- Dr. Jane Georges is Dean and Professor of Nursing at the Hahn School of Nursing and Health Science at the University of San Diego.edit
This paper is a personal dialogue of maneuvering the landscape of scholarship in the United States as a nurse faculty. The principal thesis of this paper is that a discursive shift from margins to mainstream literature has occurred within... more
This paper is a personal dialogue of maneuvering the landscape of scholarship in the United States as a nurse faculty. The principal thesis of this paper is that a discursive shift from margins to mainstream literature has occurred within nursing discourse during the past 20 years as the result of a growing body of work by nurse philosophers. I utilize my own work in nursing philosophy as an exemplar and provide a narrative situated in a feminist‐critical paradigm. This paper: (1) presents a historical background through a critical‐feminist lens of the discursive shift using my own work and lived experiences as exemplars; (2) examines a contemporary mainstream ‘authoritative’ text as an exemplar of this discursive shift and (3) proposes both potential positive intersections and threats in the future development of nursing philosophy resulting from this discursive shift.
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Grounded in a feminist perspective, a narrative analysis of letters written by Martha Lohmann, a nurse who served with the German Army on the Eastern Front in World War II, is undertaken. Utilizing... more
Grounded in a feminist perspective, a narrative analysis of letters written by Martha Lohmann, a nurse who served with the German Army on the Eastern Front in World War II, is undertaken. Utilizing "gaze" as a focus, an exploration of the narrative and the multiple gazes embedded within it is performed. Implications for future analysis of nurses' textual accounts of violence, armed conflict, and war are presented.
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The primary purpose of this study was to examine the previously untested relationships between moral distress, compassion fatigue, perceptions about medication errors, and nurse characteristics in a national sample of 205 certified... more
The primary purpose of this study was to examine the previously untested relationships between moral distress, compassion fatigue, perceptions about medication errors, and nurse characteristics in a national sample of 205 certified critical care nurses. In addition, this study included a qualitative exploration of the phenomenon of medication errors in a smaller subset of certified critical care nurses. Results revealed statistically significant correlations between moral distress, compassion fatigue, and perceptions about medication errors in this group. Implications for critical care nurses seeking to create work environments conducive to the reduction of medication errors are explored.
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Research Interests: Sociology and Perfection
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Janice M. Morse's article in Advances in Nursing Science (24:1) revised and summarized the major findings of a research program exploring the behavioral-experiential nature of suffering. Using a... more
Janice M. Morse's article in Advances in Nursing Science (24:1) revised and summarized the major findings of a research program exploring the behavioral-experiential nature of suffering. Using a feminist critical theory stance, this article addresses Morse's conceptualization of a praxis of suffering. First, it identifies the strengths and contributions of Morse's body of research to nursing science. Next, it undertakes a critique situated in feminist critical theory in which the limitations of Morse's work are explored using exemplars from the Western literary tradition. Finally, the article proposes a new conceptualization of an alternative contextual praxis of suffering in which nurses' responses to suffering are situated in an emancipatory paradigm of authentic presence.
Research Interests: Nursing, Epistemology, Praxis, Politics, Feminism, and 15 moreMedicine, Philosophy of Nursing, Knowledge, Experiential Learning, Humans, Freedom, Science and Medicine in Literature, Religion and psychology, Nursing Theory, Psychology of Power, Conceptualization, Social Dominance, Situated, Psychological Models, and Nursing Science
Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for... more
Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for nursing science. Discourse analysis of local narratives and metanarratives is undertaken as a basis for proposing alternative methods, including a critical humanities approach, for nurse scholars to use in creating a transformed, politicized epistemology of suffering.
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This philosophical article utilizes the concept of "the Unspeakable," referring to the creation of biopolitical spaces for nursing in which compassion is... more
This philosophical article utilizes the concept of "the Unspeakable," referring to the creation of biopolitical spaces for nursing in which compassion is rendered severely diminished to impossible. The effect of the Unspeakable in shaping nursing practice is explored in contemporary health care. Local, autobiographical narratives are used to illustrate the effect of the Unspeakable on nursing in both the academic and clinical settings. Alternative strategies for resisting the Unspeakable and promoting compassion as an essential element of effective nursing practice are proposed.
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Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant... more
Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant discourse informed by the processes and values of "science" in the Enlightenment sense and a concurrent marginalized discourse informed by postmodernism, are described as a context for the emerging discourse. A genealogy informed by the work of Foucault is presented as a basis for an analysis of the power effects resulting from the conflict between these 2 discourses. Finally, 3 recent texts in nursing are analyzed and common themes identified as indicative of a new intertextual discourse, termed "epistemic diversity," emerging from this discursive conflict.
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The growing exodus of indigenous people from Mexico into the United States, especially from the multiethnic state of Oaxaca, is used as an exemplar of the global phenomenon of transnational migration and its effects on health. Lately,... more
The growing exodus of indigenous people from Mexico into the United States, especially from the multiethnic state of Oaxaca, is used as an exemplar of the global phenomenon of transnational migration and its effects on health. Lately, indigenous Oaxacan women have become a predominant part of this diaspora in the United States. Driven by economic desperation most arrive across the border as undocumented persons that configure them into multiple liminal spaces inimical to health and well-being. This article provides a venue for some of their voices to be heard, some major concerns understood, and for proposing links between postcolonial Mexico, neoliberal globalization, and immigration border policy as driving forces that undergird these conditions. An emancipatory praxis of nursing to promote health and reduce suffering within transnational migrants is proposed as a starting place for future nursing scholarship.
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Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between... more
Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age ( t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.
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The medical experiments conducted on non-consenting prisoners of Nazi concentration camps during World War II necessitated the codification of principles to protect human subjects of research. Auschwitz was the largest and one of the most... more
The medical experiments conducted on non-consenting prisoners of Nazi concentration camps during World War II necessitated the codification of principles to protect human subjects of research. Auschwitz was the largest and one of the most infamous of the camps and the site of numerous 'medical' experiments. This historical study uses primary source documents obtained from archives in England and Germany to describe one type of experiment carried out at Auschwitz - the sterilization experiments. The purpose of these experiments was to perfect a technique in which non-Aryans could be prevented from reproducing while still being able to work as slave laborers. These narratives regarding the sterilization experiments at Auschwitz are remarkable in that they contain previously undocumented information regarding the voluntary and involuntary involvement of nurses. Following these narratives, a discussion of ethics in relation to the Holocaust is presented with a specific focus on the work of Agamben. Implications of the Auschwitz narratives for the application of codes of ethical principles and contemporary nursing are discussed from a postmodernist perspective.
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The purpose of this grounded theory study was to explore wives’ perceptions of their husbands’ end-of-life care. Participants were 25 elderly widows (62-103 years of age) with 19 husbands’ deaths in a hospice setting and six in the... more
The purpose of this grounded theory study was to explore wives’ perceptions of their husbands’ end-of-life care. Participants were 25 elderly widows (62-103 years of age) with 19 husbands’ deaths in a hospice setting and six in the hospital. Wives recalled significant aspects of the experience and the care their husbands received. Three major themes were identified: awareness of impending death, care and comfort connections, and bereaved responses. The core phenomenon of being together described the importance of being close, having physical contact, and saying good-bye. An emergent theory, “Shared Presence, Caring for a Dying Spouse,” described the experience of the husband and wife together at his end of life in the healthcare milieu. Several nursing implications emerged from the study including the need for nurses to recognize the wives’ “place” at their husbands’ side and to be sensitive to communication, especially death announcements. Human touch between spouses and between nurses, patients, and family members is vital in establishing supportive relationships. Further research is needed to determine how culturally diverse families access hospice services, the effect on wives of caring for a husband during the dying process, and how wives develop meaning during and after this experience.
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Grounded in a critical feminist methodology, this article undertakes a deconstructive discourse analysis of a newly emergent discourse within nursing care management, “clinical pathways.” Using a Foucaultian approach to deconstructive... more
Grounded in a critical feminist methodology, this article undertakes a deconstructive discourse analysis of a newly emergent discourse within nursing care management, “clinical pathways.” Using a Foucaultian approach to deconstructive discourse analysis, the power relations inherent in the “clinical pathways” discourse are identified and the underlying philosophical assumptions informing the discourse are explored. The metaphors of “map” and “landscape” are employed to examine the power relations within the discourse of “clinical pathways.” Finally, an alternative, praxis-based approach to transforming the discourse of “clinical pathways” from a focus of social control to one of situated engagement and community is proposed.
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The emancipatory theory of compassion, created by Dr Jane Georges, assumes the universality of suffering (physical, psychoemotional, socioeconomic, or biopolitical), and the means by which suffering can be alleviated: compassion. The... more
The emancipatory theory of compassion, created by Dr Jane Georges, assumes the universality of suffering (physical, psychoemotional, socioeconomic, or biopolitical), and the means by which suffering can be alleviated: compassion. The theory also assumes that nurses can knowingly or unknowingly create environments in which suffering is perpetuated. Through critical review of Georges' work and major caring theories, an operationalized model was developed with which nurses may frame inquiry and practice focused on compassion, the alleviation of suffering through the deconstruction of power relations, and the promotion of health equity, social justice, and human rights.
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Research Interests: Sociology and Curriculum
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Evidence exists that the ovarian hormones have a modulating effect on gastrointestinal (GI) motility, yet details are sketchy and little attention has been paid to the effect that fluctuating hormone levels might have on women who are... more
Evidence exists that the ovarian hormones have a modulating effect on gastrointestinal (GI) motility, yet details are sketchy and little attention has been paid to the effect that fluctuating hormone levels might have on women who are receiving enteral feedings. This study compared gastric motility indices in response to tube feedings at two points in the menstrual cycle, concurrently measured ovarian hormone levels, and described three potentially related factors (ie, GI symptoms, uterine cramping pain, reports of daily stressors). Intragastric motility responses to enteral feedings were obtained on 28 women (aged 19-37) during menses and midfollicular phases of two menstrual cycles. Intragastric pressure changes were monitored by an open-tipped cannula method at rest, during and after tube feeding (Ensure, 240 ml at 8 ml/min). Serum estradiol and progesterone levels were measured by radioimmunoassay. Women completed a daily diary of symptoms and stressors throughout the two menstrual cycles. Results showed that intragastric pressure amplitudes and frequencies were higher at menses compared with midfollicular recordings. At menses, prefeeding and feeding gastric pressure amplitudes were positively correlated with uterine cramping pain and GI symptoms (ie, nausea). At menses, postfeeding contraction frequencies were also correlated with uterine cramping pain. At midfollicular phase, progesterone levels correlated with gastric motility indices; number of stressors indirectly correlated with gastric motility indices. These data suggest that gastric responses to enteral feeding are influenced by menstrual cycle phase.
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Introduction Chronic pain, a persistent or recurrent pain lasting more than 3 months, is a widespread problem among military women due to combat-related injuries and post-deployment stressors. Risk factors associated with chronic pain... more
Introduction Chronic pain, a persistent or recurrent pain lasting more than 3 months, is a widespread problem among military women due to combat-related injuries and post-deployment stressors. Risk factors associated with chronic pain include gender, mental health, post-traumatic stress disorder, and prior physical or military sexual trauma. The most common prevalence of chronic pain is musculoskeletal (e.g., low back and neck), migraine, osteoarthritis, and fibromyalgia. Following deployment, 25% of military women are at risk for chronic pain. Military women are prescribed opioids for pain at a higher rate than men and are at risk for prescription opioid addiction. The unique medical needs of military women, including chronic pain, are poorly understood by health care providers and need to be addressed to achieve full integration into the military. The purpose of this study was to explore a typical day for military women living with chronic pain by examining the participants’ daily...
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Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for... more
Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for nursing science. Discourse analysis of local narratives and metanarratives is undertaken as a basis for proposing alternative methods, including a critical humanities approach, for nurse scholars to use in creating a transformed, politicized epistemology of suffering.
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Introduction Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans... more
Introduction Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans with diabetes. Changes in healthcare have been shown to decrease diabetes care compliance and diabetes self-management resulting in exacerbation in diabetes symptoms and increased healthcare expenditure. A seamless transition in healthcare management from active duty to veteran status has the potential to maintain or increase diabetes self-management. A gap in the literature exists regarding the transition process between healthcare systems, including the DoD and VA. This paper describes the transition experience of a sample of veterans with diabetes from active duty to veteran status. Materials and Methods A qualitative study was designed to document the experience of veterans diagnosed with diabetes while on active duty. A semi-structured questio...
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To report an analysis of the concept of perinatal posttraumatic stress disorder (PPTSD). Prevalence of PPTSD is rising in the United States, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being... more
To report an analysis of the concept of perinatal posttraumatic stress disorder (PPTSD). Prevalence of PPTSD is rising in the United States, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality, and healthcare costs. Concept analysis via Walker and Avant's approach. The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier, and PsychINFO were searched for articles, written in English, published between 2006 and 2015, containing the terms perinatal and PTSD. PPTSD owns unique attributes, antecedents, and outcomes when compared to PTSD in other contexts, and may be defined as a disorder arising after a traumatic experience; diagnosed any time from conception to 6 months postpartum; lasting longer than 1 month; leading to specific negative maternal symptoms, and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma, and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5(th) Edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression, and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. Further research on PPTSD antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating PPTSD. Nurses are encouraged to increase their awareness of PPTSD for early assessment and intervention, and prevention of adverse maternal-infant outcomes. This article is protected by copyright. All rights reserved.
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This historical research report presents and analyzes 2 recently identified narratives of women who underwent sterilization experiments at the Auschwitz concentration camp during World War II. A description of the historical and... more
This historical research report presents and analyzes 2 recently identified narratives of women who underwent sterilization experiments at the Auschwitz concentration camp during World War II. A description of the historical and contextual background is presented in which involvement of the prisoner nurse occurred in the sterilization experiments. Using a critical feminist perspective, the ethics of nursing involvement are discussed in these experiments, with an emphasis on the political dimension. Salient implications are explored for contemporary nursing.
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Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant... more
Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant discourse informed by the processes and values of "science" in the Enlightenment sense and a concurrent marginalized discourse informed by postmodernism, are described as a context for the emerging discourse. A genealogy informed by the work of Foucault is presented as a basis for an analysis of the power effects resulting from the conflict between these 2 discourses. Finally, 3 recent texts in nursing are analyzed and common themes identified as indicative of a new intertextual discourse, termed "epistemic diversity," emerging from this discursive conflict.
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Dyspnea is a common symptom in end-stage lung cancer patients and is only infrequently controlled. Currently, the use of complimentary therapies using traditional Chinese medicine (TCM), including auricular application of Vaccaria... more
Dyspnea is a common symptom in end-stage lung cancer patients and is only infrequently controlled. Currently, the use of complimentary therapies using traditional Chinese medicine (TCM), including auricular application of Vaccaria segetalis (a small seed), is understudied. Acupressure using auricular Vaccaria segetalis application has been reported as effective in reducing dyspnea when applied to a specific area of the ear associated with lung function in the TCM paradigm. The purpose of this feasibility study was to evaluate the effects of standardized auricular acupressure therapy using Vaccaria segetalis on dyspnea intensity and distress and oxygen saturation in end-stage lung cancer patients. The experimental design was three conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care (SC); (2) SC with Vaccaria segetalis taped to random auricular locations (placebo); and (3) SC with Vaccaria segetalis taped to the auricular location deemed specific to lung function in TCM. Subjects were 11 hospice patients with advanced lung cancer and dyspnea. Dyspnea intensity and distress were measured by the Cancer Dyspnea Scale (CDS) and oxygen saturation was measured by pulse oximeter at eight time points. Non-parametric statistical analyses suggest the presence of acupressure effects with medium to large effects and significant effect for dyspnea effort. This pilot information suggests the need for further study of auricular acupressure using Vaccaria segetalis in the dyspneic advanced lung cancer population.
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The growing exodus of indigenous people from Mexico into the United States, especially from the multiethnic state of Oaxaca, is used as an exemplar of the global phenomenon of transnational migration and its effects on health. Lately,... more
The growing exodus of indigenous people from Mexico into the United States, especially from the multiethnic state of Oaxaca, is used as an exemplar of the global phenomenon of transnational migration and its effects on health. Lately, indigenous Oaxacan women have become a predominant part of this diaspora in the United States. Driven by economic desperation most arrive across the border as undocumented persons that configure them into multiple liminal spaces inimical to health and well-being. This article provides a venue for some of their voices to be heard, some major concerns understood, and for proposing links between postcolonial Mexico, neoliberal globalization, and immigration border policy as driving forces that undergird these conditions. An emancipatory praxis of nursing to promote health and reduce suffering within transnational migrants is proposed as a starting place for future nursing scholarship.
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Background: What factors contribute to a nurse’s decision to become a travel nurse? Often travel nursing is depicted as an exciting adventure that may be more about seeing the country than developing as a nurse. This idea is only... more
Background: What factors contribute to a nurse’s decision to become a travel nurse? Often travel nursing is depicted as an exciting adventure that may be more about seeing the country than developing as a nurse. This idea is only speculation since to date there has been no research reported that examines travel nurses. Travel nurses occupy a small, but growing segment of the hospital workforce. In 2007 during an industry peak, there were approximately 18,000 travel nurses in the United States (Osborne, Calvi, & Hessinger, 2007). Since travel nurses are likely to continue to be utilized in hospital staffing, and there is no existing published research exploring travel nurses, it is important to learn more about this unique type of temporary employment for nurses and especially how it impacts a nurses’ skills and experience. Purpose: This IRB approved study explored a segment of the nursing population that has not been previously studied through an examination of the experiences and p...
Purposes/Aims: The overall purpose of this in-progress qualitative study is to explore the perceived barriers to the use of pre-exposure chemoprophylaxis (PrEP) in a group of male-to-female transgender (MtF-TG) persons ages 16-25 who are... more
Purposes/Aims: The overall purpose of this in-progress qualitative study is to explore the perceived barriers to the use of pre-exposure chemoprophylaxis (PrEP) in a group of male-to-female transgender (MtF-TG) persons ages 16-25 who are currently human immunodeficiency virus (HIV) negative. Rationale/Background: In July 2012, The United States Food and Drug Administration (FDA) approved the use of a combination of tenofovir and emtricitabine (Truvada ©) as a pre-exposure chemoprophylaxis (PrEP) method for HIV prevention among high-risk population groups (CDC, 2012). The use of PrEP subsequently demonstrated a decrease in HIV infection risk ranging from 42 to 73% in such high-risk groups as men having sex with men (MSM) and MtF-TG persons. (CDC, 2012; PrEP fact sheet, 2012). The male-to-female transgender (MtF-TG) population is at particular risk for HIV infection. This group has been documented as having a higher risk for history of injectable drug abuse and sex exchange for money,...