TECHNI CAL ATTAI NMENT, PRACTI CAL SUCCESS AND PRACTI CAL KNOW LEDGE:
HERMENEUTI CAL BASES FOR CHI LD NURSI NG CARE
Débor a Falleir os de Mello1 Regina Apar ecida Gar cia de Lim a2
Mello DF, Lim a RAG. Technical at t ainm ent , pract ical success and pract ical knowledge: herm eneut ical bases for child nursing care. Rev Lat ino- am Enferm agem 2009 j ulho- agost o; 17( 4) : 580- 5.
This reflect ive st udy aim ed t o present som e aspect s of t he concept s t echnical at t ainm ent , pract ical success and pract ical knowledge, wit h a view t o a broader underst anding of child nursing care. Healt h care is considered in t he per spect iv e of r econst r uct iv e pr act ices, char act er ized as cont ingencies, highlight ing t he im por t ance of t he connect ion bet w een t echnical at t ainm ent and pract ical success and t he valuat ion of pract ical know ledge, based on philosophical herm eneut ics, in t he cont ext of pract ical philosophy. Child healt h nursing can deal wit h t echnical at t ainm ent and pract ical success j oint ly, and also underst and pract ical knowledge in t he longit udinalit y of care. Healt h prom ot ion, disease prevent ion, recovery and rehabilit at ion of child healt h should be indissociably associat ed wit h cont ext ualized realit ies, shared bet ween professionals and fam ilies, aim ing t o follow t he child’s growt h and dev elopm ent , pr oduce nar r at iv es, ident ify ex per iences, choices and decision m ak ing t o br oaden healt h car e.
DESCRI PTORS: child; nur sing car e; nur sing
ÉXI TO TÉCNI CO, ÉXI TO PRÁCTI CO Y SABI DURÍ A PRÁCTI CA: BASES CONCEPTUALES
HERMENÉUTI CAS PARA EL CUI DADO DE ENFERMERÍ A AL NI ÑO
Est e est udio reflexivo buscó present ar algunos aspect os de los concept os éxit o t écnico, éxit o práct ico y sabiduría práct ica para am pliar la com prensión del cuidado de enferm ería al niño. El cuidado en salud es ent endido baj o la per spect iva de las pr áct icas r econst r uct ivas y con car áct er de cont ingencia, dest acando la im por t ancia de la con ex ión en t r e éx it o t écn ico y éx it o pr áct ico y la v alor ización de la sabidu r ía pr áct ica, pr ov en ien t es de la h er m en éu t ica f ilosóf ica, en el ám bit o de la f ilosof ía pr áct ica. La en f er m er ía en salu d del n iñ o pu ede lidiar ar t icu ladam en t e con el éx it o t écn ico y el éx it o pr áct ico y com pr en der la sabidu r ía pr áct ica en la ex t en sión longit udinal del cuidado. La pr om oción de la salud, pr evención de enfer m edades, r ecuper ación y r ehabilit ación de la salu d del n iñ o, de f or m a in disociable, deben est ar en con son an cia con r ealidades con t ex t u alizadas y com par t idas ent r e pr ofesionales y fam ilias, buscando acom pañar el cr ecim ient o y desar r ollo infant il, pr oducir nar r at iv as, ident ificar ex per iencias, elecciones y t om as de decisión par a la am pliación del cuidado.
DESCRI PTORES: niño; at ención de enfer m er ía; enfer m er ía
ÊXI TO TÉCNI CO, SUCESSO PRÁTI CO E SABEDORI A PRÁTI CA: BASES CONCEI TUAI S
HERMENÊUTI CAS PARA O CUI DADO DE ENFERMAGEM À CRI ANÇA
Est e est udo r eflexivo buscou apr esent ar alguns t r aços dos conceit os êxit o t écnico, sucesso pr át ico e sabedor ia prát ica para am pliar a com preensão do cuidado de enferm agem à criança. O cuidado em saúde é t om ado sob a per spect iv a das pr át icas r econst r ut iv as e com car át er cont ingencial, dest acando a im por t ância da conex ão ent re êxit o t écnico e sucesso prát ico e a valorização da sabedoria prát ica, advindos da herm enêut ica filosófica, n o âm bit o da filosofia pr át ica. A en fer m agem em saú de da cr ian ça pode lidar ar t icu ladam en t e com o êx it o t écnico e o sucesso prát ico e com preender a sabedoria prát ica na longit udinalidade do cuidado. A prom oção da saúde, pr ev enção de doenças, r ecuper ação e r eabilit ação da saúde da cr iança, de for m a indissociáv el, dev e est ar em consonância com realidades cont ext ualizadas e com part ilhadas ent re profissionais e fam ílias, buscando acom panhar o cr escim ent o e desenv olv im ent o infant il, pr oduzir nar r at iv as, ident ificar ex per iências, escolhas e t om adas de decisão par a a am pliação do cuidado.
DESCRI TORES: cr ian ça; cu idados de en fer m agem ; en fer m agem
Escola de Enferm agem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Developm ent, Brazil: 1Associat e Professor, e- m ail: defm [email protected]; 2Full Professor, e- m ail: lim [email protected].
I NTRODUCTI ON
N
o w a d a y s, h e a l t h p r a ct i ce s h a v e b e e n m ar k ed by consider able scient ific and t echnological developm ent, despite serious lim itations to effectively r esp on d t o in d iv id u als’ an d p op u lat ion s’ com p lex h e a l t h n e e d s( 1 ). D i scu ssi o n s o n h e a l t h ca r ehum anizat ion, healt h care com prehensiveness, healt h prom otion, as well as the principles of quality of life, equit y, autonom y and users’ rights have stood out in reflect ions on healt h pract ice organizat ion( 1- 4).
Nur sing is a pr ofessional gr oup t hat play s relevant roles, funct ions and responsibilit ies in healt h car e. Th e essen ce an d sp ecif icit y of t h e n u r sin g professionals is care for the hum an being, individually, in t h e f am ily an d com m u n it y, w it h a v iew t o t h e d ev elop m en t of in t er v en t ion s t o p r om ot e h ealt h , pr ev en t diseases, r ecov er an d r eh abilit at e h ealt h . Through care, nursing assum es t he responsibilit y for p a t i e n t s’ co m f o r t , w e l co m i n g , w e l l - b e i n g a n d aut onom y in care it self and in t he coordinat ion and int ersect ion wit h ot her sect ors, so as t o offer healt h care( 5).
Nu r si n g ca r e ca n b e co n si d e r e d a com m unicat ive act t hat dem ands specific knowledge and underst anding of t he cont ext people live, w ork and get ill in. Nursing com petency developm ent needs n o t o n l y t h e o r e t i ca l a n d t e ch n i ca l k n o w l e d g e acquisit ion, but also appropriat ion and developm ent of attitudes to im prove the quality of the interpersonal relat ionship and of com m unicat ion for care( 6).
Children and their fam ilies com m only contact the health system and need different health practices, n o m at t er t h ei r f r ag i l i t y o r d am ag e, d em an d i n g pr ofessional at t ent ion in view of t he healt h- disease and care process( 7).
I n child health, despite advances in term s of child m ortality reduction and expanded health service coverage, current challenges include t he qualit at ive i m p r o v e m e n t o f h e a l t h i n t e r v e n t i o n s a n d t h e in t en sif icat ion of ex ist in g in t er v en t ion s, w h ich lie b ey on d m ost ch ild r en ’s r each in m an y cou n t r ies however( 8). I t is highlight ed t hat child survival is not
enough. Children need to be offered conditions to lead a high- qualit y life, allow ing t hem t o dev elop t heir pot ent ial and enj oy goods societ y produces.
Pr im ar y ch ild h ealt h car e focu ses on ch ild g r o w t h a n d d e v e l o p m e n t f o l l o w - u p , m a t e r n a l breast feeding encouragem ent , child nut rit ion advice, im m unizat ion, accident prevent ion and care delivery
to prevailing childhood diseases, which are considered the health practices to provide good health conditions in childhood( 9).
This study highlights the concepts of technical at t ainm ent , pract ical success e pract ical knowledge, addr essed in r ecent r esear ch( 10- 11). These concept s
offer im port ant elem ent s t o underst and healt h care, and it is interesting to explore them in the context of child healt h nursing.
Hen ce, t h is st u d y aim ed t o ou t lin e som e charact erist ics of t he concept s t echnical at t ainm ent , pr act ical success and pr act ical k now ledge, r elev ant for a broader underst anding of child nursing care.
Th e co n n e ct io n b e t w e e n t e ch n ica l
at t ainm ent and pract ical success of child
health care
To under st and healt h car e fr om a pract ical perspect ive, t wo ext rem ely im port ant concept s have gained incr easing v it alit y : t echnical at t ainm ent and pr act ical success( 10- 11). These concept s or iginat e in
philosophical herm eneutics, in the context of practical philosophy, and are discussed to seek answers with a view t o ret hinking cont em porary healt h pract ices.
The philosophical her m eneut ics appr oach is relat ed t o a form of const ruct ing/ underst anding t he p r e se n t p a st f u t u r e , b a se d o n i n t e r p r e t a t i v e -co m p r e h e n si v e p r o ce sse s. Th e se f a v o r a n under st anding of som et hing, t he appr opr iat ion of a sit uat ion or som e of it s aspect s, which was not clear before and becam e a problem for som e reason, t hat is, it deser v es t o be r econsider ed( 12). Philosophical
her m eneut ics em er ges w hen a quest ion ar ises and it s applicat ion is form alized in a quest ion, som et hing t h at m ob ilizes, t h at b ot h er s an d d em an d s t o b e t h e m a t i ze d , i n a m o v e m e n t t h a t e x p r e sse s a dialect ical relat ion bet ween quest ion and answer( 12).
I n t he healt h area, m any aspect s relat ed t o healt h pract ices can be st udied from a herm eneut ics ap p r o ach , b ecau se i t i n v o l v es co n st an t t ask s o f k n ow led g e in t er p r et at ion an d sy n t h esis, of f er in g con dit ion s t o ack n ow ledge dif f er en t in t er est s an d opposit ions pr esent in a giv en int er act ion, cr eat ing n e w p o ssi b i l i t i e s f o r i t s r e si g n i f i ca t i o n a n d reconst ruct ion( 10).
Any healt h act ion has an inst rum ent al sense and t echnical base, deriving from t he const it ut ion of healt h know ledge( 11). Technical at t ainm ent r efer s t o
achievem ent of certain goals, following certain m eans. Tech n ical at t ain m en t ex pr esses r elat ion s bet w een m eans and ends t o cont rol individual or populat ional health problem s and adheres to the em pirical- analytic logic of life and healt h sciences( 11).
I n ch i l d h eal t h , t h e co n cep t o f t ech n i cal at t ainm ent can be analyzed in t he relat ion bet ween the use of therapeutic m easures and the risk reduction of ch ild h ealt h p r ob lem s, in clu d in g f or ex am p le: prevention m easures for asthm a control ( m eans) and the decrease of asthm a crisis episodes ( ends) or child v accinat ion ( m eans) and t he r educt ion of m or t alit y rat es due t o im m unoprevent able diseases ( end) . I n child healt h, concerns wit h t he im provem ent of child health indicators are usual ( reduction of child m ortality and pr ev ailing childhood diseases, am ong ot her s) , b e ca u se t h e se a r e i m p o r t a n t a n d r e f l e ct t h e developm ent of a count ry or region. Child indicat ors r ep r esen t n o t o n l y n u m er i ca l d a t a t o d ef i n e a n epidem iological sit u at ion , r esu lt in g in con t r ol an d ex p r essin g t ech n ical at t ain m en t , b u t also in clu d e im p or t an t issu es of social r elat ion s, in w h ich t h e cir cu m st an ces in v olv ed in f am ilies an d ch ild r en ’s different sit uat ions and cont ext s are also relevant .
Taking care of the health of children and their fam ilies inv olv es t echnical com pet encies and t ask s, but cannot rem ain restricted to the search for technical at t ai n m en t . I n g en er al , h eal t h p r of essi on al s ar e co n ce r n e d w i t h g o o d h e a l t h p r a ct i ce s t h r o u g h techniques, that is, through the achievem ent of good t echnical result s. Obt aining good result s is essent ial, b u t t h er e is a n eed t o g o b ey on d t h e sear ch f or t e ch n i ca l a t t a i n m e n t a n d , a l so , t o i m p r i n t co m p r e h e n si v e a t t i t u d e s o n t h e ca r e p r o ce ss, gr adu ally con st r u ct in g n ew u n der st an din gs of t h e si t u a t i o n s f a m i l i es f a ce. I t i m p l i es p a y i n g m o r e attention to a com prehensive whole that seeks to give m eaning t o t he dem ands fam ilies and children t ake t o healt h professionals and services.
The concept of technical attainm ent is closely linked with the concept of practical success. The latter refers t o t he value of t he healt h act ion for subj ect s an d p o p u l at i o n s. I t co v er s a r an g e o f sy m b o l i c, r elat ion al an d m at er ial im p licat ion s of t h e h ealt h int ervent ions and recom m endat ions in subj ect s’ daily lives. I t is a concept t hat expresses t he role of t he m eans and goals of health actions in view of the values and interests subj ects and populations grant to illness and healt h care( 11).
I n t he abov e m ent ioned ex am ples of child health, one can reflect on what it m eans for m others/ fam ilies to have a child with asthm a, or what it m eans for m others/ fam ilies when the child does not have all of it s vaccinat ions up t o dat e, how t hey underst and v accin at ion as p r ot ect ion , am on g ot h er asp ect s. Practical success is connected with the understanding of senses and m eanings. I t becom es m ore m eaningful for effective health care to talk to the m others/ fam ilies who experience t he sit uat ion of having a child wit h asthm a: what do you think your child has, what is it like for you, how is your daily realit y of prevent ion m easu r es f or disease m an agem en t , f or per iodical cont rols at healt h services and m edicat ion use, how ar e ch o i ces an d d eci si o n s b ei n g m ad e, h o w ar e difficulties to adopt nursing orientations in hom e care. Or f o r m o t h e r s/ f a m i l i e s w h o e x p e r i e n ce h a v i n g children without all vaccinations up to date, what this sit uat ion is like for t hem , what has led t o t his, what daily reality is like, what they think about the diseases vaccines pr ot ect against , w hat difficult ies t hey face t o t ake t he children t o get vaccinat ed, am ong ot her issues.
The connect ion bet w een t hese concept s is fundam ent al t o const ruct a com prehensive whole of healt h int ervent ions, cont ribut ing t o healt h care. I n t he healt h ar ea, t her e is a need t o r econsider t hat care should not be m oved exclusively by t echnique, but it is relevant for the search for technical attainm ent t o be art iculat ed wit h pract ical success, ent ailing t he et h ical ch allen g e of n ot let t in g t ech n iq u e r ep lace e n co u n t e r a n d d i a l o g u e , se e k i n g h i g h - q u a l i t y encount ers( 13).
Ch i l d n u r si n g ca r e i n a n i n t e g r a t i v e perspect ive im plies t hat cure, prevent ion and healt h p r om ot ion act ion s ar e in d issociab le, con st r u ct in g health care spaces in the fam ily context. I n that sense, child health nursing can articulate technical attainm ent and pr act ical success in t he longit udinalit y of car e, se e k i n g , i n g r o w t h a n d d e v e l o p m e n t f o l l o w - u p , int ervent ions concerned w it h good healt h indicat ors ( m at er n al br east feedin g en cou r agem en t , com plet e v a cci n a t i o n , a cci d e n t p r e v e n t i o n , d e v e l o p m e n t st im ulat ion, am ong ot hers) and t hat offer knowledge ab ou t t h e f am ily d y n am ics, t h em at ize in t er est in g aspect s ( w hat m obilizes and unset t les) , at t em pt t o p r o d u ce n a r r a t i v e s, f i n d o u t a b o u t ch o i ce s a n d decision m ade in hom e care, st rengt hen virt ues and daily ex per iences, int er act and dialogue t o ex pand car e.
The valuat ion of pract ical know ledge in
child nursing care
The concept of pr act ical k now ledge com es from practical philosophy, in the context of Aristotelian k n o w l ed g e ab o u t r at i o n al i t y( 1 2 ). Th er e ar e t h r ee
d i f f e r e n t l e v e l s o f r a t i o n a l i t y : e p i st e m o l o g i ca l , technical and practical( 11- 12). The epistem ological level
i n v o l v e s t h e o r y a n d k n o w l e d g e a n d i s m o r e im m ediately related with sciences. The technical level refers to activities to produce artifacts, create obj ects, pr oduce goods and inst r um ent s, and is dir ect ed at t he elaborat ion of principles about knowing how. The t hird level is t hat of pract ical knowledge.
Pr act ical k n ow led g e is ch ar act er ized as a co n t i n g e n cy, t h a t i s, i t d e a l s w i t h e v e n t u a l i t y, uncert aint y, event s and hum an experiences. I t does not deal with perennial, causal and universal aspects. This k now ledge does not pr oduce obj ect s, ar t ifact s or inst r um ent s( 11). I t is a space focused on hum an
int er est s. I t is a non- cum ulat iv e k now ledge, it can em er g e f r o m ex p er i en ces, co m m o n o r d i v er g i n g int erest s, t ensions and possible int eract ions. I n t his sense, although this knowledge is not less true, it does cont ain less cert aint y and det erm inat ion. I t is about const r uct ing t he sear ch about t he under st anding of life, about the experiences and choices m ade in view of the different contingencies faced in daily reality( 11).
Practical knowledge is related with the ability and t he need t o choose and, t herefore, t he need t o know or find what is good in each concrete situation( 12).
Th e essen ce of t h is k n ow ledge is t h e con t in gen cy
concept. I t entails the idea of m eeting with what com es up and what one can neither anticipate nor deduct by t hinking.
I n h e a l t h ca r e , t h e m o v e m e n t o f r econ st r u ct ion an d ar t icu lat ion bet w een t ech n ical-sci e n t i f i c k n o w l e d g e a n d co m m o n se n se i s f u n d a m e n t a l . Fo r t h i s p u r p o se , co m m u n i ca t i o n , language, dialogue between subj ects and concern with pract ical know ledge are im port ant . To enrich healt h int er vent ions, t her e is a need t o r econsider cur ing, t reat ing and cont rolling, as t hese m ay reveal t o be lim ited and obj ect- centered, and taking care of health goes bey ond t he const r uct ion of an obj ect and an intervention in it( 2).
Paying at t ent ion t o pract ical knowledge, t hat is, t o t he int er est s of people one deliv er s car e t o, i m p l i e s r e sp o n si b i l i t y f o r ca r e g i v i n g a t t i t u d e s, cen t er ed ar ou n d d ialog u e. I n t h e p er sp ect i v e of Gadam er’s herm eneut ics, t he sense of t he dialogue is t he fusion of horizons, which is t he const it ut ion of shar ing, fam iliar izat ion and m ut ual appr opr iat ion of w h a t i s u n k n o w n i n t h e o t h e r( 1 2 ). Th r o u g h t h e
h er m en eu t ical ex per ien ce, t h e en cou n t er bet w een subj ect s is r elevant t o see t he ot her, per ceive t hat t h e o t h e r m a y b e r i g h t a n d co n st r u ct sh a r e d r e sp o n si b i l i t y, p e r m i t t i n g e f f e ct i v e co n t a ct a n d solidarit y bet ween people( 14). Thus, in healt h care, it
is im port ant t o seek t he fusion of horizons bet ween h e a l t h p r o f e ssi o n a l s a n d su b j e ct s, i n t e r e st a n d attentive listening to the other( 11).
a n d t a l k i n g a b o u t l i f e a n d h e a l t h p r o j e ct s( 1 5 ).
Underst anding pract ical knowledge, t hat is, pract ical truth, related to reflexive knowledge, choices, hum an v alu es an d v ir t u es, p r iv ileg in g d ialog u e b et w een st akeholders and producing underst anding, in which one r eaches an under st anding w it h t he ot her, can resignify healt h care.
I n g en er al, n u r sin g in t er v en t ion s in ch ild healt h ar e based on t he epidem iological pr ofiles of t he child populat ion, wit h care plans t hat em phasize the identification of risk factors and prevailing childhood diseases, t he descript ion of cont rol m easures, hom e care guidelines, identification of signs of severity that require care by healt h services, priorit ies for healt h pr om ot ion, w it h int er v ent ions t hat inv olv e childr en, f am ilies an d in in st it u t ion s lik e k in der gar t en s an d schools, am ong other foci( 16). However, it is im portant
for child healt h nursing int ervent ions t o be direct ed a t t h e f u si o n w i t h f a m i l i e s a n d ch i l d r e n , w i t h possibilit ies t o apprehend world visions, experiences and m eanings and perm it closer contact with decisions m a d e a n d m e ch a n i sm s u se d t o co p e w i t h t h e sit uat ions of life.
I t is im por t ant for nur sing pr ofessionals t o m od if y t h eir r ep er t oir e of or ien t at ion s t o ex p an d n u r sin g car e, at t em p t in g t o cr eat e st r at eg ies t o approach the reality the fam ilies experience, assessing what difficult ies t he m ot her/ fam ily is facing t o t ake e f f e ct i v e ca r e o f h e r ch i l d , a v o i d i n g ch a r g e s, verificat ions and prescript ions.
Child health follow- up should be achieved by considering the social and fam ily context. Hence, this follow- up should be a broad and cont inuous process, g u i d e d b y t h e f o l l o w i n g o f ch i l d g r o w t h a n d d e v e l o p m e n t , w i t h q u a l i f i e d a n d h u m a n i ze d int ervent ions. I n t heir relat ion w it h healt h services, t he fam ilies need guidance and suppor t t o per for m car e act s t hey nor m ally deliv er t o t he childr en but which t hey som et im es perceive t o be lim it ed, like in sit uat ions of br east feeding difficult ies for ex am ple, or acu t e r esp ir at or y in f ect ion s, ch r on ic ch ild h ood diseases, obst acles t o t he st im ulat ion of child and fam ily developm ent , am ong ot hers. I n t hat process, t he fam ilies experience t he lim it s of insufficiencies in t he r elat ion w it h t heir childr en and t he sear ch for sufficiency will lead them to health services and health p r o f essi o n al s( 1 2 ). Th u s, ch i l d h eal t h n u r si n g can
broaden horizons together with the fam ilies. The fusion of horizons is not considered as a crossing. I nst ead,
healt h pr ofessionals and car e subj ect s’ hor izons do not m ix, but expand.
These aspects can shape a practical look and w a y o f d e a l i n g w i t h p r a ct i ca l k n o w l e d g e i n i t s sin g u lar it ies an d p ar t icu lar it ies. Th ey also p er m it h e a l t h ca r e d i m e n si o n s ch a r a ct e r i ze d a s contingencies, that is, situations in which nursing and fam ilies t r y and deal w it h ev ent ualit y, uncer t aint y, unpr edict abilit y, w it h w hat can happen or not , w it h asp ect s an d ev en t s lin k ed w it h ex p er ien ces. Th is perm its decision m aking without m others/ fam ilies and health professionals’ a priori attem pts to get to know values and routes towards satisfactory hum an contact, which can generate integration between practical and t echnical k now ledge.
I ntegrating practical and technical knowledge m eans attem pting to work with the subj ects’ autonom y and creat ive powers, but it also m eans giving sense to the encounter and allowing people to m ove through situations that put them in positions of solving, of not being confused, of feeling safe, of being connect ed, allow ing t hem t o r eest ablish t hem selv es in v iew of the situation and to keep on living.
Th i n k i n g a b o u t h o w p r o f e ssi o n a l s a r e delivering care and int eract ing wit h m ot hers/ fam ilies in a giv en com m unit y im plies r et hink ing r elat ions, act ions and com m it m ent s. The holist ic child healt h ca r e p e r sp e ct i v e i m p l i e s r e t h i n k i n g f o r m s o f interacting with the subj ects in the health- disease and car e pr ocess.
FI NAL CONSI DERATI ONS
Health practices, in health services as well as fam ilies and t he com m unit y, need to be reconsidered and resignified, in the attem pt to increase bonding with t he populat ion, adher ence t o healt h pr ot ect ion and pr om ot ion m easur es, healt h pr ofessionals’ effect iv e a ct i o n s t o w a r d s f a m i l i e s, t h e co n st r u ct i o n o f account abilit y plans and healt h proj ect s.
service of t he desired pract ical success, in line wit h r ealit ies t hat ar e cont ex t ualized and shar ed am ong professionals, fam ilies and children.
I t is im por t ant for nur sing pr ofessionals t o look at daily reality, a practical and not only technical look, so as to deal with the processual nature of health care. This process is not natural. I nstead, it is com plex and should be perm anently reconstructed, enrichened by t he int egrat ion bet ween t echnical at t ainm ent and p r a ct i ca l su ccess a n d t h e v a l u a t i o n o f p r a ct i ca l knowledge. By paying attention to practical knowledge, one can m ove t owards pract ical success.
This study attem pted to take a closer look at these concepts, sum m arizing its constituent traits with a f o cu s o n ch i l d h e a l t h n u r si n g . Th e co n ce p t s highlight ed here have neit her im m ediat e applicat ion n or a pr agm at ic dim en sion , bu t ar e r elev an t as a t h eo r et i cal b ack g r o u n d , o f f er i n g p o ssi b i l i t i es f o r abst ract ion and great er underst anding about healt h care issues. I t should be highlighted that other spaces for discussion and research can shape t he densit y of t hese concept s in different healt h areas and broaden reflect ions in t heir epist em ological, philosophical and pr act ical dim ensions.
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