do not think it is easy as it does not have to be creative. By looking some past dissertation sample you can have a better idea regarding this. You have to describe your intentions, and the measures you are going to apply in order to satisfy your intentions.

The first portion must introduce the topic and the background of the various envelopments the topic brings with. The direct nature for exposure of the entire length must be done so that one is able to stand for the various sub sections the topic can be broken into..

The second section deals with the first sub-section of the thesis and the various categories into which the sections must comprise. It deals with the chapter one of the paper and the very illustration of what the section contemplates and focuses.

The next sections would make sure that all the further chapters are described and the objectives are to be harbored for the purpose of getting the job done. The various aims of the section must be explicitly taken care so that enough illustration is carried for the paper and the genuine interest for the successful making of the arguments is catered to its very best.

The concluding section takes variety of options and aligns the very topics conclusion and the passion to make a difference. It takes into account the various sections that are discussed so that one is able to take control of the moments of the master’s paper and the various precise behavior of the paper on the whole.

All dissertation introductions should present the purposes of your examination. The main purpose of your investigation is to prove this or that point of view. Your dissertation introduction should also present the subjects and objects of your investigation. The introduction subject is what your investigation is going to. The objects are the means of achieving your purposes. Your dissertation template introduction should also present the methods you are going to use during your investigation: whether you apply an interview, or a questionnaire, or perhaps you are to use the observations only (depends on your topic). Every point of your dissertation introduction should be marked out either by italics, or by bold type. Your dissertation introductions should be 1 or 2 pages long. But the main thing about the dissertation introductions is that they should clearly present the hypotheses.

Top Dissertation Introduction Tips

A good formula for your dissertation introduction is to put the subject in context as in a few words as possible. Answer the question: why do this study? Why now? Why here? Why me? State the aims of the study.

Chapter one is very important and is possibly best compiled by answering a series of questions as follows.

· Is there a problem?

· What is it?

· Why does it need to be solved?

· What is your hypothesis (hunch)?

· Who will benefit from your investigation?

· In what sense will they benefit?

· In what sense will my contribution add to what is already known?

· How in general terms are you going to solve the problem, e.g., collect data, analyze data?

· By what methods? E.g., a case study approach.

· What are the constraints or limitations of the study?

A good way to end the dissertation introduction is to state the dissertation objectives. Don't forget that this is a SHORT intro for your reader to the subject, to put the issue in context. The background and history will be dealt with elsewhere.

Developing Your Dissertation Introduction

It is a good idea to get dissertation introduction help from a dissertation consultant when you are ready to begin writing the dissertation introduction chapter. You should definitely get dissertation introduction help from a dissertation consultant if you feel over whelmed or don't know where to begin. Here, we provide some dissertation tips that may help you conceptualize and write the first chapter of your dissertation- the dissertation introduction chapter

The first chapter of the dissertation is the dissertation introduction. The introduction chapter of the dissertation is the first chapter and it sets the stage for what will be presented in the pages that follow it. There are some helpful dissertation writing tips you can try when writing the dissertation introduction chapter. We do not go into detail here, but we describe what should be in the dissertation introduction chapter of your dissertation. These are general dissertation writing tips for the dissertation introduction. For specific issues related to your dissertation introduction section you may want to contact a dissertation consultant for dissertation introduction writing help.

The introduction chapter of your dissertation should include a:

1) A statement of the dissertation problem,

2) A brief overview of the dissertation study,

3) A discussion about the significance of your study and

4) A description of the various dissertation chapters.

Each of these sections will be reviewed in more detail below. Remember to contact a dissertation consultant for help with the dissertation introduction. Getting dissertation writing help with the introduction could save you time and prevent some of the dissertation anxiety you may experience.

The first section of the dissertation introduction section is a statement of the problem your dissertation addresses. You are showing the reader why your dissertation is important. In this section of the introductory chapter of the dissertation tell the reader what major problems your dissertation will address and how your dissertation will fill any research gaps. Through writing, show the reader why your dissertation matters and how it might help the field. Dissertation consultants can be especially useful when you are conceptualizing the problem your dissertation addresses. A dissertation consultant can help you conceptualize and write this section of the dissertation introduction.