Components Contemporary Nursing Knowledge. The Article Include:

¶ … components contemporary nursing knowledge. The article include: • Concept triangulation • Metaparadigms • Philosophies • Conceptual models theory.

Nursing concept: The relational theory of nursing

According to the article "A theory of the relational work of nurses" by Daniela Terrizzi DeFrino from Research and Theory for Nursing Practice, because nursing has always been conceptualized as a 'caring' profession in a demeaning fashion, quite often some nurses are apt to deemphasize this aspect of their work. This is particularly true in the modern, time and cost-conscious healthcare environment, where the relational aspects of healthcare treatment are discounted. "The relational work exists but is, as a general rule, taken for granted as 'nice' and not valued as the skillful and effective process that it is. It is valued neither by nurses explicitly nor by management in general" (DeFrino 2010: 294). This article asks an important question: in the new world of healthcare, what is the role of the nurse?

DeFrino's article analyzes Fletcher, Jordan, and Miller's (2000) theory of the relational work of nurses in the context of a larger psychodynamic theory of the relational practices of women in the workplace. Even if more males are working as nurses, this does not discount the theory's relevance given that so much of preexisting nursing and conceptual literature has revolved around the idea of woman-as-nurse, woman-as-caregiver, and how a woman can simultaneously be a worker and a caregiver.

The theory suggests that women tend to use different coping strategies at work, and tend to behave in a more relational than competitive fashion. Even in stereotypically male professions like engineering women tend to focus more on preserving one another's egos, upon mutually empowering strategies, creating teams, and less upon self and individualistic achievements (DeFrino 2010: 295-296). Relational strategies can often be confused with weakness and stereotypical femininity, because of current associations of strength with enclosed, clearly- defined ego barriers. Fletcher's theory was originally conceptualized to relate to all forms of female employment, but he noted it was especially relevant for nurses, given the degree to which nurses were forced to work with others, and to tend to others, as part of their profession. "Relational theory is an excellent window through which to view nursing expertise, power, and effectiveness ...There is not a theory in nursing that brings explicit acknowledgment of gender, relational practices, and workplace value together through which a fuller understanding of the dynamics of nurses' work functions" (DeFrino 2010: 297). Gender conceptions are often unspoken or only tacitly acknowledged in existing nursing theories, concepts, and metaparadigms. "The effectiveness of the relational practice, the benefits of professional satisfaction, the constraints of the current health care environment, the invisible work of nurses, and the disappeared achievements of nurses are all present in the literature. Fletcher's theory of relational work pulls it together" (DeFrino 2010: 297).

The theory of relational work of nurses has three assumptions. First, that "growth, achievement, and effectiveness" occurs only in a supportive and interconnected work environment; second is that interdependence is a positive, not a negative state of affairs for nurses; and thirdly that it is necessary for nurses to be reliant upon one another and that this produces positive outcomes for patients and for the healthcare system as a whole (DeFrino 2010: 298). The focus of a relational work environment is on preserving the work, focusing on tasks not egos; mutually empowering strategies; on self-achievement to modulate behavior in relation to others to achieve desired outcomes; and on fostering teamwork as a necessary condition of high-quality care (DeFrino 2010: 298-299).

The value of the relational theory is that it stresses how high-quality medical work can and must be relational, in a world where relationships are viewed as purely personal or simply as part of being a woman. Because nursing is viewed as a feminine profession, and nurses are still predominantly women, their caretaking can be taken for granted or viewed as a weakness. But both men and women must work together more in healthcare, to realize desired outcomes, and interdependence is essential, not a manifestation of a deficit.

Five main theory statements are as follows: a "significant amount of the nurse's knowledge of the patient comes from relational work with the patient; relational work creates positive professional rewards for the nurse.; relational work is invisible knowledge work; relational work is devalued and disappeared in a biomedical model; a disempowered nurse focuses more on tasks, experiences moral distress, and burns out" (DeFrino 2010: 300). The theory calls for, in short, an overhaul of the way that healthcare in general is viewed, not simply the nursing profession. Instead of nurses being called to become more 'like' doctors in their practices, the relational theory of nursing, while not discounting the scientific aspect of the profession, calls for nurses to be accorded equal respect with doctors, and for their relational duties to become better-integrated into the profession. "The professional duty of the nurse to know the patient more than as an object of clinical attention but to understand him or her as a subject (not an object) with a social history" (DeFrino 2010: 300-301).